Vulnerable Populations and Determinants of Health 1

Biology and Genetics

Examples: Sex and age

Behaviors

Examples: Alcohol use, unprotected sex

Social and Economic Factors

Examples: Discrimination, income

Physical Environment

Examples: Where a person lives and crowding conditions

Clinical Care

Examples: Access to quality health care and having or not having health insurance

Center for Disease Control. Social Determinants of Health; Frequently Asked Questions (http://www.cdc.gov/socialdeterminants/faq.html)

Hispanic Youth and Higher Rates of Suicide Attempts 2

Biology and Genetics

Latinas (gender) exhibit higher rates of suicide attempts

Behaviors

Hispanic adolescent youth are showing an increase in binge drinking

Social and Economic Factors

Acculturation stress, anxiety, depression, poverty, women heads of households

Physical Environment

Exposure to violent crimes, higher rates of criminal justice involvement

Clinical Care

34 % of Hispanics are uninsured, limited proficiency in English reduces access to health information in the media

Zayas LH, Pilat AM. (2008). Suicidal behavior in Latinas: Explanatory cultural factors and implications for intervention. Suicide & Life-Threatening Behavior, 38(3), 334–342.

Seniors and Prescription Medication Misuse/Abuse 3

Biology and Genetics

Use of more prescription and over-the-counter medications; conditions which are common in populations such as pain, sleep disorders, insomnia, and anxiety

Behaviors

One fifth of emergency department visits involving pharmaceutical misuse and abuse among older adults were made by persons ages 70 or older

Social and Economic Factors

Older women likely to use psychoactive medications associated with divorce, widowhood, lower income, poorer health status, depression and/or anxiety

Physical Environment

Shrinking social networks, poor living conditions, retirement, and family losses

Clinical Care

Hurried office visits, stigma or shame about substance use, reluctance to seek professional help, lack of financial resources or transportation

Substance Abuse and Mental Health Service Administration. (2012). Older Americans Behavioral Health; Issue Brief 11: Reaching Diverse Older Populations and Engaging Them in Prevention Services and Early Interventions. Retrieved from http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Behavioral/docs2/Issue%20Brief%2011%20Reaching%20and %20Engaging.PDF

Physical Disabilities & Depression (Poorer Mental Health Status) 4

Biology and Genetics

Prevalence rates increase with age (higher among females), greater disparity between MI & US disability rates for blacks, women are more likely to report intimate partner violence and non consensual sex

Behaviors

Higher rates of smoking, lower rates of heavy or binge drinking

Social and Economic Factors

Those with fair to poor health status tend to have lower household income and education, some not able to see a doctor when needed due to cost

Physical Environment

Social isolation, physical access to buildings

Clinical Care

Poor physical health status & higher rates of chronic conditions, attitudinal barriers that may prevent healthcare providers from seeing the whole person

Disability and Health Program, Michigan Department of Community Health. (2013). Health of Persons with Disabilities in Michigan, Annual Data Report. Retrieved August 20, 2014 from http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_54051_54052-255399--,00.html.

Model: Culturally Competent Prevention 5

Cultural Competence Techniques

Considering inequities + • Prevention programs determinants across the • Translations Strategic Prevention • Cultural adaptations Framework (SPF) for • Education and training vulnerable populations • Organizational supports • Policy development

• Behavior change Improved functioning • Social/community connectedness

Improved Prevention Reach and Effectiveness

Improved prevention outcomes for vulnerable individuals and populations

Reduction in substance abuse disparities for vulnerable populations

Can Cultural Competency Reduce Disparities? 6

Vulnerable Populations

Cultural Competency

Appropriate Services for Vulnerable Populations • Preventive • Screening • Diagnostic • Treatment

Improved Outcomes for Vulnerable Populations • Health status • Use, abuse & consequences • Functioning • Satisfaction

Reduction of Health Disparities

• Linguistically • Ethnically • Culturally

• Effective techniques • Sound implementation

Examples:

Examples:

Examples:

Examples:

Examples:

Ensure focus on communities facing behavioral and physical health disparities (Michigan PFS High Need Counties)

Transforming Cultural and Linguistic Theory Into Action: A Toolkit for Communities

Strengthening Families & Active Parenting for Teens: Families in Action (Michigan SPF-PFS)

Continually improve the quality of services and health outcomes for all cultural groups. (Michigan SPFPFS)

Targeting health disparities directly

Cultural competence strategic plan and system expectations infused into routine business practices and operations, and continuous quality improvement. (BSAAS)

All services and supports be individualized based on the needs, preferences, and cultural context of the individual, family or community.

Meet cultural and linguistic needs of diverse populations (Cultural/Linguistic Competency) (Michigan PPCGuide)

(Michigan ROSC )

Developing and Monitoring through Impact Statements (Michigan SPFPFS)

Strengthen collaboration and partnerships with FQHCs, LPHDs, IHS, and CC&UH/CCs serving individuals and families in need prevention services (Michigan SPF-PFS)

Brach C., Fraserictor I. (2000). Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review And Conceptual Model. Medical Care Research and Review, 57(1), 181-217.