How Doctors Can Help in Closing the Disparity Gap

Whether it results from a lack of education or a lack of resources, a large disparity gap exists between many people groups in Hillsborough County and across the country. Closing the gap will take hard work over a long period of time, and that work needs to begin today. How can you get involved? If you are a doctor, you hold an important position of influence in your community. For every patient that enters your office, you have an opportunity to educate and inform. Here are some ways you can do your part.

Teach Preventative Care
Doctors often get involved after an illness or injury has already presented itself. Preventative care is much cheaper, and it can negate the need for expensive medical procedures down the line. Make teaching preventative healthcare a priority in your office. You won't have time to discuss all the basics with every patient, but you can provide brochures on the importance of nutrition, exercise, stress reduction, sleep patterns, and a smoke-free lifestyle. Families could also receive information on bicycle safety, staying healthy in hot weather, and how to prepare for hurricane season. These simple instructions could prevent serious injuries today and life-threatening illnesses down the road.

Keep Clear Lines of Communication
Patients who don't speak English, or speak English as a second language, might struggle with understanding a doctor's instructions or advice. Encourage these patients to bring along a trustworthy interpreter who can translate or take notes in their first language. If you suspect a language barrier, repeat your instructions again slowly with basic vocabulary. Write down your instructions. Even if the written instructions are in English, the patient may be able to find a translator later. If needed, refer the patient to another doctor who speaks their primary language. Trust your instincts. Sometimes a patient will claim they understand you out of embarrassment, or because they don't want to waste anyone's time.

Inform Patients about Free or Discounted Health Resources
Make information about free clinics, free or discounted medications, or cheap health insurance options freely available for all of your patients. Many basic healthcare needs can be met for affordable prices, if your patients only knew where to go. It is your responsibility to make sure everyone under your care knows their options, prioritizes their health, and receives care when they need it.

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Childhood Obesity in Minorities

Research has shown that Hispanic and African-American children are more likely to struggle with obesity during their adolescent years than their Caucasian peers. Although childhood obesity has steadily become more common in every race since the 1970s, minorities still report higher percentages of overweight children. According to a study conducted by Harvard Medical School, African-American and Hispanic children are at higher risk for nearly every cause of childhood obesity before they even reach four years of age.

Risk Factors for Childhood Obesity
Many risk factors are already in place before a child is even born. Other risk factors are established during infancy. Children are more likely to experience obesity during their preschool and elementary years if their mothers are obese, if their mothers experience gestational diabetes during pregnancy, or if their mothers struggle with depression. Parents can decrease the risk of obesity in their children during their earliest stages of life by not introducing solid foods until after 6 months and continuing to breastfeed for at least a year.

As a child ages, parents can continue encouraging healthy eating habits and activities by limiting time in front of the television, not putting a TV set in the child's room, and avoiding fast food as a meal option for the kids.

What Can Be Done
CBS News
reports that inflammation and risk for future heart disease can be found in obese children as young as three years old. Before a child even reaches preschool, lifelong habits and consequences have already begun. Educating expecting or new parents could help get more children off on the right foot from birth.

Teachers and healthcare professionals can also help older children to make healthier decisions. Minority and low-income children are more likely to make their own meals while their parents are at work, and they often reach for high-sodium, fatty, processed "instant" foods that aren't nutritional and can lead to weight gain. Teaching all children the basics of nutrition and showing them how to put together a few simple, healthy meals, such as whole wheat sandwiches with dark leafy greens or salads filled with a variety of vegetables, could lower the disparities among minorities when it comes to weight. School administrators can also help out by limiting the availability of junk foods in the lunch room and through vending machines.

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Socioeconomic Status & Health Habits

According to the U.S. National Library of Medicine, recent studies have shown that the most reliable predictor of health habits is socioeconomic status. Those with lower socioeconomic status are more likely to be overweight, suffer from malnutrition, or get behind on health screenings and check-ups. Those in the upper-class even seem to have healthier habits than the typical middle class families.

The Cost of Healthy Food
Maintaining a nutritious diet comes at two costs – not just the money you hand over to a cashier, but the time it takes to prepare. The healthiest way to eat is to use whole foods, which often means cooking and preparing meals from scratch. Processed or prepackaged foods, typically found in the center aisles of the grocery store, are usually filled with salt, preservatives, sugars, oils, or ingredients you can't pronounce. For those working long hours for their paychecks, finding the time to prepare a nutritious meal may seem unreasonable.

Paying for fresh produce instead of cheaper canned vegetables can also steal a chunk from your grocery budget, especially in the winter months when you're shopping out of season. If you're looking to purchase healthier organic foods, expect another boost to your total. Many families with a lower socioeconomic status rely on coupons to keep them within their budgets, but most of these deals are for processed foods. Even when healthy foods are on sale, whole foods such as fruits, vegetables, and meats are difficult to stockpile until the next sale hits.

Health Insurance
Without affordable and comprehensive health insurance options, many in middle and lower classes find themselves underinsured, or not insured at all. Without good coverage, many adults will justify skipping recommended check-ups and screenings in order to save money, or even putting off doctor visits when they know there is a problem. Preventative medicine, quick medical interventions, and regular advice from a doctor can save money and lives down the road, but in the short-term many lower and middle class patients will only take what they think they can afford today.

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Benefits of Child Play Time on Health

Along with good nutrition, proper hygiene, and a well-kept schedule of doctor visits, children also need regular and imaginative play to have a nurturing childhood. It may seem frivolous and unnecessary to busy parents, but encouraging a lifestyle of play will help children transition into a healthy and fulfilling adulthood.

Physical Development
For toddlers and preschool-aged children, play often helps develop motor skills, balance, coordination, and strength. Whether your child is building with blocks, playing hopscotch, or catching a ball, he is slowly learning the movements and gaining the strength he'll need as he grows older. Encourage your child to engage in active play by getting involved in his play times. Initiate a game of tag in your backyard, or jump into a sandbox with him and start digging together.

Emotional Health
Young children often use role-playing games to understand and decipher the emotions they encounter in everyday life. Kids like to recreate environments that they are familiar with, such as family life or a school classroom, giving themselves the opportunity to take on a different role such as a parent or teacher. This kind of play allows the child to step into someone else's shoes and understand their interactions from a different angle.

Imaginative fantasy-based play also gives your child the opportunity to explore and express their emotions in a safe way. When your child is upset or angry, encourage him to try some kind of creative play as an outlet for his or her feelings.

Social Skills
It is important for your child to not only play on their own or with you, but also to spend time playing with other children their own age. These interactions will help your child to develop the social skills he or she will need  school, or later in the workplace. Give your children room for free play when they are playing with friends and allow him or her to try to work out conflict before stepping in to help.

Regular check-ups at the pediatrician and dentist are also important for a growing, healthy child. Visit the Hillsborough County Health Department website to find out about free and inexpensive resources for healthcare in Hillsborough County.

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Importance of Childhood Vaccines

Americans are now experiencing record lows for measles, hepatitis B, diphtheria, mumps, and many other preventable childhood diseases through vaccines, according to the Centers for Disease Control and Prevention (CDC). Dutifully following the list of vaccinations recommended by the CDC not only protects your children from serious illness, it also protects the other children and adults around them. Beginning at birth with a Hepatitis B vaccination, a schedule of shots is advised that continues regularly until the child is six years old, some requiring boosters after that.

How Vaccines Work
The only natural way to build up immunity to disease is to actually contract the illness and allow the immune system to create the antibodies. Unfortunately, for many diseases this could lead to serious consequences or fatality. Vaccines are a safe method of creating an immunity during childhood, without risking a full blown illness. The child is minimally exposed to the disease – enough for his immune system to learn how to fight back, but not enough to actually create the sickness inside him. Some vaccines may have minor short-term side effects such as muscle soreness or a slight fever.

Vaccines often work best at a certain age, so following the recommendations of the CDC and your doctor is crucial. If your child has fallen behind, it's not too late. Talk to your doctor about the most effective way to catch up.

Preventable Diseases
The CDC lists the following childhood diseases that have an effective vaccine for prevention:

  • Hepatitis A and B
  • Measles
  • Mumps
  • Rubella
  • Diphtheria
  • Haemophilus influenzae type b
  • Influenza
  • Polio
  • Meningococcal
  • Whooping cough (pertussis)
  • Pneumococcal disease
  • Rotavirus
  • Tetanus
  • Chicken pox (varicella)

You may not see many of these illnesses anymore, thanks to childhood vaccinations. It may seem tempting to skip these recommended shots, assuming that exposure won't be common, but these viruses and conditions still spread among the unvaccinated, especially when leaving the country or even enjoying the company of international travelers. If childhood vaccination numbers decrease, instances of these diseases will increase in America.

The Hillsborough County Health Department provides vaccinations for both children and adults at a variety of medical facilities. Find a location that's close to you.

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Low Health Literacy & Its Affect

One of the major problems with today's medical care is the lack of heath literacy amongst many groups of people. Even when access to healthcare is provided and an accurate diagnosis is made, treatment can still fail because of an inability to understand or follow directions given by a doctor, nurse, or pharmacist. Health literacy can span several problem areas, ranging from low reading levels to comprehension problems. When low health literacy makes a communication barrier between a doctor and patient, a dangerous drop occurs in timely diagnoses and healthy recoveries.

Understanding the Doctor's Instructions
Patients who are not receiving around-the-clock care are typically entrusted to independently follow the recovery plan given to them by their doctor. When these instructions are not understood, recovery could be slowed or prevented altogether. In the worst cases, the patient could harm himself even further. Doctors can help ensure that their patients understand their role by abandoning complicated medical jargon, keeping their instructions simple and straightforward, asking the patients to repeat instructions, and always encouraging questions.

Reading Pharmacy Instructions
Patients with low reading levels may find themselves taking incorrect dosages of medicine when they cannot decipher the instructions written out by their pharmacists. These situations can turn very dangerous, whether the patient is taking too little or too much the prescribed medication. In some cases, patients are even required to calculate their own dosages if the amount fluctuates, leaving more room for patient error when low health literacy gets in the way.

Affected People Groups
According to the National Network of Libraries of Medicine, the groups most adversely affected by low health literacy are:

  • Patients over 65 years old
  • Immigrant populations
  • Minority groups
  • Low income groups
  • Patients with mental health conditions
  • Patients with chronic physical health conditions
  • Disabled patients
  • Patients with a low level of education

According to the U.S. Department of Health and Human Services, 90 percent of adults struggle to comprehend basic health information. The Health Equity Coalition of Hillsborough County is striving to raise health literacy in our community and make healthcare more effective for groups with statistically low literacy levels. Take some time to learn more about us and our goals.

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Diabetes Disparities in Racial and Ethnic Minorities

Health care disparities exist for HIV/AIDS, oral health care, and cardiovascular disease – diabetes is no exception.  Through Health Equity’s commitment to eliminating disparities to improving access to care, building community resources and promoting physical activity and nutrition, the burden of diabetes on minority communities may be alleviated.

Type 2 diabetes
The human body produces the hormone insulin which helps the body absorb excess sugar in the blood stream. Type 2 diabetes, formerly known as adult onset diabetes, occurs when the pancreas does not produce adequate amounts of insulin or the body becomes resistant to insulin.  The elevated blood sugar levels accumulate, leading to diabetes-related complications.

Diabetes Disparities
Minorities suffer higher rates of diabetes than whites

  • 10.8 percent of non-Hispanic blacks
  • 10.6 percent of Mexican Americans
  • 9.0 percent of American Indians
  • 6.2 percent of whites

African Americans and Hispanics born in the year 2000 have a 2 in 5 risk for diabetes.

Higher rate of complications

  • The rate kidney failure and end-stage renal disease (ESRD) is 2.6 times higher for African Americans than whites
  • Rates of blindness due to diabetes are only half as high for whites as they are for rest of the population
  • Diabetes-related mortality rates for African Americans, Hispanic Americans, and American Indians are higher than those for white people

Causes
Access to Healthy Food
Diabetes is associated with being overweight and obese.  For minority communities living in poverty, access to healthy foods is limited.  Often times, fast food restaurants and convenience stores are the only accessible options, leading to increased rates of obesity and diabetes among minority children and adolescents.

Access to Care
The key to managing diabetes is care management.  Regular monitoring of blood glucose levels, controlling high blood pressure, and routine doctors visits for eye and foot exams are key.  Minority communities need access to routine care as well as diabetes management education if disparities in diabetes are to be addressed.

Resources
The American Diabetes Association has culturally-appropriated education materials for community-based efforts.  Visit www.diabetes.org for the Soul Food Recipe Sampler, Project POWER and several others.

Sources
Agency for Health Care Research and Quality
Centers for Disease Control and Prevention

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