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Health Disparities in a “Browning” and “Graying” America: Implications and Challenges

Health Disparities in a “Browning” and “Graying” America: Implications and Challenges.

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Health Disparities in a “Browning” and “Graying” America: Implications and Challenges

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  1. Health Disparities in a “Browning” and “Graying” America: Implications and Challenges James H. Johnson, Jr.William Rand Kenan, Jr. Distinguished Professor of ManagementKenan-Flagler Business SchoolDirector, Urban Investment Strategies CenterFrank Hawkins Kenan Institute of Private EnterpriseUniversity of North Carolina at Chapel Hill

  2. Overview • Health Disparities in North Carolina and Beyond • Drivers of Change • Challenges Ahead • Implications for Health and Competitiveness of our State and Nation

  3. Lower Socioeconomic Status Associated With Fewer: • Pap smear tests • Mammograms • Childhood and influenza immunizations • Diabetic eye exams Source: Fiscell, et al., 2000

  4. Lower Socioeconomic Status Also Associated With: • Lower overall health care use • Later enrollment in prenatal care • Lower quality ambulatory and hospital care Source: Fiscell, et al., 2000

  5. Race/Ethnic Group Status • Less intensive/lower quality care • Less often seen by specialists • Less appropriate preventive care Source: Fiscell, et al., 2000

  6. Blacks receive fewer… • Cardiovascular procedures • Lung resections for cancer • Kidney and bone marrow transplants • Cesarean Sections • Peripheral Vascular procedures • Orthopedic procedures Source: Fiscell, et al., 2000

  7. Blacks are also less likely to receive… • Aggressive treatment of prostate cancer • Antiretrovirals for HIV infection • Anti-depressants for depression • Tympanostomy tubes • Hospital Admissions for chest pain • Quality Prenatal Care Source: Fiscell, et al., 2000

  8. Elderly Blacks less likely to receive… • Appropriate preventive care mammograms and flu-vaccinations • Quality hospital care • Expensive, technological procedures Source: Fiscell, et al., 2000

  9. Latinas receive fewer… • Mammograms • Pap smear tests • Influenza vaccinations • Cardiovascular procedures Source: Fiscell, et al., 2000

  10. Latinas also receive less… • Prenatal care • Analgesia for metastatic cancer and treatment Source: Fiscell, et al., 2000

  11. Asians receives fewer… • Pap smear tests • Influenza vaccinations Source: Fiscell, et al., 2000

  12. Native Americans receive less… • Prenatal care Source: Fiscell, et al., 2000

  13. Socioeconomic Status and Race/Ethnicity Associated with Potentially Avoidable Procedures: • Amputation • Orchrectomies • Treatments of late stage cancer Source: Fiscell, et al., 2000

  14. Socioeconomic Status and Race/Ethnicity also related to avoidable: • Hospitalizations • Hospital Readmissions • Untreated Disease Source: Fiscell, et al., 2000

  15. Factors exacerbating SES and Race/Ethnic Disparities include: • Health care affordability • Transportation and access • Education • Knowledge and literacy • Patient attitudes and preferences • Competing demands • Provider bias Source: Fiscell, et al., 2000

  16. Health Status of North Carolina Adults, 2002-2004 Source: NC Department of Health and Human Services, Office of Minority Health and Disparities (2006)

  17. Percent of North Carolina Adults(18+) Who Are Overweight/Obese, 2002-2004 Source: NC Department of Health and Human Services, Office of Minority Health and Disparities (2006)

  18. Drivers of Change • Rapid growth of foreign born population • Aging of native born population • “First” and “second” waves of globalization

  19. Immigration Population, 1900-2004 Source: Center for Immigration Studies; U.S. Census Bureau, Current Population Survey

  20. States with Fastest Growing Immigrant Populations, 1990-2000 Source: 1990, 2000 U.S. Census

  21. States with Fastest Growing Immigrant Populations, 2000-2005 Source: 2000 U.S. Census, 2005 American Community Survey

  22. States with Fastest Growing Hispanic Populations, 2000-2005 Source: 2000 U.S. Census

  23. Blacks Return to the SouthChange in Population, 1990-2000

  24. Net Population Change in North Carolina by Race and Hispanic or Latino Origin, 1990-2000 Source: U.S. Bureau of the Census, American Fact Finder.

  25. Net Population Change in North Carolina Race and Hispanic or Latino Origin, 2000-2005 Source: US Census Bureau, 2004 American Community Survey; 2000 US Census

  26. Population in North Carolina by Age and Hispanic Origin, 2004

  27. North Carolina Births by Race/Ethnicity, 1990 and 2003 Source: Centers for Disease Control, National Vital Statistics Reports, 1990 and 2003

  28. Net Change in Total and Hispanic Enrollment in NC Public Schools, 1985-2004 Source: North Carolina Department of Public Instruction, 20051 As of September of each school year

  29. Hispanic Resident Costs and Benefits to State, 2004 • Broader Economic Benefits: • $9.2 billion in total NC Business Revenue • 89,000 additional jobs • $1.9 billion in overall statewide private-sector wage savings (1.4% of NC’s private sector wage bill) • Increased labor output for NC industries

  30. Aging America: U.S. Median Age, 1820-2000 Source: U.S. Census Bureau, San Francisco Chronicle

  31. Absolute and Relative Change in the Gender/Age Composition of the U.S. Population, 2000-2005 Source: 2000 U.S. Census; 2005 American Community Survey, PUMS Estimates

  32. Absolute and Relative Change in the Gender/Age Composition of the North Carolina Population, 1990-2000 Source: U.S. Bureau of Census (2000)

  33. Absolute and Relative Change in the Gender/Age Composition of the North Carolina Population, 2000-2005 Source: 2000 U.S. Census; 2004 American Community Survey

  34. Age Profile of UNC-CH Faculty, 2002 Source: Institutional Research - University of North Carolina at Chapel Hill

  35. Population Projections, by Race and Hispanic Origin, 2000-2050, All Ages

  36. Globalization’s Impact on the American Worker Globalization First Wave (1980-present) Second Wave (1990-present) Job Migration Blue Collar White Collar Business Process Outsourcing Knowledge Process Outsourcing Information Technology Manufacturing Near Shore Outsourcing Far Shore Outsourcing Onshore Outsourcing Right Sourcing

  37. Challenges Ahead • Denial of basic services • Racial demography of American communities • “Re”segregation of public schools • Economic plight of American youth • Medical Tourism

  38. Denial of Basic Services • Annexation • Extraterritorial Jurisdiction

  39. Raeford and Silver City N. C. SilverCity City Limits ETJ Raeford, NC CityLimit ETJ

  40. City Limit Micro, Johnston County, N.C. ETJ

  41. Creedmoor Granville County, N.C. Excluded Minority neighborhoods 2000 City Limits 1990 City Limits

  42. Southern Moore County, N.C.

  43. Balloon Annexation N.C. SatelliteAnnexation

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