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Ch 3 Health disparities associated with race and ethnicity

Health disparities statistics

Chapter 3 of “What Pharmacists Need to Know About Race and Ethnicity” presents the data documenting disparities in mortality, morbidity, provision of health care, and other health indicators by race and ethnicity. The attached infographic highlights differences in life expectancy. Students are always startled to see the data and it always provokes questions and interest.

Health disparities statistics

Health disparities occur along the causal pathway from exposures and risk factors to all health outcomes.

The chapter explores disparities in life expectancy, mortality, incidence of disease, risk factors, and access to care, allowing students to explore the disparities along the pathways from causal factors to health outcomes. Students apply their skills in epidemiology, data analysis and statistics and gain a deeper understanding of how health disparities are manifested.

The figures and data are drawn from a range of government sources including the Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and Health Resources and Services Administration. All provide extensive documentation and resources for further study, such as the CDC Health Disparities and Inequalities Report.

Ch 2 Classification of race and ethnicity in the United States

How are race and ethnicity defined in the US?

In Chapter 1 of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities,  we spoke about race and ethnicity as social constructs. In Chapter 2 we pivot to describe the process used by the United States government uses to develop operational definitions of race and ethnicity to be used in carrying out government activities. It starts with the US census, where data are collected every 10 years to provide information about the US population. The definitions developed for the Census must be used by all federal agencies, as well as any other organization receiving federal funds. This covers pretty much everyone doing research on health disparities.

Classification of race and ethnicity is an unsatisfying process for a reason – it is a social construct and not based in science or biology.

Here’s the infographic.

Classification of race and ethnicity

Chapter 2 infographic

Ch 1 Concepts of race and ethnicity

An infographic introducing the main concepts of race and ethnicity in Chapter 1 of the text, What Pharmacists Need to Know About Racial and Ethnic Health Disparities.

Before we start thinking about racial and ethnic health disparities, let’s learn a little about the concepts of race and ethnicity, ethnocentrism and racism. Many times we use these words loosely, but they have specific meanings, and sometimes a long history of changing meanings. In the 19th century, race was thought of as a biological feature, but in the 21st century we understand that racial labels represent social constructs.
Concepts of race and ethnicity

Farmer’s markets, cultural competence, pharmacy practice – do these dots connect?

A walk through the farmer’s market can be a step on the way to cultural competence.

I visited Gainesville, Florida at the end of October, and my hosts from the College of Pharmacy took me through the local farmer’s market. My attention was piqued by the sub-tropical produce such as persimmons and pecans, items I don’t see at my farmer’s market in New England. Passing up the opportunity to purchase wild boar liver and other wild boar products, I stopped in my tracks when I saw a red, fruit-like thing, exotic and new to me, the calyx of the hibiscus flower. The calyx is a capsule surrounding the seeds, and it is about an inch in diameter.

Cultural competence

Photo: Jeff McMillian, used with permission

 

The hand written sign said, “sorrelle”. Walking further we found more “sorrelle”, also labeled “roselle”, and the stand owners explained that these were used to make a tea similar to the red zinger teas we could buy in the supermarket. From this I inferred that we were looking at hibiscus, and I bought a dried sample to take home with me. Once back home, I learned that the plant has many names. The scientific name is Hibiscus sabdariffa L, but it is also called Roselle, its original Arabic name is Karkade. and other common names are Sorrel, Red sorrel, Jamaica Sorrel, Lozey, Cabitutu, Vinuela, Oseille de Guinee, Pink Lemonade Flower, Vinagrillo, Afrika Bamya, sour-sour and Florida cranberry. The names hint at the many places around the world where it is used to make teas or iced beverages, and it is easy to access recipes for the beverage, including a recipe by Martha Stewart for Hibiscus Iced Tea.

As shown on this US Department of Agriculture map, Florida is the only place in the mainland United States where this plant grows. http://plants.usda.gov/core/profile?symbol=hisa2

USDA map showing where H. sabdariffa L grows in the United States.

USDA map showing where H. sabdariffa L grows in the United States.

A number of sources refer to widely held beliefs about the herb’s efficacy in lowering blood pressure, and it is not clear where and when these beliefs arose. Even less clear is the scientific evidence supporting such beliefs. A study funded by the USDA Agricultural Research Service and Celestial Seasonings and published in 2008 reported that hibiscus tea lowered blood pressure by 7.2 in a group of pre-hypertensive and mildly hypertensive adults compared to 1.3 points in a similar group of people drinking placebo beverage. Another USDA funded study confirmed antimicrobial activity of sorrel (Hibiscus sabdariffa) on Esherichia coli 0157:H7 isolates from food, veterinary and clinical samples.  It is possible to find other studies about H. sabdariffa L, and its potential effects on blood pressure, and even cholesterol, and this might make an interesting topic for a systematic literature review.

Whether or not there is a biologic effect on health, we are left wondering about the number of people in the area drinking the beverage, as well as their beliefs about the tea. Do people believe that the herb will lower their blood pressure? If so, does this affect their adherence to pharmacologic therapies? We can begin to envision some interesting lines of inquiry. At minimum it might be an interesting way to engage the local community and learn about local customs and beliefs.

Walking around a farmer’s market (or other local sites) is a pleasant way to begin learning about a community, and a nice metaphor for one aspect of cultural competence: Go out into the community you serve, look around, ask questions, taste, learn – repeat!

References
United States Department of Agriculture Natural Resources Conservation Service Plants Profile for Hibiscus sabdariffa (roselle). Available at http://plants.usda.gov/core/profile?symbol=hisa2
Fullerton M, Khatiwada J, Johnson JU, et al., “Determination of Antimicrobial Activity of Sorrel (Hibiscus sabdariffa) on Esherichia coli 0157:H7 Isolated from Food, Veterinary, and Clinical Samples” J Med Food 2011 September 14(9):950-956. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157304/
Bliss M, “Study Shows Consuming Hibiscus Tea Lowers Blood Pressure” USDA Agricultural Research Service News 2008. Available at http://www.ars.usda.gov/is/pr/2008/081110.htm

MIE Resource publishes “What Pharmacists Need to Know About Racial and Ethnic Health Disparities”

MIE Resources is proud to announce publication of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities” by Tamar Lasky, PhD,

a text for use in public health, health disparities, health services research, and related courses for pharmacy students in their second, third, and fourth years of training.

Racial and ethnic health disparities

This book, the first of its kind, introduces pharmacy students to basic concepts about race and ethnicity, and the classification of race and ethnicity in the United States for data collection. It then moves on to an overview  of the data collected regarding disparities in mortality, morbidity, provision of health care, and other health indicators and epidemiological studies of mechanisms and pathways to demonstrate the extensive body of evidence describing racial and ethnic health disparities. The text describes mechanisms through which race and ethnicity may affect health outcomes.

After laying a general background, the text addresses racial and ethnic health disparities that can occur in real-world pharmacy care, such as differences in disease conditions, response to medication, access to care, health literacy, and understanding of health and medications. It concludes with a discussion of the pharmacist commitment to eliminating racial and ethnic health disparities.

Available at amazon.com

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