Denver Women's CommissionThe Healthy Colorado Women Initiative - April 2005
The Healthy Colorado Women Initiative:
Health Disparities Among Colorado Women
Written by Helene Kent, Juana Rosa Cavero, Jodi Drisko, Ginger Harrell, Chaer
Robert, Linda Stopp, Jennifer Wieczorek
More then ever attention is being given to the impact of health disparities among different racial and ethnic groups. This paper focuses on the health disparities found among women based upon race, ethnicity, and other factors. This information is offered so that health professionals, policy makers, advocates, and others will gain a deeper understanding of the issues and take action to improve the overall health of all Colorado women.
At the beginning of the 20th century, life expectancy for all citizens at birth was 47.3 years, which increased to 77 years by the beginning of the 21st century. However, substantial differences exist in life expectancy among different subsections of the U.S. population. Women generally outlive men on average by seven years. In 2003, the average Colorado woman could expect to live to be 80.6 years old. However, life expectancy of different subpopulations of Colorado women varies substantially from 77.8 years for African-American women to 80.5 for white women to 80.7 for Native American women, to 82.8 years for Hispanic women to 91.9 years for Asian women.
The differences in health status between specific groups and the general population are known as health disparities. To improve the health of all Coloradoans, it is necessary to eliminate health disparities. Disease, injury, disability, and death disproportionately affect specific population groups within Colorado. Groups with health disparities in Colorado include communities of color, women with disabilities, the lesbian population, and women living in rural communities. With so many groups experiencing disproportionate burden, it is necessary to actively work towards the elimination of health disparities.
Healthy Colorado Women: Steps to Success (2003) outlined how Colorado women rated on various health indicators, but statistical averages tell only part of the story. Often certain racial and ethnic groups have a far different health profile compared to the majority population. By examining these differences, we can learn more about the cause and management of diseases and how cultural, economic and genetic differences affect health. However, racial and ethnic data is missing for many health indicators. In many cases, this is due to small sample sizes. In other cases, the gathering of sex, race, and ethnic-specific data has not been a priority.
There can be false comfort in concluding that all Colorado women are healthy by looking at population-wide data, when in reality a particular group of Colorado women are in fact doing poorly on a particular factor. For example in 2003, the Colorado average low birth rate was 9.1 percent. A more complete picture appears when the data are looked at by racial/ethnic groups. The low birth weight for White Non-Hispanic women was 8.8 percent; White Hispanic women 8.3 percent; African-American women 15.9 percent; Asian women 10.3 percent; and Native American 11.2 percent. These differences can be and must be changed to ensure health equality among Colorado women. It is important to recognize the role race, ethnicity, and economics play in health. This understanding will assist in the development of customized, targeted, and more effective strategies for use with different segments of the population.
The Health Colorado Women Initiative is a project of the Colorado Women’s Health Care Coalition (CWHCC). The Colorado Women’s Health Care Coalition is a non-profit organization whose mission is to educate Colorado women on health care issues and advocate so that women have access to comprehensive, professional, high quality, and cost-effective healthcare. The Healthy Colorado Women Initiative is dedicated to improving the health of Colorado women. The Initiative’s first report, Healthy Colorado Women: Steps to Success (2003), provides a snapshot of the health of Colorado women. For more information about CWHCC, contact Marilyn Mattson at firstname.lastname@example.org.
Factors Affecting Health Disparities
According to the Health People 2010, a number of factors influence health and wellness and may result in health disparities. Some of the factors that influence health disparities are:
Overall, women have a longer life expectancy than men do. Some health differences are obviously gender related, such as cervical and prostate cancer. Research is needed to better understand how gender influences health.
Race and Ethnicity
The centers for Disease Control and Prevention recognizes that race and ethnicity do not represent valid biological or genetic categories, but are social constructs with cultural and historical meaning. Race and ethnicity in the United States are risk markers that correlate with other determinants of health such as poverty, less education, a lack of access to quality health care services, and living in an environment with greater risk of exposures to biological and environmental agents of disease. In addition, many researchers now hypothesize that race-associated differences in health outcomes are due in part to the effects of racism, discrimination, and systemic biases that have resulted in multiple barriers to optimal health.
Income and Education
Inequalities in income and education underlie many health disparities in the United States. Because income and education are intrinsically related, they often serve as proxy measures for each other. In general, population groups that suffer the worst health status are also those that have the highest poverty rates and the least education. Individuals with higher incomes experience better access to medical care, higher quality housing and safer neighborhoods, and increased opportunity to engage in health-promoting behaviors.
People with disabilities are identified as persons having an activity limitation, who use assistance, or who perceive themselves as having a disability. People with disabilities tend to report more anxiety, pain, sleeplessness, days of depression, and fewer days of vitality than do people without limitations. They may also have other health problems, including lower rates of physical activity and higher rates of obesity. Many people with disabilities lack access to health services and medical care.
Injury-related death rates are 40 percent higher in rural versus urban populations. Rates of heart disease, cancer, and diabetes are higher in rural populations. Women living in rural areas are less likely to access preventive health screening, exercise regularly, or wear seat belts.
Studies indicate that lesbians generally seek health care less often than other women do. Since lesbians are less likely to use contraception, they lose the benefits of other important preventive services associated with family planning program visits, such as breast and cervical cancer screening, cholesterol tests and blood pressure monitoring.
Eliminating Disparities Among Colorado Women
For all Colorado women to be healthy, it is necessary to eliminate health disparities among different populations of women. The literature suggests that in order to achieve the goal of eliminating health disparities, a commitment is required to identify and address the underlying root causes. According to the Kaiser Family Foundation a substantial and growing body of research indicates that race/ethnicity - independent of clinical and socioeconomic factors - continues to matter in the U.S. health care system.
Colorado data show that the health and health behaviors vary significantly among various racial/ethnic groups of women.
Health Watch: The Health of Women in Colorado, http://www.cdphe.state.co.us/hs/pubs/womenshealth4.pdf, a publication from the Colorado Department of Public Health and Environment Health Statistics Section illustrates the differences that exist for a handful of health indicators. A fuller picture of health disparities in women can be surmised by looking at health data by racial/ethnic group. Since women of color only represent 20% of all women in Colorado, looking at summary data for the total population masks many differences among sub-populations. Attention should be paid to these differences to effectively address health disparities in Colorado. Data can be used to gain a fuller understanding of the overall picture of health among various racial/ethnic groups of women.
The Institute of Medicine’s report Unequal Treatment: Understanding Racial and Ethnic Disparities in Health Care report argues for a comprehensive, multi-level strategy to eliminate health care disparities, addressing health care systems, the legal and regulatory contexts in which they operate, health care providers, and their patients. The report concludes that a significant barrier to eliminating health care disparities is a lack of awareness of the problem on the part of key stakeholders. Therefore, an important first step is to raise awareness of the health care gap among broad sectors, including health care providers, their patients, payors, health plan purchasers, and society at large.
Ways to Reduce Health Disparities Among Colorado Women
The issue of eliminating health disparities has been addressed by a number of reports. The following is a summary of some key strategies and recommendations to reduce disparities put forth by various national and state organizations.
Additional work is needed to adapt these recommendations to specifically address disparities among women. Strategies to influence health disparities among women must take into account the multiple roles of women (parent, worker, head of family, caretaker to other family members, etc.), and the tendency of many women to place their needs after those of others. In addition, factors such as trust and cultural beliefs regarding health must also be addressed. Opportunities exist for researchers and practitioners to uncover what strategies are most effective in reducing health disparities among women.
• Educate yourself, educate others, and take action within your own work environment.
Awareness, Leadership, and Advocacy
• Raise the awareness among and educate the public, health care providers, and policy makers of the existence, impact, causes of, and solutions to health disparities among women.
• Investigate and address the root social causes of health disparities and take a comprehensive, systematic approach to the elimination of factors such as poverty that influence health disparities.
• Leadership is critical in advocating for needed changes. It is especially effective when it comes from affected communities or organizations that represent affected communities.
• Secure financing and use regulatory, legal, and policy strategies as needed to reduce health disparities in Colorado.
Access to Services and Health Care
• Ensure that women have access to culturally and linguistically appropriate information and services, including how to promote and maintain health; how to access needed health care; and how to strengthen their ability to participate in health care decision-making
• Address health disparities and access to care issues for mental health, substance abuse, oral health, and other services integral to wellness.
Engage in Data Collection and Research
• Support the collection, analysis, reporting, and monitoring of data to identify groups of women at-risk for or experiencing health disparities. Use the information to identify women and communities who are most vulnerable for health disparities and target interventions to reduce their risk for poor health. Monitor and evaluate progress made to reduce health disparities.
• Engage in research to better understand the causes of health disparities; design and implement evidence-based initiatives to eliminate these disparities.
Health Systems Interventions
The Institute of Medicine has identified several steps to equalize and promote high quality care for all patients which include
• Base decisions about resource allocation on published clinical guidelines;
• Take steps to improve access to care-including the provision of interpretation and translation services, where community need exists;
• To the extent possible, equalize access to the same health care products and services, to avoid fragmentation of health plans;
• Insure that physician financial incentives do not disproportionately burden or restrict minority patients’ access to care;
• Support the use of community health workers and multidisciplinary treatment and preventive care teams; and
• Collect and monitor data on patients’ access and utilization of health care services by race, ethnicity, and primary language.
Education and Training
• Support efforts to recruit and train a diverse health care workforce. Increase the proportion of underrepresented racial and ethnic minorities among health professionals.
• Integrate cross-cultural curricula into the training of future health care providers.
• Provide health care professionals with the information and tools they need to understand and manage the cultural and linguistic diversity of patients. Assure that practical, case-based, rigorously evaluated training exists through continuing education programs.
• Increase the cultural competence of the health care workforce through training and the development of policies that support cultural competency.
How to Make a Difference in Colorado Resources for Action
The elimination of health disparities in general, and specifically among Colorado women, is possible. Many national and state resources exist that provide useful information, resources, and tools. You are encouraged to inform yourself, inform others, and take action to eliminate health disparities among Colorado women.
Statewide resources include the new Colorado Department of Public Health and Environment’s Office of Health Disparities (formerly the Colorado Turning Point Initiative) (http://www.cdphe.state.co.us/tpi/index.htm), and the Colorado Minority Health Forum (http://www.coloradominorityhealthforum.org). Some national resources are the National Center for Cultural Competence at Georgetown University (http://gucchd.georgetown.edu/nccc), the National Women’s Health Information Center (http://www.4woman.gov/minority/index.htm), and the Kaiser Family Foundation (http://www.kff.org/minorityhealth).
Colorado Department of Public Health and Environment, Health Statistics Section, Colorado Vital Statistics 2002.
Hunsaker, J.A., et al. Turning Point Initiative: Colorado’s Public Health Improvement Plan, Colorado Department of
Public Health and Environment, (Denver, CO.: August 2001). Available online: www.cdphe.state.co.us/tpi.
Institute of Medicine, Unequal Treatment: Understanding Racial and Ethnic Disparities in Health Care
Kaiser Family Foundation, Health Care & the 2004 Elections: Race, Ethnicity and Health Care, October, 2004.
Kaiser Family Foundation, Disparities in Maternal & Infant Health: Are we making progress? Lessons from California,
Kaiser Family Foundation, Racial and Ethnic Disparities in Women’s Health Coverage and Access to Care: Findings
from the 2001 Kaiser Women’s Health Survey, March 2004.
Kent, H.M., Health Colorado Women: Steps to Success. November, 2003.
U.S. Department of Health and Human Services. Health People 2010: Understanding and Improving Health.