Introduction to Healthcare Exam #2

Health Disparities

“Differences in the incidence, prevalence,

mortality, and burden of diseases and other

adverse health conditions or outcomes

that exist among specific population groups

in the United States.”

Health Disparities in MN:

2 contrasting realities

▷ Minnesota, on average, ranks among the healthiest

states in the nation.

▷ Minnesota has some of the greatest health

disparities in the country between White

individuals and people of color.

MN Dept. of Health Report:

Health Disparities

▷MDH calculated disparities for 17

health indicators, such as:

▷cancer mortality (AA 2.2 vs. Hispanic)

▷low birth weight births (AA 2.0 vs. White)

▷Infant mortality (AA 2.2 vs. Asian)

▷Chlamydia incidence (AA 14.4 vs. White)

▷Teen births (Hispanic 6.0 vs. White)

3 primary contributors to health disparities:

▷ Income

▷ Education

▷ Homeownership

2020 data:

Infant mortality rate:

▷ U.S.: 5.42 vs. MN: 4.13

Factors contributing to health disparities:

▷ Food deserts

▷ Lack of access to safe places for physical activity, green space

▷ Lack of access to healthcare

▷ Advertisements for alcohol, tobacco, or fast food

▷ Education systems

▷ Unemployment and crime

Genetic Code

▷ Sex and age dependent diseases

▷ Genetic risk factors

▷ Stress which impairs immune function

▷ Environmental impacts which express

disease (asthma)

▷ In utero exposures impact adult behavior

and development

Eight priority health areas:

▷ Breast and Cervical Cancer

▷ Diabetes;

▷ Heart Disease and Stroke

▷ HIV/AIDS and Sexually Transmitted

Infections (STIs)

▷ Immunizations for Adults and Children

▷ Infant Mortality

▷ Teen Pregnancy Prevention

▷ Unintentional Injury and Violence

Level 1: Health Promotion/Direct Service:

▷ Providing education or direct services to

individuals

Level 2: Organizational/Institutional Change:

▷ Changing organizational or institutional policies

or changing the way a system in an organization

or institution works.

Level 3: Root Causes/Conditions for Health:

▷ Participating in or leading efforts that target

specific social and economic conditions for

health (also known as the social determinants of

health) to address the root causes of health

disparities.

MDH Eliminating Health Disparities

Initiative (EHDI): Infant Mortality (LEVEL 1)

▷ Provide individual and group parenting education using a culturally specific

curriculum; conduct culturally specific home visits; conduct life skills classes.

(Level 1)

▷ Provide coaching and mentorship to parents and train parents to be mentors

to other parents. (Level 1)

▷ Co-facilitate American Indian specific Early Childhood Family Education

(ECFE) classes. (Level 1)

MDH Eliminating Health Disparities

Initiative (EHDI): Infant Mortality (LEVEL 2)

▷ Provide training to other states and local and non-profit organizations using a

culturally specific curriculum. (Level 2)

▷ Build the capacity of service providers to provide culturally specific health

services to American Indian women by creating a guide of culturally specific

health services that will be distributed to service providers. (Level 2)

▷ Develop partnerships with health and community organizations to

collaboratively review and discuss culturally appropriate curriculums and

service delivery models. (Level 2)

MDH Eliminating Health Disparities

Initiative (EHDI): Infant Mortality (LEVEL 3)

▷ Conduct historical trauma trainings to staff of state agencies involved in child

protection services. (Level 3)

National Quality Forum:

Successful Interventions

▷ Focus on improvement of outcomes within group

rather than comparison to other groups (race,

socioeconomic differences)

▷ More focus on how to improve healthcare systems to

high risk populations

▷ Focus on race/ethnicity needs to expand to include

disability, income, literacy, and community (where

they live and belong).

▷ Focus on reducing disparities in multiple conditions

(such as heart disease and diabetes).

▷ Increase health literacy for patients

What is Global Health?

▷ Health problems, issues, and concerns that

transcend national boundaries

▷ May be influenced by circumstances or

experiences in other countries

▷ Best addressed by cooperative actions and

solutions

Causative Factors for low income

▷ Poverty

▷ Poor sanitation

▷ Poor nutrition

Causative Factors for high income

▷ Smoking

▷ Ultra-processed and sugary foods

▷ Lack of physical activity

Causative factors

Newer research highlights within-country health disparities in

both low-income and high-income countries.

The common denominator in health disparities is social

inequality.

How does HC cost affect the

health of citizens?

In the case of the US:

The rise in HC costs is higher than the

inflation rate.

The costs get passed on to consumers in

insurance premiums and direct charges.

The rise in health insurance costs and

charges has outpaced income increases

for US citizens.

Why doesn’t the richest country have the best healthcare?

The reason the richest country in the

world doesn’t have the best health is

because it takes more than health care

to make a country healthy.

Disparity

Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions or outcomes that exist among specific populations groups in the United States.

Health Inequity

Health inequties are differences in health status or in the distribution of health resources between different population groups , arising from the social conditions in which people are born, grow, live, work, and age.

Groups where health disparities have been found

include socially, economically, demographically, or geographically.

Health Equity

• the absence of unfair, avoidable, or remediable differences in health among groups of people, whether those groups are defined socially, economically, demographically, geographically, or other dimensions of inequality.

3 major contributors to health disparities in MN: 

• Income

• Education

• Homeownership

Factors that contribute to health disparities:

• Food deserts

• Lack of access to safe places for physical activity, green space

• Lack of access to healthcare

• Advertisements for alcohol, tobacco, or fast food

• Education systems

• Unemployment and crime

Level 1

• health promotion/direct service 

  • Providing education or direct services to individuals

Level 2

• organizational/institutional change 

  • Changing organizational or institutional policies or changing the way a system in an organization or institution works.

Level 3

• root causes/conditions for health 

  • Participating in or leading efforts that target specific social and economic conditions for health (social determinants of health) to address the root causes of health disparities.

Causative factors for the burden of disease in low-income countries: 

• Poverty

• Poor sanitation

• Poor nutrition

Causative factors for the burden of disease in high-income countries:

• Smoking

• Ultra-processed and sugary foods

• Lack of physical activity

Key facts about the U.S.

healthcare industry

The United States spends 4.5 trillion dollars a year

on health care - more than ⅙ of our economy.

Approximately 25% of healthcare spending in the

U.S. is considered wasteful.

Health disparities and inequities continue to

increase.

4 Categories of Healthcare

Services

Health Promotion

Disease Prevention

Diagnosis and Treatment

Rehabilitation

The Affordable Care Act

(ACA)

▷ Signed into law in 2010 by President

Obama

▷ Contained provisions to roll out over 8

years.

▷ Major goals:

○ Make affordable health insurance available to

more people.

○ Expand the Medicaid program

○ Support innovative medical care delivery

methods to lower costs

Key Provisions of the ACA (2010)

▷Coverage of clinical preventative services (contraception,

cancer screening, immunizations, etc.)

▷Incentivizing providers for achieving quality health

outcomes instead of volume of services

▷Required coverage of pre-existing conditions such as

diabetes, heart disease, cancer, etc.

▷Established Health Exchanges (Marketplaces) for purchase

of insurance

▷Required essential health benefits to be included in all

qualified health plans

▷Adult children ages 19 to 25 can be covered under parents’

insurance plan

The Staggering Costs of Diabetes -

Growing Epidemic

▷ In 2021, diabetes affected 38.4 million children

and adults in the U.S (11.6% of population)

▷ 97.6 million Americans have prediabetes and are

at risk for developing type 2 diabetes.

▷ 1.2 million Americans are diagnosed with diabetes

every year.

Health Promotion and Disease Prevention

▷ Lifestyle change programs

▷ Prediabetes awareness campaigns

Diagnosis and Treatment

▷ Blood pressure management

▷ Regular foot exams and patient education

▷ Regular self-monitoring of blood sugar levels

▷ Annual screening for chronic kidney disease

Access to Health Care

▷ Insurance coverage of BG monitoring test strips

▷ Reduce the influence of pharmacy benefit manager organizations

on the cost of prescription medications.

Why is reducing healthcare

costs so hard?

▷No controls over pricing and “sticky pricing”

○Sticky pricing: prices charged for certain goods are resistant to

change despite changes in input, cost, or demand patterns.

▷Externalities

oInfluences on the marketplace beyond the pure “buyer-seller”

relationship

▷Consumers don’t know what they need or how to check for

quality

▷Costs are unexpected and expensive

▷Insured customers over-consume products, get more tests

▷Insurance markets suffer from adverse selection (when healthy

people opt out of buying insurance)

Genomics

▷the branch of molecular biology concerned

with the structure, function, evolution, and

mapping of genomes.

History of Human Genome

Project

▷October 1, 1988: The Office for Human

Genome Research is created within the

National Institutes of Health.

▷October 1, 1990: The Human Genome

Project officially begins.

▷November 1996: Researchers identify the

location of the first gene associated with

Parkinson's disease.

▷February 2000: President Clinton signs

Executive Order to prevent genetic

discrimination in any federal workplace.

▷June 2000: The Human Genome Project

consortium announces a major milestone: It

has assembled 85 percent of the sequence of

the human genome - the genetic blueprint for a

human being.

▷April 2003: The National Human Genome

Research Institute celebrates the completion

of the human genome sequence

▷February 11, 2005: NHGRI establishes

Office of Ethics, appointing Barbara Fuller, J.D.,

as Deputy Ethics Counselor

▷May 21, 2008: Pres. George W. Bush signs

the Genetic Information Nondiscrimination Act

of 2008.

▷February 26, 2010: NHGRI launches the

Genetics/Genomics Competency Center (G2C2),

an online tool to help educators teach the next

generation of nurses and physician assistants

about genetics and genomics.

▷October 1, 2015: This day marked the 25th

anniversary of the launch of the Human Genome

Project.

▷July, 2019: 1st use in the U.S. of CRISPR-Cas9

technology (genetic scissors) to treat sickle cell

anemia (at a cost of 0.5-1.5 million dollars)

Precision medicine:

▷ To more accurately predict treatment and prevention

strategies for individuals. Target the right treatments to

the right patients at the right time.

Genetic testing:

▷ To identify risk for diseases and to guide use of medical

treatments.

Pharmacogenomics

▷ To prescribe medications based upon an individual’s

genomics to achieve the most effective health outcomes.

Genetic therapies

▷ To treat or cure conditions by correcting problems in

individual’s DNA, either by providing new DNA to certain

cells or correcting errors in the DNA.

▷ Drugs with Pharmacogenomics Information on

the Label:

○ 1990: 4 drugs

○ 2003: 46 drugs

○ 2013: 106 drugs

▷ Current approaches to gene therapy

include:

○ Replacing a mutated gene that causes

disease with a healthy copy of the gene.

○ Inactivating, or “knocking out,” a mutated

gene that is functioning improperly.

○ Introducing a new gene into the body to

help fight a disease.

▷ Gene therapy is currently being tested only

for diseases that have no other cures.

▷ Limited use of gene therapy has been

conducted, including the use of CRISPR-

Cas9.

Data Analytics

▷ “Is the practice of examining data to answer

questions, identify trends, and extract insights”.

(Cote, 2021)

▷ Turns raw, unstructured data into useable

information that can inform business decisions.

▷ Uses techniques like data mining and

aggregation, regression analysis, machine

learning algorithms, and artificial intelligence.

▷ Applications naturally fall into four types of

analytics, depending on the question it helps to

answer.

Descriptive Analytics:

▷ Rooted in the past, anchored by a set of rules

▷ Example: use historical, summarized patient data to

describe the incidence of falls in a long-term care

facility

Diagnostic Analytics:

▷ Rooted in the past, based on probability

▷ Example: use historical, summarized patient data,

plus organizational data, to determine that falls

occurred most often when CNA staffing was low,

and especially during holiday periods, and

temporarily decreased after a falls program was

implemented.

Predictive Analysis:

▷ Looks to the future, based on probability

▷ Example: use historical or summarized data and

industry/demographic trends to predict if more falls with

and without harm might increase in future years.

Prescriptive Analysis:

▷ Looks to the future, anchored by a set of rules

▷ Example: use health and medical knowledge about falls

and successful fall prevention initiatives, combined with

historical patient data, to recommend a strategy that

includes prescribed minimum CNA staffing levels and a

team-based falls initiative to best protect patients from

falls.

AI Uses in Healthcare:

▷ Clinical practice:

○ A provider orders an X-ray for a patient who presents

with pain, swelling, and limited leg mobility. An AI tool

reviews the X-ray and identifies an incidental nodule

for further analysis by a radiologist.

○ A patient is discharged after hospitalization for heart

failure. Using historic heart failure reaadmission rates

and the patient’s clinical data, an AI tool predicts the

risk of the patient’s hospital readmission. (AMA, 2024)

▷ Access to care:

○ Identify optimized scheduling to minimize wait

times and maximize alignment of patient needs

and provider experience.

▷ Regulatory compliance and monitoring:

○ Automate the tracking and reporting of

regulatory compliance measures, reducing

administrative burden.

▷ Medical device design and engineering:

○ Optimize engineering parameters for faster

prototyping and reduced cost.

WHO:

6 ethical principles

▷ Protecting human autonomy

▷ Promoting human well-being and

safety and the public interest

▷ Ensuring transparency,

explainability, and intelligibility

▷ Fostering responsibility and

accountability

▷ Ensuring inclusiveness and equity

▷ Promoting AI that is responsive

and sustainable

Aging Population:

Silver Tsunami

▷ The population of seniors (65 and older) is projected to

increase from 58 million in 2022 to 82 million by 2050 (a 47%

increase).

▷ The 65-and-older age group’s share of the total population

is projected to rise from 17% (2022) to 23% (2050).

▷ Between 1980 and 2022, the median age of the population

increased from 30.0 to 38.9, but one-third (17) of states in the

country had a median age above 40 in 2022, with Maine

(44.8) and New Hampshire (43.3) at the top of the list.

▷ Between 2022 and 2050 the share of the older population

that identifies as non-Hispanic white is projected to drop

from 75% to 60%.

Wins of silver Tsunami

▷ Education levels are

increasing.

▷ Older adults are working

longer.

▷ The poverty rate for

Americans ages 65 and

older has dropped sharply.

▷ More older adults can meet

their daily care needs.

Losses of silver tsunami

▷ Gains in life expectancy recently

stalled.

▷ Obesity prevalence among older

Americans has increased at an

alarming rate.

▷ Wide economic disparities are

found across different population

subgroups.

▷ More older adults are divorced

compared with previous

generations.

▷ More older women are living

alone.

▷ Older Americans face a caregiving

gap.

▷ Social Security and Medicare

expenditures will increase.

▷ Federal budget cuts and tax

increases may be inevitable.

Percent of long-term care services users who are

ages 65 and older

▷ Percent of adult day services center

participants: 63.3%

▷ Percent of home health agency patients: 89.7%

▷ Percent of hospice patients: 95.2%

▷ Percent of nursing home residents : 82.1%

▷ Percent of inpatient rehabilitation facility

patients: 89.3%

▷ Percent of long-term care hospital patients:

77.2%

▷ Percent of residential care community

residents: 94.2%

Aging and Health Disparities WOMEN

▷ Older women make up two-

thirds of those in the top

25% of the population for

highest yearly burden when

both treatment costs and

lost wages are combined.

▷ Of those who lost wages

due to chronic disease, 56%

are older women.

▷ At the same time, older

women also have the

lowest household incomes

and the highest out-of-

pocket medical expenses.

Aging and Health Disparities PEOPLE OF COLOR

▷ Blacks and Hispanics/Latinos aged 60+ have

$4,000 more in average yearly costs due to

chronic disease than whites and far lower

financial resources to deal with this.

▷ Older people of color experience 15% higher

average yearly treatment costs than whites

because they have a greater number of and/or

more costly chronic diseases.

▷ Older people of color experience $3,000 more

in average yearly lost wages than whites

because they are more likely to experience job

interruptions due to health.

▷ Nearly 40% of Black and Hispanic/Latino older

adults lost wages because of their chronic

disease compared to 16.6% of whites.

Four Priorities

▷ Age-Friendly Communities

○ Goal: All older adults live in communities that respect and

include them and are designed to encourage health, well-

being, engagement, and connection.

▷ Coordinated Housing and Supportive Services

○ Goal: All older adults have access to housing and the services

they need to maintain their independence at home and

thrive in their community

▷ Increased Access to Long-Term Services and

Supports

○ Goal: All older adults can easily access affordable, high-

that promote their

independence and goals.

▷ Aligned Health Care and Supportive Services Goal: All older adults maximize their health and reduce preventable disease and injury through comprehensive care

that includes health and social services in the home or in the

community.

Minnesota Plan on Aging

FFY 2024-2027

▷ 24 states, including Minnesota, are

implementing or developing their own

strategic plans, called multisector plans or

master plans.

▷ Written by the Minnesota Board on Aging

and submitted to the state in October,

2023.

▷ A legislative task force is currently meeting

to recommend the state structure for

administering the implementation of the

plan.

5 Priorities of the MN Plan

1. Advance equity and eliminate disparities, while

empowering rural and diverse communities and

respecting the sovereignty of Tribal Nations

2. Make aging in community truly possible for all

Minnesotans

3. Support families, friends and neighbors in sustaining

their caregiving roles

4. Promote and support healthy aging for all

Minnesotans

5. Dismantle ageism and promote older adult rights,

autonomy, and protection

AARP’s Vision for Aging

▷ Published July, 2024

▷ Titled Aging Well in America: AARP’s Vision

for a National Plan on Aging

▷ Contains 4 goals

▷ Designed to complement and leverage

federal capabilities to bolster ongoing

community and state efforts through multi

sector collaboration

AARP’s 4 Goals for a National

Plan

Goal 1: Promote healthy living and access to affordable, high quality healthcare

Goal 2: Support family caregivers and ensure access

to affordable, high-quality long-term services and

supports (LTSS) that maximizes the dignity,

independence, and protection of older adults

Goal 3: Provide ample opportunities to generate,

save, and preserve financial resources

Goal 4: Create age-friendly, livable communities

that enable people to age in place, and continue as

engaged members of their communities

Cosequentialism

An ethical theory that says an action is right or wrong based on its consequences. “What matters most is what happens because of the action.”

Example of consequentialism in healthcare

A nurse has two patients who both need immediate attention, but one patient has a life-threatening condition while the other has a less serious condition.

Non-consequentialism

The action or principle matters, regardless of the result

What is an example of non-consequentialism in healthcare?

A patient refuses a certain medical treatment because of their personal beliefs. Even if the healthcare provider believes the treatment would lead to a better health outcome, they respect the patient’s decision because patients have the right to make their own choices.

Non-maleficence

The ethical principle of do no harm. Avoid causing unnecessary harm or injury.

Example of non-maleficence in healthcare?

A nurse checks a patient’s allergies before giving them medication to make sure the medication will not cause a harmful reaction.

Beneficence

The act of doing good, showing active kindness, charity, or working to promote the best interests or welfare of others.

Examples of beneficence in healthcare?

Providing pain relief, preventing illness, educating patients

Autonomy

The right of a patient to accept or refuse treatment after the healthcare provider explains the risks and benefits.

What is an example of autonomy in healthcare?

A patient deciding to not have surgery after their provider recommends it.

Justice

Fairness or equality

What is an example of justice in healthcare?

If two patients have the same need, they are prioritized based on medical need, not money or status.

Procedural Justice

Making sure the process used to make decisions is fair, consistent, and unbiased.

What is an example of procedural justice in healthcare?

A hospital uses the same clear criteria for deciding which patients receive a limited treatment or resource.

Distributive Justice

Fairly distributing healthcare benefits, resources, and services among people

What is an example of distributive justice in healthcare?

If a hospital has a limited number of beds, those with urgency and needs get them quicker than those who are wealthy or have connections.

List the 3 modern medical ethics codes:

American Medical Association (AMA) (For physicians), Nuremberg Code (For informed consent/research), and Delaratio of Helsinki (For research ethics)

What is the human genome project?

Major international scientific project that mapped and identified all the genes in human DNA that started in 1990 and was completed in 2003.

What is the goal of genetic testing?

Identify changes in a person’s genes that may cause or increase the risk of certain diseases or conditions.

What are some strategies that can help a population with high needs?

Increased access to healthcare, preventative care, health education, community outreach, care coordination, address social needs, culturally appropriate care.

What are medical technologies?

Tools used to prevent diagnose, or treat conditions. Examples are MRI, CT, X-rays, Pacemakers, Ventilators, Robotic surgery, Genetic testing

Implications of medical technologies?

Positive: Better diagnosis, longer lives, greater access, improved quality of life. Negative: High costs, privacy concerns, Ethical concerns, Inequality, Overreliance on technology.

The silver tsunami refers to what?

The rapid growth of the older adult population, especially as the large baby boomer generation ages. Increased demand for healthcare resources, personal, and services.

What happens as you age?

You experience comorbidity and have multiple diseases, sometimes chronic, reduce physical function, are slower to heal, may need medications, and have cognitive changes.

Sticky pricing

Prices are slow to change, even when costs or economic conditions change.

Health inequality

Differences in health outcomes between individuals or groups of people.

In 2010, what did the Affordable Care Act do?

expanded access to health insurance, made coverage more affordable, and better protected patients.

What age will you be cut off from your parents’ Affordable Care Act?

26

How do zip codes play a role in healthcare?

Where people live and the resources available to them in their community.