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Reports link health disparities among blacks, Hispanics to education, economics, lifestyle

Missouri Couny-Level Report, 2011 Comparative risk factors and chronic diseases and conditions

This article first appeared in the St. Louis Beacon: Eduardo Crespi says he puts in long hours promoting healthy habits among blacks and Latinos in the Columbia and Joplin regions of Missouri. Poli Rijos does the same in the St. Louis area. But the two and others like them still have plenty of work to do, judging from findings in two statewide reports from the Missouri Foundation for Health.

The reports on medical conditions among blacks and Hispanics show that health-care disparities persist in minority communities across the state, triggering generally higher rates of illness, injury and death than among Missouri’s whites.

Researchers note that data on certain illnesses and death rates for Hispanics can be misleading because the state’s Hispanic population isn’t clearly understood and defined. In addition, some say certain Latinos refuse to seek health care because they are in the country illegally and fear being deported.  Even so, they do have access to care through clinics such as Casa de Salud in south St. Louis.

Crespi and Rijos say health disparities affecting blacks and Hispanics have less to do with race or ethnicity than with socioeconomic conditions, lifestyle, education and solid information about prevention.

“Health literacy can make a difference,” said Rijos, a behavioral health consultant. “That’s part of my job. I am hoping that government will realize how powerful education can be and help low-income individuals have access to information. They can use it to stay healthy.”

She says some public schools' focus on health information is inadequate. Teachers in some of the schools in low-income communities have to spend so much time playing catch up on academics that “they don’t have time to focus on the importance of nutrition and exercise,” said Rijos.

Crespi, a nurse and health coordinator of Centro Latino de Salud in Columbia, notes that health disparities aren’t limited to minorities. “I’d say disparities go across the board. It affects everybody, including whites when their socioeconomic conditions aren’t good.”

He, too, thinks health literacy is the key. “If people learn how to prevent getting sick, then we could solve the disparity problem.” In addition, he says some Latinos face the added hurdles of getting access to care because they lack proper documentation of being in the country legally.

The Affordable Care Act includes funding for health literacy, and federal health officials recently awarded Missouri funding to help educate residents about accessing care at clinics and elsewhere under the health-reform law, which takes full effect in January.

Among other health conditions, the two reports show that blacks and Hispanics are more likely than whites to be current smokers, engage in less leisure time physical activity, and suffer higher rates of asthma.

Blacks also are more likely than whites to be obese and suffer from diabetes and hypertension, while Hispanics are less likely than whites to undergo colorectal and breast cancer screening and more likely to suffer from higher rates of high cholesterol.

The MFH reports say some  disparities begin before birth for many African Americans and Hispanics in Missouri. On maternal care issues, the reports make these points:

• African Americans and Hispanics are each twice as likely not to receive adequate prenatal care compared to whites (2.2 to 1 for African Americans, 2.1 to 1 for Hispanics).

• From 2001-2010,  African Americans had more than twice as many infant deaths compared to whites (2.4 to 1).

• The ratio of Hispanic mothers with less than a high school education is three times higher than non-Hispanic white mothers (3.1 to 1).

The report said the rate of communicable diseases among blacks continued to be high but has improved in some areas:

• Gonorrhea is more than 26 times higher in African Americans than whites (26.4 to 1), but has dropped almost 40 percent since the first edition of this report in 2006.

• Chlamydia is 11 times higher in African Americans (11 to 1).

• HIV is nine times higher in African Americans (9 to 1).

• Primary/secondary syphilis is nearly eight times higher in African Americans (7.6 to 1).

• AIDS diagnoses are just over seven times higher in African Americans (7.2 to 1).

Researchers found what they called extreme ratios between blacks and whites for certain emergency room visits in Missouri:

• Schizophrenia visits among African Americans are approximately seven times higher (7.1 to 1).

• Asthma ER visits are five and a half times higher (5.5 to 1).

• Diabetes ER visits are more than three times higher (3.3 to 1).

• Hypertension ER visits are nearly four times higher (3.9 to 1).

“These reports provide much needed insight to help guide community leaders to break down racial, ethnic, and demographic barriers to achieving good health,” said Akeiisa Coleman, MFH health policy associate and editor of the reports, in a statement.

Ryan Barker, MFH’s vice president of health policy, added that these reports continue to highlight “the need for statewide discussion about increasing health equity between white, African-American and Hispanic Missourians.”

Prevalence rates for select behavioral and chronic disease indicators
Credit Missouri county-level report, 2011
Prevalence rates for select behavioral and chronic disease indicators

Public understanding of Hispanics in Missouri continues to evolve; the group makes up a relatively small but growing percentage of Missouri’s population. Hispanic or Latino ethnicity includes people of Cuban, Mexican, Puerto Rican or Dominican descent, as well as people from Central and South America. While the Hispanic population includes a wide variety of nationalities and cultures, most Hispanics in Missouri have ties to Mexico, according to researchers. Officially, Hispanics make up about 3.5 percent of the state’s population, but they represented roughly 24 percent of the state’s population growth between 2000 and 2010, according to the researchers and Census data.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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