I don’t know how to handle this Psychology question and need guidance.
Respond to at least two different colleagues’ postings in one or more of the following ways:
Critique your colleague’s post by suggesting additional determinants for health disparity.
Submit a constructive critique of your colleague’s post. Expand on your colleague’s explanation about access to health care.
Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.
Post an explanation of health care disparities in a specific minority population.
Gehlert and Browne (2019) point out that health disparities exist between and among populations defined by gender and gender identification, race or ethnicity, education, socioeconomic status, employment or insurance status, geography, and/or disability status, while also being found in screening, incidence, mortality, survivorship, and treatment as well. For this particular discussion I have chosen to narrow down health care disparities amongst African American Women.
It has been well documented that African American women are disproportionately affected by conditions that negatively impact their health and that both caregiver and patient influenced behaviors create and contribute to the disparity (Movement is Life, 2015). One of the most common racially based health disparities to exist amongst African American women falls within the category of maternal and child health status indicators, such as: infant mortality (IM), low birth weight (LBW), and maternal mortality (Gehlert & Browne, 2019). IM is considered to be one of the leading indicators that is used to measure the health of a country and although the overall rate of IM decreased in the U.S., the rate is still 2.4 times greater in African American compared to White American infants as of 2007 (Gehlert & Browne, 2019). When it comes to LBW, rates for African Americans are nearly double the rate than that of their White American counterparts and 2.7 times greater for maternal mortality than the rate for White women. According to the CDC (2017), new analysis and research is showing that younger African Americans in their 20s, 30s, and 40s are living with or dying of many conditions that typically are found in White Americans at older ages, such as high blood pressure, diabetes, heart disease, stroke, and various types of cancer. And mostly recently, African Americans have been found to have a hospitalization rate of 4.7 times the rate of White Americans for COVID-19 (Marshall, 2020).
Identify three nonbiological factors (e.g., public health policy) that might be associated with health care disparities in the population you selected.
There are several nonbiological factors that have been linked as potential contributing factors associated with health care disparities amongst African American women. The CDC (2017) mentions that health differences and disparities are often due to economic and social conditions that are more common among African Americans than their white counterparts. Some of the social factors to be considered are the higher rates of unemployment, higher rates of living in poverty, as well as higher rates of no homeownership or lack of housing amongst African Americans compared to their White counterparts (CDC, 2017).
Placed-based health disparities are also prevalent and require attention to the association with health disparities amongst African American women as it is often tied to racial and socioeconomic status and contribute to limited access to healthy food, limited proximity and access to natural open spaces and parks for recreation, social health, and/or psychological restoration, and place has also been tied to the inequalities found in not only the prevalence but also in the maintenance of chronic diseases more commonly found amongst ethnic minorities, such as: cardiovascular diseases, diabetes, cancer, HIV/AIDs, etc. (Gehlert & Browne, 2019). Access to healthcare plays another major role contributing to health care disparities found amongst the African American population as members of racial and ethnic minority groups encounter more barriers to getting care, such as lack of affordability, lack of health insurance, lack of transportation, childcare, or inability to take the time off of work, etc. (Marshall, 2020).
Discrimination is another contributing factor that unfortunately continues to exist in various systems such as health care, housing, education, criminal justice, finance, etc. (CDC, 2017). The National Academy of Medicine (NAM) found that even when age, income status, insurance status, and severity of conditions are comparable, racial and ethnic minorities receive lower quality health care than White individuals and they reported that they are less likely than their White counterparts to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for AIDS, cancer, or stroke (Bridges, n.d.). Bridges points out that a major contributing factor is that of implicit bias contributing to racial disparities found in health care treatment and services provided (n.d.).
Explain medical social worker roles in addressing the three factors to eliminate health care disparities in the population.
There are several ways in which social workers can work towards addressing the elimination of health care disparities. One suggestion is to work with both communities as well as healthcare professionals and organizations to educate and eliminate cultural barriers to care. Another role a medical social worker can take on is developing and/or providing trainings to health care professionals to develop and build cultural competence and an understanding to different cultures and how they interact with the healthcare system as well as provide regular implicit bias trainings. From a macro level of practice medical social workers can advocate for changes in policy that would directly address and impact health disparities found amongst minority populations. Craig, Bejan, and Muskat (2013) recommend that medical social workers strengthen their advocacy skills and efforts and increase the public health discourse focused on health outcomes through the support of fiscal, employment, or housing programs and policies, aimed at reducing disparities that negatively impact health.
Bridges, K. (n.d.). Implicit Bias and Racial Disparities in Health Care. Retrieved from https://www.americanbar.org/groups/crsj/publicatio…
Centers for Disease Control and Prevention (CDC). (2017). African American Health. Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html
Craig, S. L., Bejan, R., & Muskat, B. (2013). Making the invisible visible: Are health social workers addressing the social determinants of health?. Social Work in Health Care, 52(4), 311-331.
Gehlert, S., & Browne, T. (Eds.). (2019). Health policy and social work. In Handbook of health social work (3rd). Wiley.
Marshall, W. F., III. (2020). Why is COVID-19 more severely affecting people of color? Retrieved from https://www.mayoclinic.org/diseases-conditions/cor…
Movement is Life. (2015). Health Disparities Among African American Women. Retrieved from http://startmovingstartliving.com/wp-content/uploads/2014/04/MIL_HealthDispAAW.pdf
According to the World Health Organization (WHO), social determinants of health (SDH) “are the non-medical factors that influence health outcomes” (WHO, 2020, para. 1). These can include income, education, socioeconomic status, food insecurity, social and cultural support, conflict, and health care. (WHO, 2020, para. 3). The WHO stated that health inequities influence SDH and that “in countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health” (WHO, 2020, para. 2).The minority population I will explore for this discussion post is American Indian/Alaskan Native (IA/AN).
In 2019, IA/ANs estimated population was 6.79 million [2.09% of the U.S. population] (World Population Review, 2020, para 3).Approximately one in three IA/AN live on Reservations, and the rest live in urban areas (Paez Errickson et al., 2011). This lack of active participation in the tribe can be problematic for individuals not living on reservations since many tribal benefits and services are linked to the reservation. Paez-Errikson et al. stated that AI risk losing their benefits within the tribe by moving off the reservation, including medical services, housing, and food benefits.They are also at risk, per Paez Errickson et al., to lose their status within the tribe.This detachment would likely lead to a sense of disenfranchisement and loss of both community and identity (The Center for American Indian Resilience [CAIR], n. d.).CAIR also explained that AI have “have a collectivist view of health, meaning they consider the health of the environment, their housing situation, family relations and much more” (CAIR, n. d., para 2). Part of this concept of health, is a deep, spiritual connection to the land.For those AI living in urban areas or those cut off from their ancestral lands, this connection is tenuous, causing distress and the sense of life out of balance.
One-in-four AI/AN are below the Federal Poverty Level, which is the highest poverty level of any other ethnic group in the U.S. (World Population Review, 2020, para 3). Additionally, whether on the reservation or living in more urban areas, AI face ongoing historical trauma related to their ancestors’ treatment by whites, including boarding schools, mandatory changes to language, culture, religion, and the forcible usurpation of ancestral lands. As more research into the possible epigenetic effects of historical trauma, the possibility increases for “transgenerational stress inheritance” (Warne & Wescott, 2019, para. 4). AI children have high rates of adverse childhood experiments, per Warne & Wescott.They stated that this might be related, in part, to historical familial stress or increased alcohol and drug use. Warne & Wescott indicated that many AI/AN adults and children live in “food deserts” on reservation lands.Because of this lack of access to a wide variety of fresh foods, many AI are reliant on governmental assistance through programs like the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), school breakfast and lunch programs, and the Food Distribution Program on Indian Reservations (FDPIR)(Warne & Wescott, 2019).According to Warne & Wescott, these unhealthy food choices have led to nutrition-related health risks, especially obesity, high blood pressure, diabetes, and cancers (para. 13-15.).Warne & Wescott also indicate that the prevalence rates for these medical illnesses (and mortality) are higher in AI.AI have the highest percentage of diabetes, and the highest diabetes-related deaths, of any other ethnic group in the U.S. (Warne & Wescott, para, 15).Compared to whites, AI’s in the plains states have a 58% higher mortality rate for heart disease. AI’s overall mortality rate related to heart disease across the country is 21% higher than whites. (Warne & Wescott, para 16.).According to Warne & Wescott, AI are at significantly higher risk for cancer mortality use as well, including lung and other cancers related to tobacco smoking (para. 17).The National Congress of American Indians [NCIA] (2020) shared that AI/AN die 5.5 years sooner than their white counterparts (para. 7). The causes of death are chronic illnesses, including diabetes, chronic liver disease, cirrhosis, and suicide (NCIA, para. 7).AI/NA die 1.3 times more often than all other races; they also die of diabetes, 3.2 times more frequently, 4.6 times as often of chronic liver disease and cirrhosis (NCAI, 2020, para 8).NCAI also indicates that AI/AN adults die from suicide almost twice as often as other races, and that number is higher (2.5 times) for youth (para 8-9).
Finally, in 2019, the U.S. Census Bureau estimated the percentages of the population by race, indicates that less than half of AI/AN men, stating a single race, have work-sponsored or private health insurance. AI/AN alone or with another race have 51,9% have private insurance.Public insurance (Medicaid or Medicare) covers 43.45% of AI/AN alone, and 42.1% of AI/AN with another race are publicly funded. 19.1% of AI/NA identifying with one race are uninsured, while 15.2 % AI/AN with another race are uninsured.
These pervasive and systemic issues facing AI/AN individuals are a challenge to social workers.To best assist this population, social workers should be aware of their clients’ ethnic/racial background.With the push in the late 19th and early 20th centuries to boarding houses and raising Native children as white, many AI are not fully Native, nor are they entirely white.The social worker can help them explore their identity and possibly assist them in connecting with their tribe.
To help with food insecurity, the social worker may refer an AI/AN person to a tribal dietitian or another helpful individual to teach nutrition about traditional or cultural food sources.Google is a useful resource for Native food production companies that can provide resources.
Social workers can be ready to advocate on a broader basis by being aware and supporting any political movements within the tribes and then advocating and working for them; however the tribe believes they need help.
In general, social workers can explore the WHO website, specifically, for resources or guides to help AI/AN individuals deal with any social determinants of health or ongoing inequity.The social worker may then support or work for a political candidate who is a proponent of a more equitable division of resources for AI/AN, universal health care, and programs and policies that will best meet the need of individual AI/AN’s identified needs, or the need for the entire population.
Findling, M. G., Casey, L. S., Fryberg, S. A., Hafner, S., Blendon, R. J., Benson, J. M., Sayde, J. M., & Miller, C. (2019). Discrimination in the United States: Experiences of Native Americans. Health Services Research, 54 Suppl 2, 1431–1441.
Hoss, A., & Blum, J. D. (2019). Federal Indian Law as a Structural Determinant of Health. Journal of Law, Medicine & Ethics, 47, 34–42.
National Congress of American Indians. (2020, June 1). Indian Country Demographics. [webpage]. www.naci.org/about-tribes/demographics.
United States Census Bureau. (2020). Selected population profile in the United States. [webpage]. https://data.census.gov/cedsci/table?q=S0201&t=006…
Warne, D., Wescott, S. (2019). Social Determinants of American Indian Nutritional Health. Current Developments in Nutrition, 3(Supplement_2), 12–18.
World Health Organization [WHO]. (2020). Social Determinants of health. https://www.who.int/health-topics/social-determina…
World Population Review. (2020). Native American population 2020. [webpage]. https://worldpopulationreview.com/state-rankings/n…
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