Exam 1 - health disparities Flashcards

Question

racial prejudice

Answer 1

Negative beliefs, attitudes, or assumptions held about individuals or groups based on their race Rooted in ideology and reflects the collective biases and misunderstandings that are perpetuated in societies. ▪ Involves stigma which can be a major source of stress for individuals in racially stigmatized groups and has negative consequences Prejudice can occur based on race, sex, disability, and other stigmatized social statuses

Answer 2

Actions or behaviors that unfairly target individuals based on their race. ▪ Also defined as “differential treatment on the basis of race that disadvantages a racial group” (National Research Council, 2004) ▪ Applies to differential treatment based on sex, sexual orientation, gender identity, and other factors. Negatively impacts health ▪ Does not have to be personally recognized nor intentional to have an impact. ▪ Institutionalized forms (e.g., housing discrimination or unequal treatment in healthcare ) also have impacts.

Answer 3

A social system rooted in racial ideologies that maintains unequal distribution of and access to power and societal resources. ▪ Viewed as a fundamental cause of health inequities among racial groups. Exemplified by historical traumas that have intergenerational effects on health. o African American enslavement o Colonization of Native Americans o Internment of Japanese Americans during WWII o Marginalization and criminalization of undocumented immigrants ▪ Can manifest in various ways: * Racial residential segregation * Environmental injustice * Political disenfranchisement * Mass incarceration * Immigration policies

Answer 4

Discriminatory policies and practices within institutions such as healthcare, education, and housing. ▪ Often described interchangeably with structural racism which deals with how stratified social systems result in differential opportunities and distributions of societal resources by race

Answer 5

When members of stigmatized races accept negative stereotypes that have been perpetuated about their individual or group abilities and self-worth. ▪ Negatively impacts persons who internalize stereotypes of racial inferiority. o Negative self-concepts o Depression o Psychological distress 14

Answer 6

a cultural system that propagates false notions of superior culture. ▪ Results in unconscious bias

Answer 7

internalized perceptions about group inferiority that are subconsciously acted upon. ▪ Can have detrimental effects on stigmatized groups, particularly in healthcare o Poor patient-provider communication o Biased treatment recommendations ▪ Related to aversive racism: subtle biases in social interactions and decision- making o Observed among even well-intentioned individuals o Contributes to disparities

Answer 8

Race is a social construct. ▪ Groups are categorized based on ideologies of superiority and inferiority that are relative to phenotype, group affiliation, and socially ascribed characteristics. ▪ Race is not “real” in the biogenetic sense. o No genes exclusively or consistently map onto “Black” or “White” races. o The complex system of racism exemplifies the materialization of this fictitious notion.

Answer 9

▪ Racism is a fundamental cause of health disparities. ▪ It operates through multiple pathways: o Stress o Racial residential segregation o Immigration policy o Healthcare access ▪ Associated with poor mental and physical health among racial/ethnic groups

Answer 10

Diabetes, hypertension, and cardiovascular disease(CVD) disproportionately affect African Americans. ▪ Other conditions: Kidney disease, cancer. ▪ Mental health disorders and obesity associated with self- reported racism. ▪ Smoking and alcohol use linked with perceived racial discrimination. ▪ Most studies of racism and health have examined African American populations.

Answer 11

Usually categorized as “White”. ▪ Often marginalized as “foreign” regardless of nativity or immigration status. ▪ High prevalence of perceived racial/ethnic discrimination based on race, ethnicity, and language. ▪ Negative impact on health as a result: o High blood pressure o Increasing BMI o Smoking ▪ Common conditions- Diabetes, CVD, Cancer, Asthma, Obesity, Mental health disorders. 19

Answer 12

Positive association between perceived discrimination and a number of chronic health conditions. o Cardiovascular disease o Respiratory disease o Cancer o Chronic Pain ▪ Mental disorder 3× more likely among those that report experiences with discrimination. o Depression o Anxiety

Answer 13

increased risk of experiencing racial hostility. ▪ Also formally classified as “White”. ▪ Perceived religious or ethnic discrimination associated with higher levels of psychological distress and poor health status. o e.g., Increased low birth rate and preterm birth reported among some women with Arab surnames 6-months after 9/11. o Physical and psychological trauma due to hate crimes. o Cardiovascular disease, Respiratory disease, Mental health disorders.

Answer 14

History of experienced racial inequities. ▪ Social disadvantage and psychological trauma have influenced health outcomes and behaviors. o Alcohol and drug use o Smoking o Cardiovascular disease (especially high blood pressure) o Diabetes and other chronic diseases

Answer 15

Stress is a major mechanism through which racism harms health. ▪ Racism is a chronic stressor and can cause biological dysfunction and health deterioration over a lifetime (allostatic load). o Dysfunction of stress pathways in the body- HPA axis o Increase in cellular aging and chronic disease risk ▪ Stress-induced unhealthy behaviors are potential pathways to racism through which racism can influence health outcomes. ▪ Internalized racism linked with poor health outcomes. ▪ Racism is not merely a life event, but a total lived experience.

Answer 16

Racial residential segregation refers to the relative concentration and geographic separation of racial groups in residential areas. ▪ Influences the built environment (supermarkets, parks, safety, etc.) ▪ Food desserts, Food swamps ▪ Dictates the quality of schools and employment opportunities. ▪ Increased exposure to environmental toxins and lack structural supports for health-promoting activities

Answer 17

Immigration policy can be conceptualized as structural racism to the extent that it negatively targets and disadvantages racialized groups. ▪ The marginalization and exclusion of immigrant groups as a result of immigration policy constricts opportunities for immigrant groups, in turn creating health inequities. ▪ restricted access to safety nets such as Medicaid, housing and education subsidies, and other public support programs.

Answer 18

Differences in the access to, and quality of, care for racial and ethnic minorities that are associated with poorer health outcomes. ▪ Implicit bias and perceived racism are associated with: ▪ less patient-centered communication ▪ patient mistrust of the healthcare system ▪ delayed entry into care ▪ lower adherence to prescribed treatment

Answer 19

Socio-ecological Approach - Socio-Ecological Model (SEM) recognizes the need for engagement at all levels. ▪ This model provided a broad platform for addressing social determinants of health associated with racial disparities. Intersectional approach ▪ REACH program Racial and Ethnic Approaches to Community Health (REACH) ▪ Comprised of public health, community, academic, and other institutional partners, developed and implemented interventions with a focus on “undoing” racism at the individual, institutional, and systems levels. ▪ REACH adopted principles of the People’s Institute for Survival and Beyond (PISAB) ▪ To undo Racism: understand what it is, where it comes from, how it functions, and why it is perpetuated Community-based/Community-engaged research ▪ CBPA/CE principles Community-based participatory approaches (CBPA) fall on the spectrum of CE (Community Engagement) and necessitate CE throughout the process. ▪ Engaging community-based organizations, faith-based organizations, and other institutions within the community in creating culturally specific interventions. ▪ Garner community buy-in and provide education through Community Outreach events.

Answer 20

The frameworks, models, and theories that have been developed are integral to understanding the field of health equity. ▪ The major concepts that will be discussed are the following: ❑ Social Determinants of Health ❑ Intersectionality Theory ❑ Minority Stress Theory ❑ Maslow’s Hierarchy of Needs ❑ Social Ecological Model ▪ These models do not compete with each other, nonetheless, they each help to explain a different dimension of health equity.

Answer 21

The conditions in which people are born, grow, live, work, and age” (WHO, 2019). ▪ Helps with understanding the ways in which a person’s context and lived experiences shape their health and influence their health decisions and actions. ▪ A major component regarding the origins of health disparities lies in the sociocultural context individuals find themselves. ▪ The term was not used in the health equity field until the 1990s and took decades for it to come to the forefront of research

Answer 22

Developed by Healthy People 2020 and consists of five key areas: ❑ Economic Stability ❑ Education ❑ Social and Community Context ❑ Health and Healthcare ❑ Neighborhood and Built Environment ▪ Healthy People 2020 also identified key underlying issues that make up each category. ▪ The SDOH framework provides the means to analyze the impact of factors such as discrimination and the role in which they play in health disparities. Avoid the temptation to conclude that variations in the socioeconomic aspects of the social determinants of health are the entire source of disparities. ▪ For example: Differences in education attainment among racial/ethnic groups do not explain differences in employment rates The role that social determinants play in health disparities and health equity should not be overlooked or oversimplified.

Answer 23

Term traces its roots to 1989 article by Kimberlé Crenshaw : “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Policies”. ➢ Used in the context of the lived experiences of African American women in terms of oppressions associated with their gender and their race. ➢ Crenshaw argues that in order to truly understand injustice, one cannot ignore the presence of either identity. ➢ Article led to looking at not only gender and race but all dimensions of an individual’s identity (sexual orientation, gender identity, geographic origin, etc.) when addressing health disparities and inequities Focuses on how the multiple identities within an individual combine in ways that can have a profound impact on health. ▪ One of the most important guiding principles in the field of health equity because of its ability to incorporate an individual’s multiple identities in a way traditional disparities work did not. ▪ Solutions that examine the overlap of these identities have the greatest chance at success, scalability, and acceptability. ➢ Intersectionality is critical when discussing groups impacted by health disparities because everyone is made of multiple identities.

Answer 24

Initially developed to describe how the oppressive experiences of LGBTQ+ individuals contribute to increased levels of engagement in health-risk behaviors. ➢ Critical in understanding LGBTQ+ health because it helped refocus intervention targets away from LGBTQ+ individuals and more on the social reasons for the risky behaviors. ➢ Also used as a model for minority oppression in other groups (racial/ethnic minorities) due to its flexibility to multiple identities, and its focus on the process through which individuals experience oppression Minority stress is a created, nonessential stress that presents a unique opportunity for intervention and a larger social justice focus. ➢ Stressors experienced by LGBTQ+ individuals (and by extension, other minority groups) have three aspects that uniquely drive health risks: ❑ These stressors are unique. o Minority stress focuses on experiences that are specific to the minority group. ▪ Prejudice ▪ Microaggressions ▪ Identity rejection ▪ Internalized homophobia ▪ Hate-based victimization ❑ Minority stress is chronic because it is integrated into the very fabric of society. ❑ Minority stress is derived from social origins

Answer 25

Holds that degree of motivation for a certain behavior is driven by the level of needs that person has already met. ▪ Can be used to understand the ways in which people make decisions about their health- related behaviors. ➢There are five levels of needs ❑ Physiological ❑ Safety ❑ Love and belonging ❑ Esteem ❑ Self-actualization ▪ Until a more basic level of needs is met, an individual will not be motivated to engage in activities related to a higher level of need. Relevance to health equity is in its ability to explain how sociocultural disadvantage prevents individuals from pursuing certain health-related behaviors and from achieving their full potential in society. ➢Also overlaps with the SDOH framework because it explains why the continued threat of losing access to basic needs has such a systemic impact on an individual.

Answer 26

Focuses on the ways in which an individual’s own beliefs and behaviors interact with and are influenced by their broader social, geographic, and cultural context. ▪ Used to describe the ways in which health disparities are created and sustained. ▪ Also used to develop multilevel interventions to address the inherently complex nature of solutions. There are four levels of complex systems that affect the individual ❑ Individual Level: traits of the person that influence their behaviors ▪ Knowledge ▪ Attitudes ▪ Beliefs ❑ Interpersonal (Microsystem) Level: made of the interactions of individuals ▪ Influence of family/friends ❑ Community (Mesosystem) Level: connects different microsystems together ▪ Schools ▪ Churches ▪ Organized sports ▪ Social clubs ❑ Organizational (Exosystem) Level: factors that influence collections of mesosystems ▪ Local politics ▪ Major regional employers ❑ Environment (Macrosystem) Level: comprised of factors that affect the system in which everyone operates ▪ Cultural values ▪ Norms ▪ Laws ▪ Policies

Answer 27

Health equity research is relatively new. ➢ Various methodologies have been developed or adapted specifically for health equity work. ❑ Community-based participatory research (CBPR) ❑ Mixed-methods research ❑ Collective impact ❑ Multilevel interventions ➢These approaches provide health equity practitioners and researchers the tools to develop and implement strategies to understand and achieve equity. Health Equity Research Health Equity Promotion Work

Answer 28

he gold standard for engaging communities impacted by health disparities in impactful research. ❑ Involves partnering with communities affected by disparities and engaging them in the research process. ❑ The voice of the community is the driving force. ❑ Helps form sustainable community partnerships by promoting collaboration in the development of innovative solutions that have positive impacts on the community. ❑ To be successful- Bidirectional relationship between community and academic institution. “nothing about us, without us Three components are essential for understanding the concept of CBPR: ❑ Action research ❑ Participatory research ❑ Community partnerships ➢Traditional research has been investigator-driven, devoid of all three concepts.

Answer 29

Developing solutions that directly address the problem at hand. o E.g., What are the removable barriers to the outcome of interest and what happens when they are removed? ❑ Directly connected to changing the concept under investigation.

Answer 30

Ensures that impacted individuals play an active role in shaping the project. ❑ What are the impacted individuals saying about ways in which the problem can be addressed? o E.g., What do breast cancer survivors identify as ways to decrease depression in women post-mastectomy, and how would they design an intervention to do so?

Answer 31

Combines the action and participatory components of CBPR. ❑ Depends on the notion that those who are impacted by the outcome of interest will in turn impact the outcome. ❑ How can we establish a breast cancer survivor research network to develop and implement prevention strategies? ❑ Looks at how community research networks can be established to develop and implement intervention strategies.

Answer 32

Encourages community involvement. ❑ Community placed oPhysically moving the research to the impacted community oGoing to the community rather than have the community come to you ❑ Involves actively engaging the impacted community in the design, conduct, interpretation, or dissemination of research findings. ❑ Empowers individuals to be agents of change. ❑ E.g., new substance abuse prevention program in the community.

Answer 33

❑ Step 1: Form partnerships ❑ Step 2: Assess the community’s strengths and dynamics ❑ Step 3: Identify priority health concerns and associated research questions ❑ Step 4: Design and conduct epidemiologic, intervention, and/or policy-related research ❑ Step 5: Feed results back to all partners and collaboratively interpret research findings ❑ Step 6: Disseminate and translate the research findings to a broader audience

Answer 34

Has existed for decades. ➢ Closely tied to the field of behavioral intervention development. ➢ Well suited for health equity studies. ❑ Data gathered in a study can be diversified. ❑ Multiple sources of data can be triangulated. qualitative research - data collected through unstructured open ended tex and verbal responses - 1-1 interviews, focus groups, surveys quantitative research - data collected through structured and controlled instruments like surveys or experiments

Answer 35

Involves collecting and analyzing data, integrating the findings, and drawing inferences using both qualitative and quantitative approaches in a single study or a program of inquiry. ❑ Provides the opportunity to simultaneously examine research questions that are both participatory and preplanned. ❑ Also provides the chance to draw insider vs. outsider perspectives (Emic vs. Etic). What do you need to know about this? ❑ Multiple data sources: Surveys & Interview. ❑ You must integrate the findings of both data sources for true mixed methods research. ❑ In this example, we used what we learned in the surveys to inform the questions we ask in the interview, and then we use the data from both to make conclusions. The core of mixed methodology’s power in health equity research is the ability to integrate insider and outsider perspectives while combining participatory and preplanned research questions. ❑ Use of a qualitative component has several implications for health equity research. o Individuals impacted by the outcome of interest can have their voices heard. o Promotes inclusivity through the incorporation of the different perspectives presented by the impacted community

Answer 36

When a group of important actors from different sectors commit to a common agenda for solving a specific social problem. ❑ Supports the implementation of the large social change initiatives that are necessary for achieving health equity. ❑ Enables organizations to not only coordinate the overall impact of what they seek to accomplish, but also enhance and expand on the work of their collaborators. Collective impact is guided by five key principles ❑ Common agenda - x shared vision; conducts collaborative strategic plan to develop mutually-endorsed action plan ❑ Shared measurement - ground for how success will be measured ❑ Mutually reinforcing activities - Cohesive plan that builds intersections and synergy across agencies ❑ Continuous communication - Full transparency and openness, trust, and buy-in are continually reinforced ❑ Backbone support- dedicated staff coordinates collective efforts he overall process consists of three phases ❑ Initiate action: ▪ Kick off steering committee and begin community outreach ▪ Create baseline landscape and data mapping ▪ Secondary research on other collaboratives ❑ Organize for impact: ▪ Create a common agenda and develop a high-level goal ▪ Solicit and incorporate community perspective/voice ❑ Sustain action and impact: ▪ Begin implementing strategies and measuring indicators ▪ Continue ongoing activities to share initiative progress and gain community input

Exam 1 - health disparities Flashcards

(60 cards)