Background:

The events that took place in 2020 demonstrated how racism has afflicted our nation’s structures and policies resulting in fewer opportunities and inequities among black, Indigenous, and people of color (BIPOC). Following these events, on January 12, 2021, San Diego County declared racism as a public health crisis. It is necessary to examine how racial discrimination has created health inequities among local BIPOC populations in San Diego County.

Methods:

A research-based framework was applied to summarize how racial discrimination affects mental and physical health outcomes among BIPOC populations. Local data was used to quantify these effects on medical encounters, access to care, living conditions, psychological stress, and economic opportunities. Data from the California Office of Statewide Health Planning & Development and California Health Interview Survey were utilized to evaluate the elements in the framework.

Results:

Among BIPOC residents in San Diego County, blacks accounted for under 5% of the population and experienced the highest rates of any group. Black residents suffered poorer living conditions, decreased quality of and access to healthcare, higher psychological stress, and higher assault rates between 2015-2019. Following the framework, results demonstrated that black residents suffered poorer mental health outcomes and were twice as likely to be discharged from the emergency department (ED) for anxiety, depression, or substance use disorders. Black residents also suffered poorer physical health outcomes and were nearly three times more likely to be discharged from the ED due to heart failure and more than 1 out of 3 black residents reported they had been diagnosed with high blood pressure or hypertension, a common indicator of systemic stress.

Conclusions:

This framework demonstrated how racial discrimination creates health inequities among BIPOC communities in San Diego County. As a result, this allows for a data-based discussion and change in those policies and practices that continue to sustain these racial health inequities.

Implications:

This framework serves as a starting point for quantifying health inequities within BIPOC populations and a structure for identifying root causes. These results can inform policy changes and create opportunities that positively impact the entire population by encouraging a state of health equity.

Background

Public health priority setting often relies on population health indicator data with limited community input on health concerns. Self-determination theory and prior research on identifying patients’ health priorities suggest that individuals are more likely to participate in a public health initiative when their health concerns are solicited. Soliciting a community’s health concerns leads to more equitable public health priority setting processes as it amplifies concerns of otherwise marginalized sub-populations within a community.

Objectives

1. Compare the top health concerns for participants in a regional health equity survey by race/ethnicity; and
2. Articulate a rationale for utilizing community identified health concerns in equitable public health priority setting processes.

Methods

A health equity survey was administered to residents in a 9-county, western New York region. This study focused on responses to the open-ended question: “All things considered, what would you say is your biggest concern or fear in terms of your own health and well-being?” Responses (n = 5,553) were thematically coded until saturation was reached (inter-rater reliability κ = 0.916). Using frequency distributions, the top ten health concerns were ranked and compared for the entire sample and each racial/ethnic sub-group.

Results

All racial/ethnic sub-groups (White, African American/Black and Hispanic/Latinx) identified weight/diet, fear of future, cancer, cardiac disease and orthopedic problems as top health concerns. African American/Black and Hispanic/Latinx participants were more concerned with diabetes, stress and high blood pressure. Mental health was a top concern amongst Hispanic/Latinx participants only, while aging and health care costs were top concerns for White participants only.

Conclusions

There were unanticipated similarities and differences between health concerns of racial/ethnic sub-populations. Since respondent-identified concerns is more effective for motivating change than expert determination of what is best for a community alone, eliciting sub-population health concerns should be incorporated into public health planning.

Implications

Health equity requires an understanding of how health concerns differ by race/ethnicity and a commitment to addressing these concerns. The use of open-ended questions allows for these concerns to be captured and incorporated into more equitable public health planning processes.

Differential exposures to environmental containments have a long history of driving health inequities. Today, one of the most preventable environmental-related outcomes in young children is lead poisoning. There is no “safe” level of lead. Lead is known to cause irreversible cognitive damage. At more significant risk to traditional and non-traditional sources are children from racial/ethnic, immigrant, and low socioeconomic status backgrounds. Despite this, the rate of lead testing in Nevada, home to over 200,000 diverse children under the age of 6, is less than 4% - one of the lowest in the nation. One of the barriers to lead testing is the common misconception among physicians that children are not at risk for lead exposure due to newer housing.

Since medical providers play such a pivotal role in recommending blood lead testing to parents, we implemented an academic detailing (AD) approach that utilizes the foundations of transtheoretical behavior change and social marketing theory to increase the likelihood that physicians apply CDC recommendations. AD sessions consisted of key messages on the most recent scientific data, state law mandates, methods to overcome barriers and objections, and enabling messages to promote blood lead testing.

To determine the success of the AD approach, the authors compared blood lead testing rates between 24 pediatric medical practices that received in-person academic detailing and 72 pediatric medical practices that received mailed information packets only. Results of this approach will be discussed in the session. Participants will learn about the framework used to implement AD sessions with medical providers and how it can be used as a health promotion tool to address health inequities.

Background: Culture competency is the ability to engage, understand, and communicate in a respectful and effective way through interaction among people cross-culturally. There remains a need for cultural competency as health care disparities persist across the U.S., racial and ethnic minority groups, people with limited English proficiency and low health literacy, sexual and gender minorities, and people with disabilities experience worse health outcomes than the general public. Therefore, a cultural competency training was created through different resources for improving interactions between Native Hawaiian/Pacific Islander patients and healthcare professionals. Cultural competency has gained attention because it can bridge patient health perspectives between health professionals and social and cultural influences, and can work to eliminate racial/ethnic disparities in health care by encouraging understanding through cultural and linguistic health-based services. To improve patient experiences in Hawai’i, healthcare professionals need the tools to better interact with patients from different cultures such as Native Hawaiians and Pacific Islanders.

Objectives: Objectives for the training include: to promote understanding of other communities’ cultures and values, to understand how cultural values and beliefs impact treatment and interaction among healthcare professionals, to identify challenges and learn culturally appropriate strategies to address them, and to bridge the gap between Pacific Islander and Western understanding of traditional and Western healing.

Methods: This training was pilot tested with key stakeholders from community organizations and cancer center faculty and staff. Local health clinics, providers, and practices will have the opportunity to take part in this training through a Zoom-based electronic training format, and provided three continuing medical education credits. Initial delivery of the training was intended for in-person format; however, because of the COVID-19 pandemic and social distancing regulations, a virtual format had to be adapted.

Intended Results: Healthcare providers will be provided pre-training resources, a pre and posttest, as well as a six-month follow-up survey to determine training objectives validity.

Conclusion/Public Health Implications: This training provides healthcare professionals culturally based content for improving cultural competence techniques for interacting with Pacific Island patients with the overarching goal of improving health equity and reducing health disparities for Pacific Islander populations’ seeking healthcare.