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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Free and Inexpensive Health Resources in Hillsborough County

There is a wealth of resources here in Hillsborough County for those who do not have health insurance or a means to pay for healthcare, be it preventative, emergency or dental. Some clinics offer reduced or sliding rates based on individual income. The library can be a great resource for health information. Here is a list of just some of the resources available to you:

Hillsborough County Public Library Cooperative
You may not think of the public library as a health resource, but it can be helpful for looking up information and other health resources. All of the local county libraries have computer labs and free internet for you to use. If you don’t have internet at home and need to locate a doctor or lookup health information online, the Hillsborough County Public Library is a great place to go. Visit them online to find a location today.

Suncoast Community Health Centers
Suncoast Community Health Centers are non-profit and community owned and operated. They accept walk-ins and can provide pediatric healthcare, family healthcare, internal medicine, obstetrics and gynecological services. They also offer dental services ranging from routine cleanings to minor oral surgery and root canals. Suncoast Community Health Centers accept Medicaid, Medipass, and Medicaid HMO’s. They also offer sliding fees based on income for those who choose to self-pay. Find a clinic here.

Tampa Family Health Centers
Tampa Family Health Centers are also non-profit health centers providing primary health care services to Hillsborough County residents. Their services include pediatrics, family medicine, internal medicine, OB/GYB, psychiatric care, family planning and dental. Tampa Family Health Centers accept Medicaid and Medicare, as well as many insurance plans. They also offer sliding fees based on income. Find a list of their locations here.

The Health Equity Coalition of Hillsborough County strives to implement community based programs that will promote organizational, systems and environmental community change, including increased access to quality healthcare. These resources can be invaluable to those who are medically underprivileged, and help in bridging the gap in quality healthcare.

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Effects of Education on Health

Studies continue to show that more education is linked with better health and even longer life expectancy for most individuals. Children who are born to parents with more education have also shown to have better health in the long run and longer life expectancies. But why is it that the amount of education an individual has affects his or her health?

Some researchers believe that simply having additional years of education can add years to a person’s life and promote better health. However, education also affects other aspects of living that can be associated with better health. Here are some examples:

More education usually leads someone to advanced careers with increased pay. People with higher income can afford to take better care of their health. From being able to afford healthier foods to doctor’s visits and hospital stays, they can lead healthier lives.

Working Conditions
Better working conditions and jobs can be attributed to education level, and these can play a big role in someone’s health. Someone who lacks education may be left at a job that does not provide healthy working conditions or health insurance, requires long hours, or has safety issues.

Health Insurance
People who have further education may have better access to careers and employers that provide good health insurance coverage, or they can afford to buy it individually. Someone who is only a high school graduate may not be able to afford quality healthcare that insurance would usually cover.

Home and Neighborhood
Something as simple as the homes and neighborhoods people live in can be related to their long-term health and life expectancy. Those who live in neighborhoods near a pollution site or interstate highway will be exposed to conditions that can negatively impact their health. An old or rundown house might expose inhabitants to hazards like mold and asbestos.

People with more education are likely to be more knowledgeable about their health, eating habits, exercise and so forth. Because they have this knowledge as a tool, they may be more likely to care about their own health and well-being than someone without it.

There are many other reasons that education can directly and indirectly impact the quality of an individual’s health. Take some time to think about how these can influence people’s health and consider ways we can work around them to increase equality of health in our community.

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Air Quality and Its Effects on Overall Health

In urban areas of the United States, air quality is a public health concern, since air pollution can cause respiratory problems, asthma, and even heart attack and stroke. Poor air quality or pollution does not always affect everyone the same. Some groups of people are more susceptible to harm from air pollution due to their location or socioeconomic status.

What Is Being Done About Air Quality?
Air pollution has decreased over the past year, but research shows that the effects of it on our health are worse than they were originally thought to be. So what is being done about it?

· Clean Air Act. In 1970 Congress passed this act, which sought to protect people and the environment from the effects of air pollutants. A main component of the act was that the Environmental Protection Agency (EPA) was required to reduce routine, or daily, emissions of powerful air pollutants that cause serious health problems.

· Amendment to the Clean Air Act. In 1990, the Clean Air Act was amended to require the EPA to use a technology-based and performance-based method of reducing toxic emissions from major sources of air pollution.

· Enforcement. National Air Quality standards are enforced at both the state and local levels. In Florida, the Florida Department of Environmental Protection monitors air quality, and in Hillsborough County, the Hillsborough County Environmental Protection Commission does.

· Transportation/ metropolitan planning. As transportation contributes to air quality, the Metropolitan Planning Organization (MPO) for transportation plays a role in reducing air pollution. MPO implements Congestion Management System planning, organizes bicycle and pedestrian programs, and promotes mass transit in an effort to reduce air pollution.

Why Are Some People Affected More?

· Location. Sometimes, sources of pollution may be located closer to areas of underprivileged communities, thus increasing the residents’ exposure to toxins.

· Socioeconomic status. People of a lower social position may be more inclined to health effects of air pollution. They may lack the access to health care, work at places with poorer air quality, or already have existing health conditions that would put them at greater risk.

What Can I Do?
While changing air quality altogether is a larger issue that you cannot change on your own, there are ways you can protect your own health and reduce your exposure to poor air and pollution.

· Check the AQI. The Air Quality Index shows you the air quality in your area on a daily basis. You can check it each day through Air Now and reduce your exposure on days when the index is at an unhealthy level.

· Avoid heavy traffic. Regularly commuting during rush hour may increase your risk of health effects from air pollutants, so if possible, try commuting during irregular hours.

· Exercise at the right time. Exercising outdoors is best done in the morning, when ozone is low. Avoiding exercising outdoors during rush hour traffic, as that will protect you from air pollutants as well.

· Use your car’s A/C re-circulate. If you do sit in rush hour traffic often, use your air conditioning’s re-circulate feature.

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Free Back-to-School Physicals

Schools supplies and a new backpack aren’t the only things children need to get back to school. Hillsborough County schools require students to have up-to-date immunizations and a routine health physical within one year of entrance. There are several locations in Hillsborough County that provide free back-to-school physicals and immunizations. The last two free events are this week:

SouthShore Community Resource Center
201 14th Avenue SE, Ruskin, FL 33570
Saturday, August 20, 2011
9 a.m. to 1 p.m.
Appointment required; call (813) 443-3048 for more information

Webb Middle School
6035 Hanley Rd., Tampa, FL 33634
Saturday, August 20, 2011
9 a.m. to 12 p.m.
Walk-ins only; call (813) 443-3048 for more information

A parent or guardian must accompany child at all times, and a valid immunization record is required for free immunizations. Physicals for sports, Head Start or childcare will not be provided. Any school-aged K-12 child is eligible to participate. Hillsborough County will also be providing free backpacks with school supplies at these back-to-school events.

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