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Hypertension, diabetes, and health disparities in the black population in Miami-Dade County

Presented by:Regine J. Joly, MPH,BS,RN

Yvonne Fray-Clarke, MPH,BS

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The city of “Miami”• Blessed with year-round mild climates and

unrivaled ocean access, America’s southernmost resort city is also a sought-after international recreation destination. Ranked the nation’s #1 Healthiest City by Natural Health Magazine in 2002, Miami caters to action-oriented visitors from around the globe with some of the world's top golf, tennis and sporting facilities. Add sparkling waters that are a magnet for boating enthusiasts, fishermen, divers and water sports and it is easy to see why Miami is a number one choice for active travelers of all ages. They enjoy the beautiful sunshine and our warm beaches.

• Beneath all that glamour and rays of sunshine lies a group of people plagued by health disparities. They cannot enjoy their surroundings because of the hand life has dealt them, not because of where they were born but due to the disparities that encompass them because of their race and cultural ethnicity.

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African-American, Bahamian, Cayman American, Trinidadian

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Jamaican, Haitian, Barbados Americans, Dominica Americans

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Abstract

Race and ethnicity have been seen to profoundly affect the health of the United States” (Schneider, 2000 pg 205) and Miami, Florida is no exception. Miami-Dade County, Florida, is a very culturally diverse city, because of the influx of immigrants. Not all blacks such as Jamaicans, Haitians, and Bahamians are African Americans but they share the same barriers and disparities to healthcare access due to genetic risk factors in hypertension, obesity and diabetes. Further analysis will reveal similarities in healthcare inequality due to their dark pigmentation, acculturation and assimilation. Therefore, when we speak of “African Americans” blacks from the Caribbean are part of the ethnic and racial mix and they must also be recognized.

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Abstract

For African Americans living in Miami-Dade County, treatment for hypertension diabetes, and health prevention services are often hard to obtain. Based on research analysis and evaluation of literature reviews, lack of insurance coverage, inadequate education¸ transportation, socioeconomic status, and cultural barriers are the major deterrents and contributors of this “minority groups” barriers to adequate healthcare services.

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Learning Objectives

• Identify the barriers and disparities to healthcare access due to genetic risk factors in hypertension, diabetes, and obesity in the black community in Miami-Dade County.

• Analyze the culture barriers and differences within the diverse black community in Miami-Dade County that is compose of not only African-Americans, but also a large Caribbean black population

• Create a plan that will promote prevention, promotion, and access to appropriate health care services for all.

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Methodology•A descriptive survey of Florida’s communities was conducted on racial and ethnic minority groups access to health care in the state

•The survey focused on identifying gaps and areas where health care services are lacking

•The assessment was directed towards understanding issues of access to health care regarding public awareness and public education, coordination, research and transportation

•A review of reported structural, socioeconomic and personal barriers were identified

•The survey instruments were formulated based on a comprehensive literature review of existing community-based assessment tools focusing on access to health care among minorities.• The Center for Disease Control and Prevention (CDC) Community questionnaire survey instrument of children, adults, and older adults ages 18-65; and, the Florida Health Planning Councils Inc., statewide and local districts survey designs, utilizing six of the eleven district plans available were modified and adapted to develop the survey instruments.

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Barriers and Disparities in Healthcare

•Disparities in health care refer to the differences between two or more population groups in health care access, coverage, and quality of care, including differences in preventative, diagnostic, and treatment services

 

•Numerous studies and reports have documented the fact that racial and ethnic minorities, compared to whites, are in poorer health, receive lower quality • Health care, suffer worse health outcomes, and have higher rates of illness, injury, and premature  

death.

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Barrier’s Continued

•Health insurance and access to care•Genetic risk factors such as obesity•Physical activity

•Transportation•Housing

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Access To Health Care

38%

20%

13%10%

9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Figure : #23 Access to health care barrier

health care costs

insurance cost

lack of geog.Accesslack of know.about svs.insufficient # ofproviders

Florida Regional Community Health Survey on Racial and Ethnic

Minorities Access To Health Care Providers Survey, 2004

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Figure 16: The major barriers to health care access among racial and ethnic groups in the community

72 72

5343

37

22

0

20

40

60

80

100

Percent ranking issue as one of the top five issues

Florida Community Survey on Access to Health Care: Stakeholders, 2004

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Figure 17: The major health care issues in the community

71

6053 53 52 49

39

24 2317

10

0

20

40

60

80

100

Percent ranking issue as one of the top five issues

Florida Community Survey on Access to Health Care: Stakeholders, 2004

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Culture Barriers

•Acculturation•Assimilation•Skin pigmentation

•Language and accent

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Figure 11: Difficulty getting specialty care referrals

44

34

62

40

52 50

0

20

40

60

80

100

Total Black Haitian Asian Hispanic Unknown

Percent reporting difficulty

Florida Community Survey on Access to Health Care, 2004

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Figure 8: Last time visited a physician for a routine check-up

14 14

7

141718

26

13

9

22

11

17

0

5

10

15

20

25

30

2-5 years 5 years or more or never

Total Black, non-Hispanic, non-HaitianHaitian AsianHispanic Unknown

Percent

Florida Community Survey on Access to Health Care, 2004

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Figure 24: Lack of knowledge or education about available services

4% 1%

63%

32% Yes

Somewhat

No

Other

Florida Regional Community Health Survey on Racial and Ethnic Minorities

Access to health Care Providers' Survey , 2004

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As shown in Figure 21, 27.5 percent of 141 people surveyed reported using public transportation, with a slight increase, especially among the Haitian population (41.4%)

Figure 21: Proportion of Users of Public Transportation by Ethnic

27.5 22.2 31 30.441.4

0

20

40

60

80

100

(% )

Population

Whites

Blacks

Hispanics

Haitians

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Figure 19: Top approaches for improving access among racial and ethnic minority groups

81 8071

56

2515

0

20

40

60

80

100

Percent indicating that approach is one of their top five approaches

Florida Community Survey on Access to Health Care: Stakeholders, 2004

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Black Experience in Miami-Dade County

• Dr.James Lynch, a psychiatrist and professor at John Hopkins University believe it is the emotional effect of racism

• Poor socioeconomic condition and stress• Poor self-esteem• Physicians understanding patients view on illness,

lumping all blacks in one category and not addressing ethnicity

• Adequate time in a Doctor’s office• Obesity, diabetes , smoking, medication compliance• Language barrier

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Miami-Dade County

• In 1999 24.6% were uninsured; 2004 28.7%. Miami Dade County has the highest population of uninsured

• 2004 White non-Hispanic 12.1%, Hispanics 33.0%, Blacks 29.2, Other 19.0%

Racial and Ethnic Health Disparities Advisory Committee. (June 2005), Closing The

Gap Reducing Racial & Ethnic Health Disparities in Florida.

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Proposal

• Provide a screening program for African Americans in South Dade

• Recognize that blacks may include Haitians, Jamaicans, Bahamians and other West Indians.

• Uninsured population• Involve local politicians• Involve local churches• Healthy Lifestyle that are culturally sensitive• Education of community recourses, long wait for

appointments, navigating the health care system, and transportation

• Due to barriers such as transportation, poverty and lack of other resources, many African Americans and other minority groups are often left out of healthcare screenings, promotions and preventions.

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Proposal Continued

• The percentage living in Miami warrants an equal access to screening not just in North Miami Dade but also in the South as well.

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Conclusion

• Eliminating disparities will have to require improved efforts in preventions, promotions and access to appropriate health care services and delivery for all. “Whether social class is measured by income, education, employment grade, or prestige, it determines the recourses that are available to meet life's challenges and thereby influences the control that one has in shaping life”

• It will also require improving access to the benefits of society, including quality preventive and treatment services, as well as innovative ways of working in partnership with health care systems, State and local governments, tribal governments, academia, national and community-based organizations, and communities.

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Conclusion• Obesity, diabetes, and hypertension are the number

one chronic conditions affecting the African American Community. We would like to address health disparities , access to health care, and transportation affecting our South Dade Community and include the West Indian Caribbean population (e.g. Haitian, Jamaican).

• We combined our research in order to make this project a reality using the recourses available at the Florida Health Department.

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Regine J. Joly, MPH, BS, RN

• I am currently employed at Blue Cross Blue Shield of Florida (BCBSFL). I am currently designing a program to overcome disparities and prevalence of risk factors, outcomes in the existing health care delivery system due to racial and ethnic minorities composition of the demographics of the population in Florida with a special focus on South Florida for BCBSFL . The name of this program is " Regional Lifestyle Management Program" which is now currently being implemented. My background is disease Management and Case Management.

• Regine.Joly@bcbsfl.com• Regine99@bellsouth.net• Blue Cross blue Shield of Florida• 1-800-955-7635 X 17430• 305-772-2543

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Yvonne Fray-Clarke, MPH, BS

• I currently work for Jackson South Community Hospital, which is a part of the Public Health Trust. My specialty is to work with patients with Medicare and Medicaid indigents. I have seen so much disparities and I have extensive first hand knowledge about access to care due to culture, language and ethnicity since so many patients/immigrants that go to Jackson are uninsured and have to be qualified for Medicaid or for some of the many other programs that are available that they did not know existed.

• YFray@um-jmh.org• Fraytops@aol.com• Jackson South Community Hospital

786-466-7000 ext 87043 305-903-3729

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Barry University• We would like to acknowledge our professor Tim Patton, for

being our inspiration as students in the Public Health Program at Barry University. During our first class he challenged us on a simple question “ What is Public Health?”

Richard T (Tim) PattonDirector Professional Master of Public Health &

Institute for Community Health and Minority MedicineSchool of Graduate Medical Science

BARRY University11300 NE Second AvenueMiami Shores, FL 33161

305.899-3257RPatton@mail.barry.edu

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References• Agency for Healthcare Research and Quality (AHRQ, 2001) Diabetes Disparities

Among Racial and Ethnic Minorities Publication No. 02-007• American Diabetes Association (n.d.) Diabetes Statistics for African Americans

Retrieved June 20th, 2005 from http://www.diabetes.org/diabetes-statistics/african- americans.jsp

• Black Healthcare (n.d.) Addressing the Healthcare issues in African Americans Retrieved June14th, 2005 from http://www.blackhealthcare.com

• CDC. Health, United States, 2005: 30. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2004.

Retrieved October 17th, 2005 from:http://www.cdc.gov/nchs/data/hus/hus04trend.pdf#03.

• CDC. Health, United States, 2005: . Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2004. Retrieved from: http://www.cdc.gov/nchs/data/hus/tables/2004/04hus053.pdf.

• Centers for Disease Control and Prevention, (2002) Racial and Ethnic Disparities in Health Status. Retrieved June 14th, 2005 from http://www.cdc.gov

• Centers for Disease Control and Prevention (2002-2003) National Diabetes Fact Sheet General Information and National Estimates on Diabetes in the United States Retrieved June 14th, 2005 from http://www.cdc.gov

• Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Examination Statistics. Unpublished data, retrieved

October 17th, 2005 from: http://www.cdc.gov/nchs/fastats/overwt.htm• Cleveland Clinic Diabetes Syndrome X

Retrieved January 10th, 2005 from: http://www.clevelandclinic.org/health

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References Continued• Dixon B. M. & Wilson J. (1994) Good Health for African Americans New York: Crown Publishers• Florida Department of Health: Diabetes. Retrieved October 17th, 2005 from:

http://www.doh.state.fl.us/equopp/ctg/CTG _Diabetes.html http://www.doh.state.fl.usfamily/dcp/default.html

• Gladstone, E. (2004) NIH News: African Americans Unaware of High Kidney Disease

Risk. Retrieved from http://nih.gov/news/pr/mar2004/niddk-08.htm• Gasana, Janvier (2003) Essentials of Environmental Health Management

Hallandale Beach Florida: Aglop Publishing• Green L. & Ottoson J. (1999) Community and Population Health

(8th ed.). New York/McGraw-Hill• Healthy People 2010 Retrieved October 17th, 2005 from:

http://www.healthypeople.gov/• Health and Healthcare 2010, (2003) The Forecast, The Challenge

2nd edition Princeton NJ: Jossey-Bass Publication • Insulin Resistance; the metabolic syndrome X,  Reaven & Laws, Humana

Press, 1999 Diabetes Mall Types of Diabetes Retrieved February 8th, 2006 from ile://C\Documents and Settings/admin\My Documents\syndromex insulin Resistance.htm

• Journal of the American Medical Association (JAMA, 2002) Volume 287: pages 356-359, Jan 16th, 2002.

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References Continued• M.A. Winkleby, H.C. Kraemer, D.K. Ahn and A.N. Varady, (1988-1994) Ethnic

and Socioeconomic differences in cardiovascular disease risk factors: findings for women from the third national health and nutrition examination survey, 1988–1994. JAMA 280 (1998), pp. 356–362

• McKinnon J. The black population 2000. Census 2000 brief. Washington, DC: US Department of Commerce, US Census Bureau; 2001. Retrieved October 17th, 2005 from: http://www.census.gov/prod/2001pubs/c2kbr01-5.pdf

• National Diabetes Information Clearinghouse, "Diabetes in African Americans," http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm.

• National Institutes of Health. Consensus conference on physical activity and cardiovascular health. 1996: 276, 241–6.

• National Diabetes Information Clearinghouse (NDIC 2005) National Diabetes Statistics Fact SheetGeneral Information and National Fact Estimates on Diabetes in the United States

• National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health Retrieved October 17th, 2005 from: www.niddk.nih.gov

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References Continued• Black Health Care.com (n.d.). Addressing the health care issues of African-

American. Retrieved October 17, 2004, from http://www.blackhealthcare.com

• Center for Disease Control (CDC) (1990). Topics in minority health beliefs and • Compliance with prescribed medication for hypertension among black women

—New Orleans, 1985-86. MMWR weekly October 12, 1990/39 (40); 701-704. Retrieved October 13, 2004, http://www.cdc.gov/mmwr/preview

• Davis Sharon, Young Liu. & Gibson Gary. (2003. March). Research and practice disparities in trends of hospitalization for potentially preventable chronic conditions among African Americans during the 1990’s: implications and benchmarks. American Journal of Public Health. Vol 93, No. 3. Retrieved October 16, 2004, from http://www Ajph.org

• Dixon M. Barbara& Wilson Josleen. (1994).Good health for African Americans. New York: Crown Publishers.

• Douglass. G.J., Ferdinand, C.K., Bakris, Sowers, R. J. Barriers to blood pressure control in African Americans. Post Graduate Medicine Online. October 2002 Vol. 112 (4) Retrieved December 27, 2005.

• Dyer G., Janice. (summer 2003). The black cloud over the sunshine state: health disparities in south florida.Journal of Cultural Diversity. Retreived February

14,2006, from http://findarticles.com/p/articles/mi_mOMJU/is_2_10/• Fine, J.M., Said, A.I., Thomas S. The role of race and genetics in health disparity

Research. (December 2005) American Journal Public Health, (95), 2125-2127.• Florida Health Department. (2003) Florida cardiovascular health strategic plan

2003-Retrieved January 21, 2006. http://www.doh.state.fl.us/Family/heart/Programs.html

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References Continued• Florida Department of Health. (2003) Your guide to lowering blood pressure.

Retrieved • December 27, 2005. www.myflorida.gov• Heart Center Online for Cardiologist & Their Patients. High blood Pressure & African • Americans. Retrieved October 17, 2004, from http://

www.hearcenteronline.com• Hajjar, I & Kotchen, T. (2003 July). Trends and prevalence, awareness, treatment,

and • control of hypertension in the Unites States, 1988-2000. Journal of the American

Medical Association vol. 290 No. 2, July 9, 2003. Retrieved October 11, 2004 from http:// Jama.ama-assn.org

• Institute for The Future. (2003). Health & health care 2010, the forecast • the challenge. (Second edition). Wiley Imprint, San Francisco California.• Racial and Ethnic Health Disparities Advisory Committee. (June 2005), Closing The • Gap Reducing Racial & Ethnic Health Disparities in Florida. Retreived January 23,

2006, from http://www.doh.state.fl.us/equopp/ctg/CTG_Report_JUNE_2005.• Reed, W. James & Hudson, M. Hilton. (2002). High Blood pressure the Black man and • woman’s Guide to living with hypertension. Roscoe: Hilton Publishing

Company.• Thomas, A.J., Eberly, L.E., Smith, G.D., Neaton, J.D., Stamler, J. (2005).• Race/ethnicity, major risk factors, and cardiovascular disease mortality. American

Journal of Public Health, 95 (8), 1417-1422.• Schneider, Mary-Jane. (2004). Introduction to public health. Sudbury,

Massachusetts: Jones and Bartlett Publishers.

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References Continued• Tulchinski H., Theodore & Varavikova A., Elena. The new public health: an

introduction • for the 21st century. San Diego California: Academic Press• Weaver, L. M. (2004). Fit for God. Doubleday, New York• Winkleby M., Kraemer, H., Ahn D., & Varady, A. (1998 March). Ethnic • And socioeconomic differences in cardiovascular disease risk factors.

Journal of the American Medical Association. Vol. 280 No. 4, July 22, 1998. Retrieved October 20, 2004 from http:// Jama.ama-assn.org