UNDERSTANDING AND REDUCING THE SIGNIFICANT DISPARITIES IN MENTAL HEALTH, PHYSICAL HEALTH, AND SUBSTANCE ABUSE THAT EXIST IN THE COMMUNITY.
"Decades have been spent emphasizing how personal choice affects health. However, this approach fails to address a major cause of ill health. Racial minorities and people who live in poverty are more likely to be burdened by such factors as substandard housing, pollution, and public policy decisions that contribute to health risks" (PBS, January 19, 2000).
There is considerable evidence of striking disparities in the health status among different racial/ethnic populations within the community.
Strong scientific documentation exists that concludes that minorities diagnosed with chronic diseases have less quality of life than Whites and that minority individuals tend to live for a shorter period of time after diagnosis (Amick, Leavine, Tarlov, & Walsh, 1995).
As the following graph illustrates, the years of potential life lost before age 65 is significantly greater for minorities than that of Whites.
The Texas Department of Health, Bureau of Vital Statistics, estimates life expectancy, by race, for individuals born in 1998 to be:
- Whites - 77.2 years
- Blacks - 71.0 years
- Hispanics - 77.5 years
The ten year (1989-1998) average infant mortality rate per 1,000 births, by race, in Travis County is:
- Whites - 5.0
- Blacks - 11.2
- Hispanics - 5.5
In Travis County (1998), deaths related to HIV and intravenous drug use was proportionately higher among minorities, ages 18-99 (68% minority males and 70% minority females). The Texas Department of Health, Bureau of Vital Statistics (Epigram TX) reports a significant disparity related to the proportion of African-American male (44 percent) and female deaths (70 percent) compared to the deaths of other intravenous drug users. Anglo male and female deaths combined were less than African-American females. The 1998 data report there were 24 percent male Hispanic deaths and zero deaths for HIV and intravenous drug use among Hispanic women. The Texas Department of Health, Bureau of Vital Statistics (Epigram TX) reports the following:
- Black Males- 44%
- White Males - 32%
- Hispanic Males- 24%
- Black Females- 70%
- White Females - 30%
- Hispanic Females- 0%
In Travis County, the per capital income of Hispanics ($8,259) is lower than that of both Blacks ($9,201) and Whites ($18,544). The Texas Human Services Commission data also shows that a larger percent of all Hispanics (27.66 percent) in Texas are living in poverty than both Blacks (25.73 percent) and Whites (8.05 percent) (Texas Health and Human Services Commission, September 2000, Demographic profile of the Texas population living in poverty in 1997).
Approximately 6,211 persons (adults) with severe and persistent mental illness were served by the local mental health authority. (The Texas Department of Mental Health Mental Retardation defines priority population for mental health services as: Adults who have such severe and persistent mental illnesses as schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders which require crisis resolution or ongoing and long-term support and treatment.) Almost 95% of the people in this population make less than $16,000 a year and it is estimated that over 90% live below the federal poverty income guideline.
When the demographic summary by race and consumers with a mental disorder served is compared, there is an overwhelming disparity in the number of Hispanics served.
Even though Hispanics are over-represented in the lower socioeconomic segment of the population, in many cases their health status is closer to that of Whites than Blacks. In fact, their health status is better than both Whites and Blacks in areas such as coronary heart disease and cancer. However, Hispanics fare worse in the area of diabetes and chronic liver disease than both Whites and Blacks.
Disparities in health are far more complex than just assuming that health is directly related to income and social status. In the area of mental health these factors are further complicated when considering psychiatric symptoms (e.g., hallucinations, delusions, or bizarre behaviors). Cultural or ethnic variation in the diagnosing of these symptoms may lead to misdiagnosis due to clinicians' training, experiences, and skills that often reflect their own social and cultural influences. For example deferential avoidance of direct eye contact may be determined as a symptom of withdrawal, paranoia, or abnormal affect. In reality this may simply be a cultural norm (National Institute of Mental Health, 1999).
Understanding racial disparities is contingent on (1) identifying factors that may affect health status and (2) systematically assessing these factors as determinants of differences between the races in health status (King & Williams, 1995). More and different information than is usually collected for measuring health status and/or researching health outcomes is required to fully understand these issues.
The following figure provides one possible organizational framework for understanding racial disparities in health. It posits etiological relationships and interactions among the various components of race and a broad range of intervening variables as determinants of biological processes and health status. Each component may affect health status directly or indirectly depending on the biological nature of the disease or illness.
The determinants of racial disparities in health are varied and complex. The interactions of these determinants are not well understood or even completely identified as being causes of health disparities. Much exploration will be required before prevention strategies can be formulated. Additional resources and the cooperation and support from the entire community, especially policy makers and community leaders, are necessary to embark on this exploration.
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