How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary (2012) / Chapter Skim
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6 What Do We Still Need to Learn About Reducing Health Disparities?
6 What Do We Still Need to Learn About Reducing Health Disparities?
Pages 69-84
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From page 69... ...
Each speaker was asked the question, "What do we still need to learn about reducing health disparities? " PAULA BRAVEMAN Paula Braveman is a professor of family and community medicine and has published extensively on disparities in health and health care.
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From page 70... ...
© 2008 Robert Wood Johnson Foundation. www.commissiononhealth.org.
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From page 71... ...
(Social position can also be reflected by sexual orientation, disability status, or any number of other characteristics that define the likelihood that an individual will experience discrimination on the basis of that social position.) Furthermore, social position determines the extent to which a person is exposed to either factors that promote health or factors that have adverse effects on health.
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From page 72... ...
Disease, injury, and the differential consequences of being ill or physically disabled also affect social position and lead to further social stratification. Social stratification -- that is, how people sort themselves into hierarchical groups according to characteristics like race or income -- in turn affects access to more resources or more opportunities.
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From page 73... ...
Lower levels of educational attainment, in turn, lead to lower wage earnings, poverty, and poor health outcomes. Although educational attainment influences health by several potential pathways, Figure 6-4 shows the pathway for which the knowledge base is the most limited (inside box)
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From page 74... ...
Translational Research Finally, Braveman stated that more translational research that will translate the existing knowledge base into action is strongly needed. She said that the biggest barrier to reducing health disparities is not a lack of knowledge; rather, it is a lack of political will.
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From page 75... ...
In other words, Beal said, "where you live makes a difference." Just as the saying states that "all politics is local," Beal said that "all disparities are local" as well. Although national data are useful for moving to an evidence-based action plan, what is needed are more localized and focused action plans.
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From page 76... ...
Need for an Evidence-Based Action Plan What is needed, said Beal, is what Paula Braveman called "intervention research," that is, research that "tells us where to go in terms of next steps." This is what Beal called an "evidence-based action plan." Beal reiterated Braveman's statement that research to describe disparities is not needed. What is needed is an evidence-based action plan for improving health care quality.
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From page 77... ...
For example, poor health literacy perpetuates health disparities, as does a lack of access to care, a lack of access to a regular provider, and a lack of access to a medical home. No single factor can be considered to be the root cause of disparities.
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From page 78... ...
Beal concluded by emphasizing several future needs: the need for a paradigm shift from health disparities to health equity, the need for an evidence-based action plan, and the need to be prepared for complexity. DENNIS ANDRULIS Dennis Andrulis is a senior research scientist at the Texas Health Institute, where he conducts research with vulnerable populations on the topics of urban health, cultural competence, and language assistance.
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From page 79... ...
However, although a base has been established, knowledge gaps persist. Andrulis explained that the knowledge gaps occur at three key levels: the individual, organizational, and community levels.
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Work in the area of standards development for cultural competence has also taken place. For example, the Joint Commission, the Office on Minority Health in HHS, and the National Quality Forum are all developing standards for interpreter qualifications as well as language and culture measures.
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From page 81... ...
Specific Elements of a Cultural Competence Model Perhaps the biggest knowledge gap in the implementation of cultural competence interventions and the creation of measures involves the specific elements of a cultural competence model. Andrulis asked what works, when, and how.
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From page 82... ...
The third area of research needed is the creation and testing of specific interventions that train and educate health care organizations and practitioners to use broader intersectoral strategies to promote health and prevent chronic illness. It is not enough to look at the health care system, because the health care system often serves as the funnel for other problems facing diverse populations (for example, domestic abuse, poor housing options, and homelessness)
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From page 83... ...
Vega explained that because supervisors and chief executive officers set and sustain policies, they should be willing to experiment. And as they experiment, those in leadership roles should be aware of the complexity of measuring cultural competence and the tentative nature of the process that Anne Beal described and have the willingness to go the distance in order to achieve cultural competence.
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From page 84... ...
2004. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children.
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