271249 Evidence from nurses and social workers: Social determinants of inequality in health care service delivery as a challenge to achieving wellness across the lifespan

Monday, October 29, 2012

Barbara Wallace, PhD , Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY
  
Results from two studies demonstrated that racial and ethnic disparities in healthcare exist across the lifespan. The studies identified social determinants of inequality in health care service delivery. First, a sample of nurses (n=179) reported on their experiences observing service delivery within hospital settings, indicating that Whites and those of high socioeconomic status (SES) received the best care, while Blacks and those of low SES received the worst care. Seniors received significantly worse care relative to that delivered to children and adults. Relative to other racial/ethnic groups, Black nurses perceived witnessing a significantly greater gap in health care delivered to Blacks versus Whites, and had a significantly higher ability to perceive racism and/or oppression, as well as a higher level of knowledge about how to cope with and respond to racism and/or oppression. Knowledge about how to cope with racism and/or oppression was the only significant predictor of perceiving Whites as receiving better health care than Blacks—accounting for just 9.8% of the variance. The second study with social workers (n=81) confirmed the largest gap in health care service delivery was between high SES (best care) and low SES (worse care); and the next greatest gap was between Whites (best care) and Blacks (worse care). Years practicing as a social worker predicted rating adults as receiving better care than children or seniors, as a significant finding—accounting for 17.7% of the variance. Findings suggest challenges to achieving wellness across the lifespan. The two studies suggest the validity of three new measures.

Learning Areas:
Diversity and culture
Other professions or practice related to public health
Provision of health care to the public
Public health or related nursing
Public health or related research

Learning Objectives:
Using three new valid measures used in two separate studies with nurses and social workers, participants will be able to assess varied health care workers'for their: 1) ability to perceive racism and/or oppression; 2) coping responses to racism and/or oppression; and 3) ratings of inequality in health care service delivery, given what they have observed, specifically when comparing health care service delivery within five demographics groups (i.e. racial, gender, age, SES, and sexual orientation groups). Participants will be able to design a research study for any category of health care delivery worker. Participants will be able to evaluate and analyze data collected, given exposure to the methods presented in the session. Participants will be able to contribute to the scientific literature seeking to identify the social determinants of inequality in health care service delivery--as a starting point for making improvements. Participants will be able to demonstrate increased knowledge of those social determinants of health disparities that serve as a barrier to achieving wellness across the lifespan for Blacks and those of low SES.

Keywords: African American, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My qualifications include: Founder/Director of the Research Group on Disparities in Health at Teachers College, Columbia University; Founder/Conference Director, the Annual Health Disparities Conference at Teachers College, Columbia University (2006-2009, to be revived in 2013); editor of the volume, Toward equity in health: A new global approach to health disparities (Springer, 2008); author/editor of 6 other books, and approximately 60 other academic publications; tenured Full Professor of Health Education; and, over 150 conference presentations--national/international.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3117.0: Evidence-Based Community Health Interventions for African American Communities