Luce Faculty Seminar 2002

 

Luce Faculty Seminar 2002

Luce Faculty Seminar 2002 (Info)

Health Disparities in the U.S.A.

Welcome
Mario Incayawar, M.D., M.Sc.
Henry R. Luce Professor in Brain, Mind and Medicine: Cross-Cultural Perspectives
Pitzer, Claremont McKenna, Harvey Mudd Colleges.

Opening Address
Alan Jones
Vice President and Dean of Faculty
Pitzer College

First Session
March 15

Introducer
Cristina Leal, CMC Student

Second Session
April 12

Introducer
Siobhan Acosta, Pitzer Student

Determinants of Cancer Mortality and Cancer Survival Among American Indians and Alaska Natives
Nathaniel Cobb, M.D.

Barriers to Health Care Access for Latino Children
Glenn Flores, M.D.

Language Barriers - Who's at Risk Patient or Provider?
Yolanda Partida, M.S.W., D.P.A.

Patterns of Cardiovascular Morbidity and Mortality among African Americans and Latinos.
Sean O. Henderson, M.D.

Racial Profiling and the Treatment of Pain
Knox H. Todd, M.D., M.P.H.

Economic Benefits to Society Resulting from Elimination of Health Disparities
Robert H. Topel, Ph.D.

Moderator:
Prof. Frederick H. Lynch
Department of Government
Claremont McKenna College

Moderator:
Prof. Ann Stromberg
Peter and Gloria Gold Professor of Sociology
Pitzer College

Location
First Session: Pickford Auditorium,
Bauer Center, Claremont McKenna College, 500 Ninth Street, Claremont.

Second Session: Hampton Banquet Room, Malott Commons, Scripps College, Ninth Street and Colombia Avenue, Claremont.

Time
10:00 AM to 12:30 PM

Lunch-discussion
First Session: McConnell Living Room, Pitzer.

Second Session: Hampton Living Room, Malott Commons, Scripps College

Driving Directions and Maps

Pickford Auditorium, Bauer Center, Claremont McKenna College
Directions & Campus Map

Hampton Banquet Room, Malott Commons, Scripps College
Directions & Campus Map

McConnell Living Room, McConnell Center, Pitzer College
Directions
& Campus Map

NOTICE
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
A breakthrough report by the Institute of Medicine presents evidence that ethnic groups
 in the United States tend to receive lower-quality health care.

 

 

 

Nathaniel Cobb, M.D.

Determinants of Cancer Mortality and Cancer Survival among American Indians and Alaska Natives

Friday, March 15

American Indian and Alaska Natives (AI/AN) represent one of the most vulnerable populations in the United States, with heavier burdens of many disease categories (diabetes, injury, alcohol related deaths, tuberculosis, suicide, etc.) and more unfavorable measures of health and economic status (infant mortality rate, life expectancy, poverty rate) than all other ethnic groups in the US. Once considered very rare among AI/AN, cancer is now their second leading cause of death. There is a remarkable variation of cancer rates among tribes, which may be caused by genetic, environmental, or behavioral differences. Although overall rates of cancer among AI/AN are still lower than the US all-races rates, 5-year survival from cancer is much worse than other groups. In this presentation I will describe geographic patterns of cancer mortality among AI/AN and advance hypotheses to explain the variability. I will also present results of research that attempts to explain the disparity in cancer survival rates through analysis of various characteristics of the patient (age, distance from hospital, frequency of visits, other conditions) and the health care system (missed opportunities, referral patterns, screening).

Dr. Cobb received his undergraduate degree from Fort Lewis College in Durango, Colorado and his M.D. from Harvard Medical School. He trained in Family Practice at the University of New Mexico, and after practicing with Indian Health Service for several years, he completed the two year Epidemic Intelligence Service fellowship at the Centers for Disease Control and Prevention in Atlanta. Dr. Cobb also completed the academic portion of the Cancer Prevention and Control fellowship at the National Cancer Institute.

Dr. Cobb is currently Director of the Chronic Disease Epidemiology Section of the Indian Health Service National Epidemiology Program, Chief Medical Officer for IHS National Programs, and Director of the IHS Cancer Prevention and Control Program. In addition to his IHS duties, he teaches at the University of New Mexico MPH program and maintains a part-time clinical practice in Emergency Medicine. He also races bicycles and tries to stay ahead of two teenage sons.

References:

Patterns of Cancer Mortality among Native Americans. Cancer 1998;83:2377-83.  MEDLINE

 

 

 

 

Yolanda Partida, M.S.W., D.P.A.

Language Barriers - Who's at Risk Patient or Provider?

Friday, March 15

A growing body of research on health disparities between ethnic groups is making increasingly clear the case that being a member of a minority group in the United States, in and of itself, can be a barrier to health care. And though socioeconomic status and ethnicity are only two elements in the larger picture of access to care, statistically they have shown to be critically important. The inability to speak English, in particular, has been empirically associated with less care-seeking and diminished access.

In her presentation, Dr. Yolanda Partida will address the issue of language barriers in health care and will ask the question: who is at risk—patient or provider? She will then introduce a new national program, the Robert Wood Johnson Foundation called Hablamos Juntos, or We Speak Together. The program, housed at the Tomás Rivera Policy Institute at Pitzer College, will aim to improve communication between health care providers and their patients with limited English proficiency through the use of 10 test sites around the U.S. over the course of four years.

Dr. Partida is the director of the National Hablamos Juntos Program, and Health Policy Director of the Tomás Rivera Policy Institute.  She has extensive experience in public/teaching and private hospital administration, as well as public policy and public health administration, and is the founder and Executive Director for The Partida Group, a Latina-owned, health policy, research and management consulting firm specializing in diverse populations.

While working as Assistant Hospital Administrator for Valley Medical Center, a public hospital, Dr. Partida worked with a local community college to develop a hospital-based Interpreter Training Program. This program worked to define the role of the interpreter and improve interpreter competency. Dr. Partida and program staff learned that the process of establishing interpreter programs within existing health care organizations can illuminate culturally insensitive organizational practices. The existence of such practices highlights the importance of training staff on how to use interpreters.  In addition to her current work with Hablamos Juntos, Dr. Partida is also working with an Institute of Medicine committee to study effective health communication and behavior change strategies for diverse populations. The overall goal of this study is to develop recommendations that will increase the efficacy of public health communication and behavior change interventions targeted toward culturally and demographically divergent populations.

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KNOX H. TODD, M.D., M.P.H.

Racial Profiling and the Treatment of Pain

Friday, March 15

When considering issues involving pain management in the cross-cultural setting, ethnic disparities are likely to be magnified for a number of reasons. Healthcare providers often view pain as only a clue to underlying pathology, rather than as an entity deserving of treatment in and of itself. The degree to which the amelioration of pain is felt to be important is likely to be greater for those patients that the provider identifies with more closely, usually the ethnic majority group. statement and interpretation of the pain experience are also affected by the health professional’s and patient’s understanding of the underlying meaning of pain. This meaning and the behaviors associated with pain-related behavior are inextricably tied to cultural norms and perceptions and may be more difficult to communicate when the health professional’s and patient’s ethnicities are discordant. Also, ethnic stereotypes may impair the ability of healthcare providers to assess pain in a valid fashion. 

In his presentation, Dr. Todd will examine evidence of ethnic disparities in pain management and suggest approaches to better understand and eliminate these inequalities. He will review studies from the emergency department setting, oncology clinics, and the post-operative setting and examine potential mechanisms that result in pain treatment disparities.

Dr. Todd received his MD from the University of Texas Southwestern Medical Center and is board-certified in internal medicine and emergency medicine. He received his MPH in epidemiology from the UCLA School of Public Health in 1993 and currently holds the titles of Visiting Associate Professor in the Rollins School of Public Health of Emory University in Atlanta and as Medical Fellow to the National Highway Traffic Safety Administration in Washington, DC.

Dr. Todd’s research interests include pain management, injury control, clinical informatics, and health services research. He has conducted seminal studies of ethnic disparities in analgesic use in the emergency department setting. His publications have appeared in the New England Journal of Medicine, JAMA, Annals of Emergency Medicine, Academic Emergency Medicine, Academic Medicine, American Journal of Medical Sciences, American Journal of Medicine, Journal of Emergency Medicine, and Prehospital and Disaster Medicine. He has received numerous grants and contracts from public and private sources, including the Agency for Healthcare Research and Quality, the National Highway Traffic and Safety Administration, the CDC’s National Center for Injury Prevention and Control, the Electric Power Research Institute, and the State of Georgia.

References:

Bonham VL. Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to the Disparities in Pain Treatment. Journal of Law, Medicine & Ethics, 29(2001): 52-68.  MEDLINE

 

 

 

 

GLENN FLORES, M.D.

Barriers to Health Care Access for Latino Children

Friday, April 12

Latinos will soon be the largest minority group in the United States, but too little is known about major access barriers to health care for this community and whether these barriers result in adverse consequences.  In his cross-sectional survey of 203 parents of children coming to a pediatric Latino clinic, Dr. Flores found that parents identified language problems, cultural differences, poverty, lack of health insurance, transportation difficulties, and long waiting times as the major access barriers to health care for their children.  According to Dr. Flores, language problems can result in adverse health consequences for some children, including poor medical care, misdiagnosis, and inappropriate medication and hospitalization.

Dr. Flores is Associate Professor of Pediatrics and Public Health at the Boston University Schools of Medicine and Public Health. He founded and is the Director of the Pediatric Latino Clinic at Boston Medical Center. He is a former Robert Wood Johnson Minority Medical Faculty Scholar and is currently a Robert Wood Johnson Generalist Physician Faculty Scholar. He has published over 35 articles and book chapters on a variety of topics, including access barriers to health care for Latino children, the impact of ethnicity, family income, and parental education on children's health and use of health services, cultural competency in health care, and how a pediatric Latino clinic can serve as a national model for providing health care to an under-served population. He is a consultant on cultural and linguistic issues for the Center for Mass Health Evaluation and Research at the University of Massachusetts School of Medicine.  Dr. Flores's current research includes an investigation of medical interpreter errors and their clinical consequences (funded by the Office of Minority Health), and a randomized trial of case management to insure uninsured Latino children (funded by AHRQ, CMS, and the Robert Wood Johnson Foundation).

References:

Flores G, Abreu M, Olivar MA, Kastner B. Access Barriers to health Care for Latino Children. Archives of Pediatrics and Adolescent Medicine 1998:152:1119-1125. MEDLINE

 

 

 

 

Sean O. Henderson, M.D.

Patterns of Cardiovascular Morbidity and Mortality among African Americans and Latinos.

Friday, April 12

Racism is not solely a psychological phenomenon but rather is described as underpinning a whole variety of factors related to health care. These include differences in socioeconomic position, health related behavior, the experience of medical care, and the ability to take action to maintain and improve health. Given the similarity in median incomes and percentage of the population below the poverty line, Latinos would be expected to experience similar racial stresses as well as the added burden of very real language and cultural barriers to health care. The ability of African American populations to access care or their ability to afford such care have also been issues raised as contributors to their increased mortality.

Latinos share these same obstacles and, in fact, given that more dramatic language and cultural differences exist, are even slower to access care than many other minority groups. Despite the fact that both groups appear to have similar socioeconomic profiles and at least somewhat similar access to health care, the relative burden of cardiovascular disease is borne primarily by the African Americans. After adjustment for the potential risk modifiers such as age and lifestyle (e.g. smoking, body-mass index) and presence of hypertension, African Americans in Los Angeles remain with an adjusted relative risk of cardiovascular mortality higher than Latinos, an excess not immediately attributable to any known modifiers. It suggests therefore, that even though several environmental risk factors, such as obesity and cigarette smoking, are well established, hypertension results from an interaction between environmental and genetic influences.

References:

Henderson SO, Coetzee GA, Ross RK, Yu MC, Henderson BE. A Possible Association Between ACE Genotype and Elevated Mortality Rates from Circulatory Disease in African-American Men and Women of Los Angeles County, California. The American Journal of Medical Sciences 2000;320:18-23.

Henderson SO, Magana RN, Korn CS, Genna T, Bretsky PM. Delayed Presentation for Care during Acute Myocardial Infarction in a Hispanic Population of Los Angeles County. Ethnicity and Disease 2002;12:38-44.

 

 

 

 

Robert H. Topel, Ph.D.

Economic Benefits to Society Resulting from Elimination of Health Disparities

Friday, April 12

Robert H. Topel is the Isidore Brown and Gladys J. Brown Professor in Urban and Labor Economics at the University of Chicago Graduate School of Business. He has been a member of the Chicago faculty since 1986. He received a B.A. in economics (with high honors) from the University of California at Santa Barbara in 1974 and a Ph.D. in economics from the University of California at Los Angeles in 1980.

Professor Topel is the recipient of numerous awards and fellowships. Currently, he is a Faculty Research Fellow at the National Bureau of Economic Research and an Editor at the Journal of Political Economy. He is the author or co-author of some 50 published articles and other publications. His most recent research has focused on the economic value of medical research and issues in labor markets and economic growth.

Professor Topel lives in the Chicago area with his wife and two daughters.

 

 

 

 

Home Up