Skip Navigation LinksHome > March 2014 - Volume 114 - Issue 3 > More Work Needed to Equalize U.S. Health Care
AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000444478.10973.22
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More Work Needed to Equalize U.S. Health Care

Potera, Carol

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Carol Potera

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Accurate assessments require cultural awareness and communication skills.

Despite improvements in some areas of U.S. health care, health disparities still plague many Americans, according to the CDC Health Disparities and Inequalities Report—United States, 2013. Differences in age, income, education, sex, race, and disability underlie the inequalities.

Figure. Photo by Pat...
Figure. Photo by Pat...
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The report from the Centers for Disease Control and Prevention covers 29 areas, including disparities in deaths and illness, use of health care, lifestyle risk factors, environmental hazards, and social aspects of health. Ten new areas have been analyzed since the first report in 2011: access to healthful foods, unemployment, asthma attacks among those with asthma, fatal and nonfatal work-related injuries and illnesses, living close to highways, activity limitations caused by chronic illness, health-related quality of life, periodontal disease, and tuberculosis.

Here are some of the key findings.

* Diabetes rates are higher among blacks, Hispanics, and people with lower incomes than among whites and Asians.

* Blacks are 50% more likely than whites to die of premature heart disease or stroke.

* Tuberculosis rates have dropped 58% since 1992, but racial and ethnic minorities are infected disproportionately.

* Men, whites, people with higher incomes, and people 18 to 34 years old are more likely to be binge drinkers.

* Asthma attacks were more prevalent among females, children, the poor, persons of multiple races, and Puerto Ricans.

* Infant death rates among blacks are 2.3 times higher than those among whites, and the South and Midwest have the highest infant death rates.

Identifying and monitoring disparities are necessary first steps in focusing efforts to equalize care. One good model for reducing ethnic and racial health inequalities is the 20-year-old Vaccines for Children program, which protects millions of children from disease. The Affordable Care Act should further improve care by providing guidelines on using national population surveys to collect data on, analyze, and report disparities.

“Any ethnic group can have health care disparities,” Larry Purnell, professor emeritus, at the University of Delaware School of Nursing in Newark, told AJN. To accurately assess patients, providers must be aware of cultural differences in communication. Necessary communication skills include knowing preferred greetings, asking permission to touch and explaining why, eye contact, and voice volume and tone. “When discharge instructions are provided, they must be translated by a qualified translator and at the patient's level of understanding,” said Purnell.—Carol Potera

© 2014 Lippincott Williams & Wilkins. All rights reserved.


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