1. Community Health
and Minorities
Chapter 10

2. Introduction
• Strength of America lies in diversity of people
• Race remains an issue in U.S.
• U.S. population
• Majority – white, non-Hispanic (66%)
• Racial or ethnic minorities (34%)
• Minority health – morbidity and mortality of
ethnic minorities

3. U.S. Population by Race/Ethnicity, 2008

4. U.S. Population Projection by
Race/Ethnicity

5. Introduction
• Advances in health gains are not equal in U.S.
• Secretary’s Task Force Report on Black and
Minority Health
• Initiative to Eliminate Racial and Ethnic
Disparities in Health (Race and Health
Initiative)

6. Racial and Ethnic Classifications
• Classifications used to operationalize race and
ethnicity
• Challenges with classifications representing
diversity of population
• Categories of race are more social than
biological
• Self-reported data can be unreliable
• Many nonfederal systems do not collect racial
and ethnic data

7. Health Data Sources and Their Limitations
• Challenges in complete and accurate collection
of racial and ethnic data
• Bias analysis
• HHS has long-term strategy for improving
collection and use of racial and ethnic data
• Important to understand health beliefs of
various groups
• Heterogeneity within groups

8. Americans of Hispanic Origin
• Hispanic origin is an ethnicity, not a race
• Persons of Mexican, Puerto Rican, Cuban,
Central American, or South American descent,
or some other Spanish origin
• Nearly all Hispanics (96%) in the U.S. are
classified by race as white
• Educational attainment
• Income
• Health beliefs

9. Black Americans
• Black or African Americans
• People having origins in any of the black racial
groups from Africa
• More than ½ live in southern regions of U.S.
• Educational attainment
• Income
• Health beliefs and culture

10. Asian Americans and Pacific Islanders
• Now two separate racial groups
• Generally concentrated in the western states
• Educational attainment
• Income
• Health beliefs
• Variations among the many groups
• Generational differences

11. American Indians and Alaska Natives
• Original inhabitants of America
• Economically and socially disadvantaged
• Relatively poor health status
• Education
• Income
• Health beliefs
• Various tribal groups have distinct customs,
languages, and beliefs
• Many share the same cultural values

12. Native Americans and Health Care
• Many tribes are sovereign nations
• Tribes transferred land in U.S. to federal
government in return for provision of certain
services
• Indian Health Services (IHS) within HHS
• Responsible for federal health services to
Native Americans and Alaska Natives
• Goal to raise health status to highest possible
level

13. Completed High School by Race and
Hispanic Origin, U.S.

14. Real Median Income by Race and Hispanic
Origin, U.S.

15. Poverty Rates by Race and Hispanic
Origin, U.S.

16. Refugees
• Refugees
• Immigrants
• Aliens
• Illegal aliens
• Can be classified into existing racial/ethnic
groups; as a single group, present special
concerns
• Education, health problems, injuries,
employment, etc.

17. Race and Health Initiative
• Goal to eliminate disparities among racial and
ethnic minority populations in six areas of
health while maintaining progress of overall
health of American people
• Infant mortality
• Cancer screening and management
• Cardiovascular disease
• Diabetes
• HIV/AIDS
• Adult and child immunization

18. Infant Mortality
• Serious disparity in U.S. among racial and
ethnic minorities
• Black Americans infant death rate more than
two times that of white Americans
• Lack of prenatal care and low-birth-weight
babies

19. Infant Mortality Rates by Race and
Hispanic Origin of Mother, U.S.

20. Babies of Low Birth Weight by Mother’s
Race and Hispanic Origin, U.S.

21. Cancer Screening and Management
• Incidence and death rates highest among black
Americans for various types of cancer
• Many disparities attributed to lifestyle factors,
late diagnosis, access to health care
• Less primary and secondary prevention in
various minority groups

22. Cancer Incidence and Death Rates, U.S., by
Cancer Site and Race

23. Cardiovascular Diseases
• Death rates vary widely among racial and
ethnic groups
• Black Americans have higher rates from CHD
and stroke
• Hypertension prevalence as a risk factor varies
according to race/ethnicity
• Black American tend to develop hypertension
earlier in life than whites; unknown reason

24. Diabetes
• Overall prevalence has risen in U.S. in recent
years
• Prevalence in those 20 and older varies in
minority groups
• Increase in age-adjusted death rates in all racial
and ethnic groups
• Significantly higher in minority groups

25. Diabetes Age-Adjusted Prevalence by
Race/Ethnicity, U.S.

26. HIV Infection/AIDS
• Proportional distribution of AIDS cases has
increased in black Americans and Hispanics
and decreased in white Americans
• Attributed to higher prevalence of unsafe or
risky health behaviors, and lack of access to
health care to provide early diagnosis and
treatment

27. Percentages of AIDS by Race/Ethnicity and
Year of Diagnosis, U.S.

28. Child and Adult Immunization Rates
• Early childhood immunizations do not vary
significantly by race or ethnicity
• Older adult immunization rates are
substantially lower in minority groups, even
though an overall increase has occurred

29. Socioeconomic Status and Racial and
Ethnic Disparities in Health
• Many factors contribute to health disparities –
economic, educational, behavioral, cultural,
legal, and political
• Socioeconomic status (SES) considered the
most influential single contributor to premature
morbidity and mortality
• Association between SES and race/ethnicity is
complicated and cannot fully explain all
disparity

30. Relationship Between Race and Health

31. Equity in Minority Health
• Simple solutions unlikely
• Solutions to problems for one group may not
work for another
• Solutions must be culturally sensitive

32. Cultural Competence
• A set of congruent behaviors, attitudes, and
policies that come together in a system,
agency, or among professionals, that enables
effective work in cross-cultural situations
• Culture is vital in how community health
professionals deliver services and how
community members respond to programs and
interventions

33. Empowering the Self and the Community
• To enable people to solve their community
health problems
• Three kinds of power associated with
empowerment
• Social – access to “bases”; needed to gain
political power
• Political – power of voice and collective action
• Psychological – individual sense of potency

34. Discussion Questions
• Why have there been so many changes to
racial and ethnic classifications in the United
States in recent decades?
• How can community health programs
empower minority groups?