filipino americans & health inequality filipino community cancer collaborative meeting...

Filipino Americans & Health Inequality

Filipino Community Cancer Collaborative Meeting12.10.2012

Rachel J. MesiaStanford Cancer Institute

What do I mean by…• Social determinants of health?

– The conditions in which people are born, grow, live, work and age, including the health system.. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels (WHO).

• Social Inequality?– Differences in group due to socially-defined categories (Hoffmann, 2008).

• Health disparity or Health inequality?– Difference between the presence of disease, health outcomes, or access

to health care of one population compared to another population as a result of uneven distribution of health or health resources (HRSA). “Health inequality” is a term used commonly outside of the U.S.

• Health Inequity? – Inequity refers to unfair, avoidable differences in health that are

considered unfair and unjust. Health inequities are the presence of such differences (WHO).

What do I mean by…• Upstream intervention?

– Approaches that can affect large populations through regulation, increased access, or economic incentives.

• Downstream intervention?– Targeted programs often involve individual-level behavioral

approaches for prevention or disease management.

How does the US compare to other high income countries in regards to health and social problems?

Differences in social class

What do we know about Filipino health?• 25% of adult Filipino males are current smokers, exceeding the state

average for adult males of 19%

• More than 1 in 3 Filipinos are overweight. Among Asians, Filipinos have the highest proportion (46%) of overweight or obese adults.

• More than 60% of Filipino adults are eating less than 5 fruits and vegetables a day

• Filipinos also have the highest mortality rates for female breast cancer, prostate cancer, and thyroid cancer among Asians subgroups in California.

• Filipinos have the second poorest five-year survival rates for colon and rectal cancers of all U.S. ethnic groups (second to American Indians).

www.gapminder.org

MITCHELL, T., ARMSTRONG, G. L., HU, D. J., WASLEY, A., & PAINTER, J. A. (2011) The Increasing Burden of Imported Chronic Hepatitis B—United States, 1974–2008. PloS one, 6(12).

Table 1. Number of Immigrants, Estimated HBsAg prevalence, and number of imported chronic hepatitis B cases by country of birth, 1974–2008.

1. Median US married couple income with 2 children and employer-sponsored health plan.

1. Gross annual income increase from $76,000 in 1999 to $99,000 in 2009.

2. By 2009, it was found that a family’s monthly health premiums rose to 128% ($490 to $1,115) and out-of-pocket spending increased by 78% (up to $235 per month from $135 in 1999).

1. Family budgets shrunk despite the family’s pre-tax income increased by approximately 30%. Forty-three percent (43%) of the increase went towards health care costs and taxes for public health care programs.

• AUERBACH, D. I. & KELLERMANN, A. L. (2011) A decade of health care cost growth has wiped out real income gains for an average US family. Health Affairs, 30(9).

Does universal health care eliminate the social inequalities of health?

• National Insurance Scheme (NIS) of Norway– Individuals choose NIS or

combine it with voluntary private insurance.

– Patients select their GPs under the NIS, who are also the gatekeepers for specialist services.

– Out-of-pocket payments are mainly subsidized. There are exemptions made on out-of-pocket payments for patients with certain diseases and some groups of people.

• Norway has a higher index of social inequality obesity and smoking than other Euro countries.

• The highest income group have greater use of specialist services.

• GPs spend more consultation time with affluent patients

Example of addressing a health issue

www.measureofamerica.org

How can we reduce health inequality among Filipino Americans?