RACIAL AND ETHNIC HEALTH DISPARITIES IN NORTH …
RACIAL AND ETHNIC HEALTH DISPARITIES IN NORTH CAROLINA
NORTH CAROLINA HEALTH EQUITY REPORT 2018
TABLE OF CONTENTS
Understanding Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Racial and Ethnic Health Disparities in North Carolina
Purpose of this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 About the Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Health Equity Report Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Social and Economic Well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Maternal and Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Child and Adolescent Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Health Risk Factors Among North Carolina Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Mortality Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Communicable Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Violence and Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Opioid Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Access to Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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UNDERSTANDING HEALTH
There are a few concepts we need to know before we can understand health .
Health equity is the absence of avoidable or remediable differences, allowing for the attainment of optimal health for all people . Health equity is achieved when everyone has the opportunity to attain their full health potential and no one is disadvantaged because of socially determined circumstances . Achieving it requires focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities .1
Health inequities are unfair health differences closely linked to social, environmental, or economic disadvantages that adversely affect specific groups of people . Inequity involves more than inequality with respect to health determinants and access to resources; it also represents a failure to avoid or overcome inequalities that infringe on fairness and human rights norms . It is important to understand that health inequities are different from health disparities .
geographic region . While ensuring equality in health and access to resources seems appropriate to mitigate health disparities, it should be noted that equality differs greatly from equity . Figure 1 demonstrates the differences between these concepts .
Equality, demonstrated in the first image, refers to equal inputs, though the outcomes can still be unequal .
Equity, demonstrated in the second image, refers to inputs that may need to be different to achieve equal outcomes .
FIGURE 1: EQUALITY VS. EQUITY
In the third image, no support or accommodations are needed because the cause of inequity has been addressed and the systematic barrier has been removed .
Social Determinants of Health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life . The five determinant areas that reflect the critical components that influence health outcomes in the state of North Carolina are neighborhood and built environment, economic stability, health
Health disparities are measurable differences in health status between people that are related to social or demographic factors such as race, gender, income, or
Photo adapted by City for All Women Initiatives equity and inclusion lens .
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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and health care, education, and social and community context . Within those areas, access to healthy foods, primary and other quality health care, and environmental conditions have a significant impact on disease development and prevention . For years, wealth and income have been linked to health . Economic resources protect people from certain daily stressors that, over time, can be particularly damaging to health .
ACCESS TO HEALTHY FOODS
Diet plays a critical role in the incidence and prevalence of chronic diseases . In 2014, 23 percent of North Carolina's total population lived in food deserts ? areas where residents experienced both a lack of access to supermarkets and healthy food, and high death rates from diet-related disease . The lack of adequate transportation available in low-income, segregated communities exacerbates malnutrition among the poor by hindering access to healthy foods in surrounding grocery stores .
ACCESS TO HEALTH CARE
ENVIRONMENTAL CONDITIONS
Racial and ethnic communities are less likely to have access to parks and other physical activity settings compared to white communities . Resource-poor neighborhoods can contribute to chronic and acute daily stress . Stress and other negative emotions have shown to evoke physiological processes that are associated with cardiovascular and liver diseases, obesity, hypertension, and diabetes .2
Residents living in low-income, segregated communities face greater barriers in accessing health services due to a growing shortage of providers . Adding to the problem is the lack of physicians willing and able to work in impoverished neighborhoods . Access to quality health care is an important component of prevention and management . Studies have shown that many low-income individuals do not seek needed medical care due to competing priorities, such as having to pay for food, shelter, or utilities bills .3 Adults and children from all racial minority and ethnic groups are less likely to have a usual place of care than whites .
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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Racial and Ethnic Health Disparities in North Carolina
PURPOSE OF THIS REPORT
Racial and Ethnic Health Disparities in North Carolina Health Equity Report 2018 is a tool that:
? Measures and monitors the state's progress toward eliminating the health status gaps experienced by racial/ethnic minorities;
? Provides current data that can aid community-based organizations, faith-based organizations, tribal governments, local health departments, state agencies, legislators, local businesses, and communities in devising services and outreach plans; and
? Can inform key decision makers about eliminating health disparities through policy reform and system change .
America's Health Rankings a report that analyzes states' health through the lens of clinical care, behaviors, community and environment, policy, and outcomes data, ranks North Carolina 32nd in the nation in overall health status in 2016 . Health status is directly impacted by the health status of minorities and other underserved populations .
ABOUT THE DATA
This North Carolina Health Equity Report contains data from various sources . The key indicators used were chosen based on their relevance to health and health disparities and the availability of data . Although data are presented by race/ethnicity to describe health status gaps, race/ ethnicity by itself is not a cause of any health condition or health status . For this 2018 Health Equity Report, all rates presented by race/ethnicity are mutually exclusive categories . Therefore, rates and figures presented here will differ from earlier Report Cards . Note: Some data show percentages, e .g ., from the North Carolina Behavioral Risk Factor Surveillance System (BRFSS), while other data show rates per 100,000 population (e .g ., mortality data) .
The ratios in this report are a measure, within each of the predominant racial/ ethnic groups in North Carolina, divided by that same measure in the White group; each indicates whether a disparity exists and the extent of that difference . The white population is used as a point of comparison because they are the majority population in North Carolina . In this report, the ratios have been categorized by color: red indicates a
group fares worse than the referent group, green indicates a group fares better than the referent group, and white indicates no significant difference between the referent and comparison group .
Here is an example .
The 2004--2008 prostate cancer death rate shown for African Americans (59 .1) divided by the prostate cancer death rate for whites (21 .3) provides a ratio of 2 .8 (i .e ., 59 .1?21 .3=2 .8) . This ratio indicates that the prostate cancer death rate for African American men was 2 .8 times the rate for white men during this time period .
The color coding system provided in this report does not consider trends in the data nor the ranking of North Carolina relative to the United States . Also note that data are not shown in cases where racial/ethnic groups have a small number of reported events or if their rates/ percentages are statistically unstable . The symbol is used to indicate reliable rates could not be calculated .
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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HEALTH EQUITY REPORT SUMMARY
Subject
Subcategory
Income
Social and Economic Well-Being
Education
Employment
Maternal/Child Health
Infant Death Rate Late or No Prenatal Care
Death of Children
Child and Adolescent Health
Teen Pregnancy
Children without Health Insurance
Risk Factors
Current Smokers Overweight
Mortality Rates
Cancer Heart Disease
Communicable Diseases
HIV Infection Chlamydia
Violence and Injury
Homicide Suicide
Access to Health Care
No Health Insurance Could Not See a Doctor
Green indicates a group is faring better than the referent group Red indicates a group is faring worse than the referent group
African American
American Indian
Hispanic/Latinx
Other
o White indicates there is no significant difference between the referent and comparison group Symbol indicates reliable rates could not be calculated
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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DEMOGRAPHICS
2016 Population Estimates 4
Total Gender
Male Female Age Group Under 18 18-64 65 & Over
Total Number % 10,146,788 100.0
White Number % 6,539,036 64.4
4,932,952 48.6 3,191,245 48.8 5,213,836 51.4 3,347,791 51.2
2,298,720 22.7 1,258,132 19.2 6,278,603 61.9 4,040,457 61.8 1,569,465 15.5 1,240,447 19.0
African American Number % 2,243,994 22.1
1,049,934 46.8 1,194,060 53.2
566,279 25.2 1,419,866 63.1 260,849 11.6
American Indian Number % 121,630 1.2
58,386 48.0 63,344 52.0
30,420 25.0 76,565 62.9 14,645 12.0
Hispanic/Latinx Number % 932,221 9.2
484,263 51.9 447,958 48.1
363,788 39.0 537,146 57.6 31,287 3.4
Other Number % 309,907 3.1
149,124 48.1 160,783 51.9
80,101 25.8 207,569 67.0 22,237 7.2
In 2016, North Carolina's population was an estimated 10 .1 million, with whites constituting the majority population at 6 .5 million people (64 .4 percent of the total state population) . African Americans represent the largest minority group, constituting 22 .1 percent of the population, followed by Hispanic/Latinx at 9 .2 percent . Data suggest that by 2050 there will be a demographic shift, with racial minorities becoming the majority population .5
North Carolina Health Equity Report 2018 ? Racial and Ethnic Health Disparities in North Carolina
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SOCIAL AND ECONOMIC WELL-BEING
Subject
Subcategory
Total %/Rate
White %/Rate
African American
%/Rate
Disparity Ratio
High School Graduation Rate, 2016-2017 6
86.5 89.2 83.8
1.1
Education
Adults 25+ with High School Diploma or GED, 20167 87.3 89.3 84.7
1.1
Adults 25+ with Bachelor's Degree, 2016 7
30.4 33.2 20.3 1.6
Employment Unemployed, 2016 7
3.8
3.0
6.1
2.0
Income
Median Household Income, 2016 7
$50,584 $55,656 $36,014 1.5
Poverty Rate
All Ages Children ................
................
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