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Hispanic Health in the United States

Hispanic Health in the United States. Judy Monroe, MD. Deputy Director Centers for Disease Control and Prevention. March 18, 2011. Edward Roybal 1822–1995. CDC is better aligned to address public health priorities…. Excellence in surveillance, epidemiology, and laboratory services

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Hispanic Health in the United States

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  1. Hispanic Health in the United States Judy Monroe, MD Deputy Director Centers for Disease Control and Prevention March 18, 2011

  2. Edward Roybal1822–1995

  3. CDC is better aligned to address public health priorities… • Excellence in surveillance, epidemiology, and laboratory services • Strengthen support for state, tribal, local, and territorial public health • Increase global health impact • Use scientific and program expertise to advance policies that promote health • Better prevent illness, injury, disability, and death

  4. Winnable battles • Each area is a leading cause of illness, injury, disability, and death • Evidence-based, scalable interventions • Our efforts are likely to make a difference • We can get results within 1 to 4 years― but none are easy

  5. Key winnable public health battles for the United States Nutrition, Physical Activity, Obesity and Food Safety Tobacco Healthcare- AssociatedInfections Motor Vehicle Injuries Teen Pregnancy HIV

  6. Tobacco • Tobacco is the leading preventable cause of death • After 40 years of progress, the decrease in adult smoking rates has stalled in the past 6 years • But most people who have ever smoked have already quit, and most of today’s smokers want to quit Progress stalls starting in 2004 Prevalence of current smoking among adults, US, 1997–2009

  7. Nutrition, physical activity, obesity, and food safety Obesity rates, 1960–2008 • Since the 1960s, obesity rates doubled for adults and tripled for children • >36% of adults (>72 million) and 17% of children are obese • Each year, foodborne diseases sicken 1 out of 6 Americans and cause >$9 billion in health care-related costs

  8. Healthcare-associated infections • Inpatient hospital setting • 1 out of 20 patients contracts an HAI • 100,000 patients die/year from an HAI • HAIs costs range between $26–$33 billion/year • Outpatient settings (eg, dialysis, laboratory, long-term care) • Patients can acquire bloodstream infections in these settings At least 1/3 of HAIs are preventable with simple, existing tools

  9. Motor vehicle injuries • Motor vehicle crashes are leading cause of death among Americans ages 5–34 • Despite progress, U.S. rates of death from car crashes are twice rates of other countries and could be reduced by simple, low-cost methods Causes of death among people ages 5–34, U.S., 2007

  10. Rates are far lower and are decreasing much faster in other countries Teen pregnancy 39% 80% 68% 81% 82% 80%

  11. HIV HIV continues to spread despite being preventable Estimated number of new HIV infections by transmission category, U.S.,1977–2006 Source: Hall Irene et al. Estimation of HIV Incidence in the US. JAMA 2008 Aug 6; 300(5): 520-529

  12. The excess medical cost of diseases • Diabetes: +$6,600 • Obesity: +1,430 • Tobacco: +$1,400 is increment of current vs former smoker; $2,400 is increment of current vs never smoker

  13. Smallest Impact Largest Impact Factors that affect health Examples Eat healthy, be physically active Counseling & Education Clinical Interventions Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Long-lasting Protective Interventions Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Changing the Context To make individuals’ default decisions healthier Poverty, education, housing, inequality Socioeconomic Factors

  14. Hispanic population in U.S. increased 29% from 2000 to 2009 Hispanics represent 16% of U.S. population Source: U.S. Census Bureau

  15. The majority of Hispanics living in the U.S. are from Mexico Source: U.S. life tables by Hispanic origin, CDC, October 2010

  16. Hispanics experience lower health status Hispanics have disproportionate health needs compared with other racial or ethnic groups in the U.S.

  17. Inequalities in health status in the U.S. are large, persistent, and increasing…poverty, income and wealth inequality, poor quality of life, racism, sex discrimination, and low socioeconomic conditions are the major risk factors for ill health and health inequalities National Association of County and City Health Officials Health and Social Justice Committee

  18. Hispanics have higher life expectancy than whites or blacks Life expectancy at birth, U.S. 2006 Age in years Source: CDC/NCHS, National Vital Statistics System, 2006

  19. Yet they face many health disparities Disproportionate disease burden linked to • Low education • Language and cultural barriers • Poor access to preventive care and health insurance • High poverty • Unsteady/poor/unsafe working conditions • Precarious social status • Use of unconventional medicine • Cultural views on health

  20. More than twice as many Hispanics as whites live below poverty level Adults ≥18 years who live below federal poverty level Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60

  21. Four times as many Hispanics as whites do not complete high school Adults ≥18 years who did not complete high school Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60

  22. Hispanics adults have the highest rate of uninsured of any group Adults 18–64 without health insurance, U.S., 2008 Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60

  23. Lower-income Hispanic children are twice as likely as whites to be uninsured Percentage of children without health insurance, U.S., 1998–2001 Source: 1998–2001 National Health Interview Surveys

  24. Top 10 leading causes of death for Hispanics, 2007 1.5 1.6 2.5 Source: Health, US, 2009

  25. Puerto Ricans have highest rates of asthma and Mexicans have lowest Asthma prevalence, U.S., 2009 Adults 18–64 without health insurance, U.S., 2008 Source: National Health Statistics Report, Nr 32, January 12, 2011

  26. Hispanic teens engage in high-risk behavior more frequently than whites or blacks • 34% rode in car driven by someone who drank • 15% seriously considered attempting suicide • 8% attempted suicide • 19% smoke • 14% used inhalants • 9% used cocaine in past and 4% use now • 8% used ecstacy in past • 6% used methamphetamines Source: 2009 Youth Risk Behavior Surveillance System

  27. Hispanic Black AI/AN White Asian/Pacific Islander Since 1995, Hispanic girls have hadthe highest birth rate of any group U.S. birth trends by race/ethnicity girls 15–19, 1991–2009 Source: National Center for Health Statistics

  28. Teenage childbearing varies widely among Hispanic groups Birth by race and Hispanic origin for girls < 18, 1980–2007 Percent of live births Source: Health, US, 2010

  29. CDC is working in communities with high teen birth rates • Enhancing community partnerships and improving access to family planning • Promoting evidence-based prevention programs and policies • Working with diverse communities—especially Hispanic and black youth • Grantees are funded, in part, through a collaboration with the HHS Office of Adolescent Health, President’s Teen Pregnancy Prevention Initiative and the Office of Population Affairs, Title X Program.

  30. CDC teen pregnancy prevention grantee activities Hartford, CT, Health and Human Services • Collaborate with CBOs and clinic partners that serve Hispanics in area • Population is 41% Hispanic; 38% black • Implement ¡Cuidate! in English and Spanish • Evidence-based intervention to reduce sexual risk behavior related to HIV infection among Hispanic youth • Increase bilingual communications efforts with targeted teen pregnancy prevention public awareness campaigns • Sponsor parent education

  31. CDC teen pregnancy prevention grantee activities Fund for Public Health in New York • Work in South Bronx, Community District 2 and 3 • Population of 15−19 year old Hispanic youth is 65% • Implement Reducing the Risk in 9th grade through school system South Carolina Campaign to Prevent Teen Pregnancy • Provide training and technical assistance to partner organizations on the ¡Cuidate! curriculum

  32. CDC teen pregnancy prevention grantee activities Massachusetts Alliance on Teen Pregnancy • Collaborate with CBOs and clinical partners that serve Hispanic populations in Springfield/Holyoke • Predominantly minority population (65% black and/or Hispanic) female ages 15−19 • Partner with the YEAH Network • Focus on reducing racial and ethnic health disparities and improving reproductive health for Hispanic youth • Implement ¡Cuidate!

  33. CDC teen pregnancy prevention grantee activities University of Texas Health Science Center,San Antonio • Work in south and southwest portion of Bexar County (San Antonio) • Population is >90% Hispanic • Work with 15 Hispanic youth serving CBOs to implement evidence-based programs • Translate all curricula and information into Spanish

  34. Estimated percentage of new HIV infections by race/ethnicity, 2006 N = 56,300 Source: CDC surveillance data; Hall JAMA 2008

  35. HIV among Hispanics Source: CDC, HIV Surveillance Report,2009 (ww.cdc.gov/hiv/surveillance/resources/reports); Purcell National STD Prevention Conference 2010; National HIV Behavioral Surveillance System, Denning IAS 2010; *40 states with mature HIV reporting, year-end 2008; Diagnoses of HIV infection among Hispanics decreased from 2006−2009 In 2009, the rate was 23 in Hispanic population Hispanics are 3 times more likely to be living with HIV than whites* Hispanics account for 17% of new infections and 18% of people living with HIV

  36. CDC HIV prevention activities for Hispanics • Work with local communities and health care providers to increase HIV testing, early diagnosis, and access to care for Hispanics • Implement routine testing recommendations and expand testing in non-medical settings • Provide training for researchers of minority ethnicities via the Minority HIV/AIDS Research Initiative • Expand access to effective prevention programs to reach a broad spectrum of Hispanic populations

  37. State-specific prevalence of obesity among Hispanic adults, 2006−2008 20−24 30−34 25−29 35+ Source: CDC Behavioral Risk Factor Surveillance System

  38. More than 75% of Hispanic adults have unhealthy weight (38% are overweight and 39% are obese) Source: Flegal K et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303(3): 235-241

  39. Hispanics have high rates of overweight and obesity • Ranged from 21% (Maryland) to 37% (Tennessee) • Adult obesity rates for Hispanics are higher than those for Whites in most states* • Adult obesity rates for Hispanics are ≥30% in 11 states* • Obesity rates for Hispanics high school students are 10% higher than for white students* • 40% of Hispanic mothers and 38% of Hispanic toddlers are overweight or obese** Source: *F as in fat: How obesity threatens America’s future, 2010 ** Racial and ethnic differentials in overweight and obesity Among 3-year-old children, Am J Public Health, Feb 2007;97:298-305

  40. Control prevalence and treatment for hypertension and cholesterol are low for Mexican Americans Percentage Source: Vital Signs, February 2011. www.cdc.gov/VitalSigns/CardiovascularDisease/index.html

  41. 38% of Hispanic children are overweight or obese Cultural food intake factors • Equating overweight with healthiness in children • Use of food treats by parents as token of love and caring • Gorditos y colorados • Taking a bottle to bed (14% do vs. 4% for blacks and 6% for whites) Data for children between 2 and 19 years of age

  42. Hispanics have the highest risk of developing diabetes of any group Estimated lifetime risk of developing diabetes for individuals born in the U.S., 2000 Source: Narayan KMV, JAMA, 2003

  43. Mexican dishes are high in sodium • Hispanics aged 2 and older consume 3,097 mg of sodium per day • Mexican mixed dishes contribute • 7% of sodium intake in the diet of the general population • 11% of sodium intake in the diet of the Mexican-American population

  44. Americanized Mexican food is high in calories, fat, and salt • Rubio's Fresh Mexican Grill Carne Asada Taco with rice and beans: 710 calories and 22 g of fat • Taco Bell Nachos Bell Grande: 770 calories and 39 g of fat • Baja Fresh Steak quesadilla: 1,450 and 86 g of fat Beef burrito Calories: 830 Saturated fat: 10.5 g Cholesterol: 95 mg Sodium: 1,570 mg Sugar: 1 g Source: F as in fat: How obesity threatens America’s future, 2010

  45. Age-adjusted prevalence of diabetes and percentage at high risk for diabetes (IFG), by country of residence: 2001−2002 IFG = Fasting Plasma Glucose ≥ 126 mg/dL Source: Diaz-Apodaca BA, Rev PanamSaludPublica, 2010

  46. Prevalence of type 1 (T1) and type 2 (T2) diabetes among US youth, 2006 0−9 years 10−19 years White Black Asian/Pac. Isl. Am. Ind./Al. N. Hispanic Source: SEARCH Study Group, Pediatrics, 2006

  47. Age-adjusted prevalence of gestational diabetes, by race/ethnicity and country of birth: Kaiser-Permanente, Northern CA, 1995-2004 Mexicanshave a 60% higher prevalence of gestational diabetes than whites

  48. CDC diabetes prevention activities for Hispanics • Mobilize Communities to Reduce Diabetes: 5-year cooperative agreement with National Alliance for Hispanic Health (the Alliance) • Focus on Phoenix, AZ; Rio Rancho, NM, Watsonville, CA • National Diabetes Education Program • Focus on Hispanics and other at-risk groups

  49. Affordable Care Act (ACA) Funds prevention at sustainable level Lowers barriers to preventive care by eliminating cost-sharing for critical services HHS is working with state and local partners and dispersing grant assistance to ensure that Americans get needed care ACA investments in public health workforce will benefit our communities for decades

  50. ACA reduces health disparities by improving access to health care Preventive care: Medicare and some insurance plans cover recommended preventive services Coordinated care: Make investments in community health teams to manage chronic diseases Diversity and cultural competency: Increase racial and ethnic diversity in health care professions

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