health disparities in a “browning” and “graying” america: implications and challenges
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Health Disparities in a “Browning” and “Graying” America: Implications and Challenges. - PowerPoint PPT PresentationTRANSCRIPT
February 2007
Health Disparities in a “Browning” and “Graying” America: Implications and
Challenges
James H. Johnson, Jr.William Rand Kenan, Jr. Distinguished Professor of Management
Kenan-Flagler Business SchoolDirector, Urban Investment Strategies Center
Frank Hawkins Kenan Institute of Private EnterpriseUniversity of North Carolina at Chapel Hill
February 2007
Overview
I. Health Disparities in North Carolina and Beyond
II. Drivers of Change
III. Challenges Ahead
IV. Implications for Health and Competitiveness of our State and Nation
February 2007
Lower Socioeconomic Status Associated With
Fewer: Pap smear tests Mammograms Childhood and influenza immunizations Diabetic eye exams
Source: Fiscell, et al., 2000
February 2007
Lower Socioeconomic Status Also Associated
With: Lower overall health care use Later enrollment in prenatal care Lower quality ambulatory and hospital care
Source: Fiscell, et al., 2000
February 2007
Race/Ethnic Group Status
Less intensive/lower quality care Less often seen by specialists Less appropriate preventive care
Source: Fiscell, et al., 2000
February 2007
Blacks receive fewer…
Cardiovascular procedures Lung resections for cancer Kidney and bone marrow transplants Cesarean Sections Peripheral Vascular procedures Orthopedic procedures
Source: Fiscell, et al., 2000
February 2007
Blacks are also less likely to receive…
Aggressive treatment of prostate cancer Antiretrovirals for HIV infection Anti-depressants for depression Tympanostomy tubes Hospital Admissions for chest pain Quality Prenatal Care
Source: Fiscell, et al., 2000
February 2007
Elderly Blacks less likely to receive…
Appropriate preventive care mammograms and flu-vaccinations
Quality hospital care Expensive, technological procedures
Source: Fiscell, et al., 2000
February 2007
Latinas receive fewer…
Mammograms Pap smear tests Influenza vaccinations Cardiovascular procedures
Source: Fiscell, et al., 2000
February 2007
Latinas also receive less…
Prenatal care Analgesia for metastatic cancer and treatment
Source: Fiscell, et al., 2000
February 2007
Asians receives fewer…
Pap smear tests Influenza vaccinations
Source: Fiscell, et al., 2000
February 2007
Native Americans receive less…
Prenatal care
Source: Fiscell, et al., 2000
February 2007
Socioeconomic Status and Race/Ethnicity Associated with
Potentially Avoidable Procedures: Amputation Orchrectomies Treatments of late stage cancer
Source: Fiscell, et al., 2000
February 2007
Socioeconomic Status and Race/Ethnicity also related to
avoidable: Hospitalizations Hospital Readmissions Untreated Disease
Source: Fiscell, et al., 2000
February 2007
Factors exacerbating SES and Race/Ethnic Disparities
include: Health care affordability Transportation and access Education Knowledge and literacy Patient attitudes and preferences Competing demands Provider bias
Source: Fiscell, et al., 2000
February 2007
Health Status of North Carolina Adults, 2002-2004
Race/Ethnic Group % in Fair or Poor Health Ratio to Whites
All 19.1
White 17.8 1.0
African American 23.6 1.3
American Indian 23.5 1.3
Asian/Pacific Islander 9.9 0.6
Hispanic/Latino 29.7 1.7
Source: NC Department of Health and Human Services, Office of Minority Health and Disparities (2006)
February 2007
Percent of North Carolina Adults(18+) Who Are
Overweight/Obese, 2002-2004Race/Ethnic Group % Ratio to Whites
All 61.4
White 58.6 1.0
African American 72.8 1.2
American Indian 70.0 1.2
Asian/Pacific Islander 29.7 0.5
Hispanic/Latino 59.8 1.0
Source: NC Department of Health and Human Services, Office of Minority Health and Disparities (2006)
February 2007
February 2007
Drivers of Change
Rapid growth of foreign born population Aging of native born population “First” and “second” waves of globalization
February 2007
Immigration Population, 1900-2004
10.313.5 13.9 14.2
11.6 10.3 9.7 9.6
14.1
19.8
31.133.1 34.2
0
5
10
15
20
25
30
35
40
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2002 2004
Year
Num
ber
of Im
mig
rant
s (i
n m
illio
ns)
Source: Center for Immigration Studies; U.S. Census Bureau, Current Population Survey
February 2007
February 2007
February 2007
States with Fastest Growing Immigrant Populations, 1990-
2000274%
233%
202% 196%
171% 169% 165% 160%
136% 135%
NC (1) GA (2) NV (3) AR (4) UT (5) TN (6) NE (7) CO (8) AZ (9) KY (10)
States
US Avg 57%
Source: 1990, 2000 U.S. Census
February 2007
States with Fastest Growing Immigrant Populations, 2000-
200547%
40% 40%38% 38% 37%
34%31% 30% 30%
SC (1) TN (2) DE (3) GA (4) AL (5) AR (6) NH (7) NV (8) NC (9) IN (10)
States
US Avg. 15%
Source: 2000 U.S. Census, 2005 American Community Survey
February 2007
States with Fastest Growing Hispanic Populations, 2000-
2005
48%46% 45% 45%
43% 43%40% 39%
36% 36%
AR (1) SC (2) GA (3) TN (4) NV (5) NC (6) NH (7) MD (8) AL (9) SD (10)
States
US Avg 19%
Source: 2000 U.S. Census
February 2007
Blacks Return to the SouthChange in Population, 1990-2000
-387,019
-149,674
579,491
-42,798
-400,000
-300,000
-200,000
-100,000
0
100,000
200,000
300,000
400,000
500,000
600,000
Northeast
Midwest
South
West
February 2007 Source: U.S. Bureau of the Census, American Fact Finder.
Net Population Change in North Carolina by Race and Hispanic or Latino Origin,
1990-2000
Race and Hispanic or Latino2000
Population
Net Gain
1990-2000Percent Change
Total 8,049,313 1,420,676 21.4%
White 5,804,656 796,237 15.9%
Black or African American 1,737,545 281,222 19.3%
American Indian or Alaska Native 99,551 19,396 24.2%
Asian 113,689 63,719 127.5%
Native Hawaiian and other Pacific Islander
3,983 1,787 81.4%
Some other race 186,629 155,127 492.4%
Hispanic or Latino (of any race) 378,963 302,237 393.9%
February 2007 Source: US Census Bureau, 2004 American Community Survey; 2000 US Census
Net Population Change in North Carolina Race and Hispanic or Latino Origin,
2000-2005
Race and Hispanic or Latino2005
Population
Net Gain
2000-2005Percent Change
Total 8,411,041 361,728 5%
White 6,005,471 200,815 3%
Black or African American 1,765,698 28,153 1%
American Indian or Alaska Native 106,931 7,380 7%
Asian 146,795 33,106 29%
Native Hawaiian and other Pacific Islander 3,344 -639 -16%
Some Other Race 257,169 70,540 38%
Hispanic or Latino (of any race) 533,087 154,124 41%
February 2007
Population in North Carolina by Age and Hispanic Origin,
2004
February 2007 Source: Centers for Disease Control, National Vital Statistics Reports, 1990 and 2003
North Carolina Births by Race/Ethnicity, 1990 and 2003
1990 2003%
Change
All Races 10,525 118,308 13.2
White 69,512 70,458 1.4
Black 30,726 27,170 -11.6
American Indian 1,516 1,637 8.0
Asian/Pacific Islander 1,052 3,106 195.2
Hispanic 1,754 16,084 817.0
February 2007 Source: North Carolina Department of Public Instruction, 2005
1 As of September of each school year
Net Change in Total and Hispanic Enrollment in NC Public Schools, 1985-2004
Years1
Total Enrollment
Change
Hispanic Enrollment
Change % Change
1985-1990 -3,558 4,795
1990-1995 90,378 13,769 15.2
1995-2000 95,472 33,933 35.6
2000-2004 78,755 45,148 57.3
February 2007
Hispanic Resident Costs and Benefits to State, 2004
Total Estimated Major Public Costs $816,559,000
Total Estimated Taxes Contributed $755,520,000
Net Cost to State($102 per Hispanic resident)
$61,039,000
Broader Economic Benefits: $9.2 billion in total NC Business Revenue 89,000 additional jobs $1.9 billion in overall statewide private-sector wage savings
(1.4% of NC’s private sector wage bill) Increased labor output for NC industries
February 2007
0
5
10
15
20
25
30
35
40
Source: U.S. Census Bureau, San Francisco Chronicle
Aging America: U.S. Median Age, 1820-2000
February 2007
Gender/Age
2005
Population
Net Change
2000-2005
% Change
2000-2005
Total 292,261,463 10,839,557 3.9%
Male 143,203,258 5,149,695 3.7%
Female 149,058,205 5,689,862 4.0%
Age 18-34 65,962,739 -1,072,439 -1.6%
Age 35-54 86,399,619 3,573,140 4.3%
Age 55-64 30,528,710 6,254,026 25.8%
Age 65+ 35,199,481 207,728 0.6%
Source: 2000 U.S. Census; 2005 American Community Survey, PUMS Estimates
Absolute and Relative Change in the Gender/Age Composition of the
U.S. Population, 2000-2005
February 2007 Source: U.S. Bureau of Census (2000)
Absolute and Relative Change in the Gender/Age Composition of the
North Carolina Population, 1990-2000
Gender/Age
2000
Population
Net Change
1990-2000
Percent Change
1990-2000
Total 8,049,313 1,420,676 21.4%
Male 3,942,695 728,405 22.6%
Female 4,106,618 692,271 20.3%
Age 18-34 2,020,236 95,308 4.9%
Age 35-54 2,372,270 665,954 39.0%
Age 55-64 723,712 136,809 23.3%
Age 65+ 969,048 164,707 20.5%
February 2007 Source: 2000 U.S. Census; 2004 American Community Survey
Absolute and Relative Change in the Gender/Age Composition of the
North Carolina Population, 2000-2005
Gender/Age
2005
Population
Net Change
2000-2005
% Change
2000-2005
Total 8,411,041 361,728 5%
Male 4,112,482 169,787 4%
Female 4,298,559 191,941 5%
Age 18-34 1,888,012 -132,224 -7%
Age 35-54 2,496,261 123,991 5%
Age 55-64 890,668 166,956 23%
Age 65+ 988,887 19,839 2%
February 2007
Age Profile of UNC-CH Faculty, 2002
Employee Type Number < 40 40-59 60+Average
Age
Tenured/Tenure Track 1,821 310 1,213 298 50.4
(%) (100) (17) (67) (16)
Fixed Term 870 254 570 46 45.5
(%) (100) (29) (66) (5)
Total 2,691 564 1,783 344 48.8
(%) (100) (21) (66) (13)
Source: Institutional Research - University of North Carolina at Chapel Hill
February 2007
Population Projections, by Race and Hispanic Origin, 2000-
2050, All Ages
0% 20% 40% 60% 80% 100%
2050
2040
2030
2020
2010
2000
Black
Asian
Other
Hispanic (any race)
White (non-Hispanic)
282,125
308,936
335,936
363,584
391,946
419,854
0% 20% 40% 60% 80% 100%
2050
2040
2030
2020
2010
2000
Black
Asian
Other
Hispanic (any race)
White (non-Hispanic)
282,125
308,936
335,936
363,584
391,946
419,854
February 2007
Globalization’s Impact on the American Worker
Globalization
Job Migration
Blue Collar White Collar
ManufacturingInformationTechnology
Business ProcessOutsourcing
Knowledge ProcessOutsourcing
Onshore Outsourcing Near Shore Outsourcing Far Shore Outsourcing
Right Sourcing
First Wave (1980-present) Second Wave (1990-present)
February 2007
Challenges Ahead
Denial of basic services Racial demography of American communities “Re”segregation of public schools Economic plight of American youth Medical Tourism
February 2007
Denial of Basic Services
Annexation Extraterritorial Jurisdiction
February 2007
Raeford
and
Silver City
N. C.
City Limits
ETJ
City LimitETJ
Raeford, NC
Silver City
Micro,
Johnston County,
N.C.
City Limit
ETJ
Creedmoor
Granville County, N.C.
1990 City Limits
2000 City Limits
Excluded Minority neighborhoods
Southern Moore County, N.C.
Satellite Annexation
Balloon Annexation
N.C.
Colerain,
N. C.
City limitCity Limit
February 2007
Racial Demography of American Communities
Racial/Generation Gap Minority/Majority Majority/Majority
February 2007
A Racial/Ethnic Typology of U.S. Counties, 2004
Source: U.S. Census Bureau, Population Division (2004)
February 2007
Area
Number of
Counties
Total Population
(% Nonwhite)
Adult Population
(% Nonwhite ≥ 15 years)
Youth Population
(% Nonwhite < 15 years)
All Counties 3,141 33% 30% 42%
Racial Generation Gap
242 46% 42% 58%
Minority-Majority 235 65% 62% 75%
Majority-Majority 2,663 19% 17% 25%
Other 1 50% 52% 43%
Source: U.S. Census Bureau, Population Division (2004)
Percent Nonwhite Population, Adult and Youth, by County
Type, 2004
February 2007
“Re”-segregation of Public Schools
February 2007 Source: North Carolina Department of Public Instruction
February 2007
Racial Composition of North Carolina’s Low-Performing High
Schools, 2004-2005
NC SchoolsTotal
EnrollmentBlack
EnrollmentPercent Black
All High Schools 399,261 123,779 31%
Low Performing High Schools
20,123 15,924 79%
Hillside High School 1,576 1,450 92%
Southern High School 1,509 1,121 74%
Source: North Carolina Department of Public Instruction
February 2007
Selected Indicators of North Carolina Student Preparedness
and Performance on…End of Course Test
State 74.8
District 58.0
P/LP 46.0
Black Students 43.0
SAT Participation
Nation 49%
State 74%
P/LP 59%
Average SAT Score
Nation 1,028
State 1,010
District 941
P/LP 829
P/LP = Priority/Low Performing School
February 2007
North Carolina Indicators of Teacher Quality, 2004-2005
Fully Licensed Teachers
78%
69%
85%
0% 20% 40% 60% 80% 100%
District
LP/P Schools
State
Emergency/Provisional License/Lateral Entry Tech
22%
27%
15%
0% 5% 10% 15% 20% 25% 30%
District
LP/P Schools
State
Teacher Turnover
21%
27%
19%
0% 5% 10% 15% 20% 25% 30%
District
LP/P Schools
State
Source: North Carolina Department of Public Instruction
February 2007
County Appropriations and Supplemental Taxes for Education (Current Expenses), Year 2004-05
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
2000-01 2001-02 2002-03 2004-05
Year
Per P
upil
App
ropr
iatio
n
All Counties
Majority-Majority
Minority-Majority
Racial Generation Gap
Source: http://www.ncpublicschools .org/docs /fbs /resources /data/financialdata/2004-05data.pdf
February 2007
Economic Plight of America’s Youth
February 2007 Source: American Community Survey (2004).
Population of U.S. children under 18 years by race/ethnicity, income, and
other social characteristics, 2004
All White Non-white Hispanic
All Children under 18
72,879,035 42,845,704 16,142,067 13,891,264
Families w/ low income($30,000/yr)
29.1% 19.5% 43.1% 42.6%
Householders or Parents w/ no college experience
47.7% 41.6% 46.4% 68.2%
Householders or Parents w/ no college experience and low income
18.8% 10.6% 25.9% 35.7%
February 2007 Source: American Community Survey (2004).
Population of U.S. children under 18 years by race/ethnicity, income, and
other social characteristics, 2004
All White Non-white Hispanic
All Children under 18
72,879,035 42,845,704 16,142,067 13,891,264
Non-Homeowner Families
33.2% 15.9% 50.8% 66.2%
Foreign-born Head of Household w/ no college experience
12.9% 2.8% 10.4% 46.9%
February 2007
Medical Tourism Cost Comparison
Type U.S. India
Hip Replacement (partial)
$18,000 $4,500
Hip Replacement (full) $39,000 $3,000
Orthopedic surgery $18,000 $ 4,500
Cardiac surgery $40,000 $6,500
Gall bladder surgery $60,000 $7,500
Source: http://www.cbc.ca
February 2007
Implications for NC’s Health and Competitiveness
Create healthy and viable communities Active living by design Health eating by design Infuse health and wellness education
throughout K-16 curriculum Strategically re-position health disparities as a
competitiveness issue.