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Minority Health

Definition, Description, Causes and symptoms, Diagnosis, Treatment, Alternative treatment, Prognosis, Prevention

Minority health addresses the special medical and/or health needs associated with specific ethnic groups.

Description

The United States, as well as many other countries, experiences cultural diversity. This poses specific health issues that are specific to ethnic groups. Additionally, the propensity for certain diseases or illnesses is of concern in certain minority groups. These specific health issues include infant mortality rates, cancer, cardiovascular disease, diabetes, HIV infection, and immunizations.

Infant mortality rates

Infant mortality rates (IMRs) in the United States and in all countries worldwide are an accurate indicator of health status. They provide information concerning programs about pregnancy education and counseling, technological advances, and procedures and aftercare. IMRs vary among racial groups. African Americans had an IMRs of 14.2 per 1,000 live births in 1996, approximately 2.5 times higher than Caucasians. The IMRs among American Native Indian groups varies greatly, with some communities possessing IMRs about two times more than national rates. Additionally Hispanic IMRs (7.6 per 1,000 live births) are also diverse for separate groups, since the IMRs, for example, among Puerto Ricans is higher (8.9 per 1,000 live births).

Cancer

Cancer is a serious national, worldwide, and minority health concern. It is the second cause of death in the United States, claiming over half a million lives each year. Approximately 50% of persons who develop cancer will die. There is great disparity among the cancer rates in minority groups. Across genders, cancer death rates for African Americans are 35% higher when compared to statistics for Caucasians. The death rates for prostate cancer (two times more) and lung cancer (27 times more) are disproportionately higher when compared to Caucasians. There are also gender differences among ethnic groups and specific cancers. Lung cancers in African American and Hawaiian men are elevated compared with caucasian males. Vietnamese females who live in the United States have five times more new cases of cervical cancer when compared to Caucasian women. Hispanic females also have a greater incidence of cervical cancer than Caucasian females. Additionally, Alaskan native men and women have a greater propensity for cancers in the rectum and colon than do Caucasians.

Cardiovascular disease

Cardiovascular disease is the leading cause of disability and death rates, about equal to death from all other diseases combined. Cardiovascular disease can affect the patient's lifestyle and function in addition to having an impact on family members. The financial costs are very high. Among ethnic and racial groups cardiovascular disease is the leading cause of death. Stroke is the leading cause of cardiovascular related death, which occurs in higher numbers for Asian-American males when compared to Caucasian men. Mexican-American men and women and African American males have a higher incidence of hypertension. African American women have higher rates of being overweight, which is a major risk factor of cardiovascular disease.

Diabetes

Diabetes—a serious health problem in Americans and ethnic groups—is the seventh leading cause of death in the United States. The prevalence of diabetes in African Americans is about 70% higher than Caucasians.

HIV

HIV infection/AIDS is the most common cause of death for all persons age 25 to 44 years old. Ethnic groups account for 25% of the United States population and 54% of all AIDS cases. In addition to sexual transmission there is an increase in HIV among ethnic groups related to intravenous drug usage.

Immunizations

Immunization, the reduction of preventable disease by vaccination, was lower in 1996, but there has been a rapid increase in African Americans taking vaccinations. The coverage for immunization among African Americans and Hispanics for persons age 65 and over is currently below the general population. This may increase the death rates due to respiratory infections.

Causes and symptoms

IMRs are correlated with prenatal care. Women who receive adequate prenatal care tend to have better pregnancy outcomes when compared to little or no care. Women who receive inadequate prenatal care also have increased chances of delivering a very low birth weight (VLBW) infant, which is linked to risk of early death.

Cancer is related to several preventable lifestyle choices. Tobacco use, diet, and exposure to sun (skin cancer) can be prevented by lifestyle modifications. Additionally many cancers can occur due to lack of interest and/or lack of availability for screening and educational programs.

Cardiovascular diseases are higher among persons with high blood cholesterol and high blood pressure. Certain lifestyle choices may increase the chance for heart disease includes lack of exercise, overweight, and cigarette smoking. Cardiovascular disease is responsible for over 50% of the deaths in persons with diabetes.

HIV occurs at a higher frequency among homosexuals (the number of African Americans males who have AIDS through sex with men has increased). Additionally, unprotected sexual intercourse and sharing used needles for IV drug injection are strongly correlated with infection.

Vaccinations are an effective method of preventing certain disease such as polio, tetanus, pertussis, diphtheria, influenza, hepatitis b, and pneumococcal infections. Approximately 90% of influenza related mortality is associated with persons aged 65 and older. This is mostly due to neglect of vaccinations. About 45,000 adults each year die of diseases related to hepatitis B, pneumococcal, and influenza infections.

Diagnosis

The diagnosis of VLBW is by weight. Infants who weigh 1,500 g are at high risk for death. For cancer, the diagnosis can be made through screening procedures such as mammography (for breast cancer), PAP smear (for cervical cancer), and lifestyle modifications such as avoidance of sun and cigarette smoking. Balanced diets and adequate nutrition also help. Other specific screening tests (PSA, prostate surface antigen) are helpful for diagnosing prostate cancer. Cardiovascular diseases can be detected by medical check-up. Blood pressure and cholesterol levels can be measured. Obesity can be diagnosed by assessing a person's weight relative to height. Diabetes and its complications can be detected by blood tests, in-depth eye examinations and studies that assess the flow of blood through blood vessels in legs. HIV can be detected through a careful history/physical examination and analysis of blood using a special test called a western blot. Infections caused by lack of immunizations can be detected by careful physical examination and culturing the specific microorganism in the laboratory.

Treatment

Treatment is directed at the primary causes(s) that minorities have increased chances of developing disease(s). Cancer may require treatment utilizing surgery, radiotherapy, or chemotherapy. Cardiovascular diseases may require surgical procedures for establishing a diagnosis and initiating treatment. Depending on the extent of disease, cardiovascular management can become complicated requiring medications and daily lifestyle modifications. Treatment usually includes medications, dietary modifications, and—if complications arise—specific interventions tailored to alleviating the problem. HIV can be treated with specific medications and more often than not with symptomatic treatment as reported complications arise. Diseases caused by lack of immunizations are treated based on the primary disease. The best method of treatment is through prevention and generating public awareness through educational awareness.

Alternative treatment

Alternative therapies do exist, but more research is needed to substantiate present data. The diseases that relate to minority health are best treated with nationally accepted standards of care.

Prognosis

Generally the prognosis is related to the diagnosis, patient's state of health, age, and if there is another disease or complication in addition to the presenting problem. The course for IMR's is related to educational programs and prenatal care, which includes medical and psychological treatments. The prognosis for chronic diseases such as cardiovascular problems, high blood pressure, cancer, and diabetes is variable. These diseases are not cured and control is achieved by standardized treatment options. Eventually complications, even with treatment, can potentially occur. For HIV the clinical course at present is death even though this process may take years. Educational programs with an emphasis on disease prevention can potentially improve outcomes concerning pediatric and geriatric diseases.

Prevention

Prevention is accomplished best through educational programs specific to target populations. IMRs can be prevented by increasing awareness, interest, and accessibility for prenatal care that address a comprehensive approach for the needs of each patient. Regular physicals and special screening tests ca potentially prevent certain cancers in high-risk groups. Educational programs concerning lifestyle modifications, diet, exercise, and testing may prevent the development of cardiovascular disease and diabetes. Educational programs assemble to illicit IV drug abusers and persons who engage in unprotected sexual intercourse may decrease the incidence of HIV infection.

Resources

BOOKS

Rosen, Peter. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book, Inc., 1998.

ORGANIZATIONS

Office of Minority Health. 2001. <http://www.omhrc.gov/rah/3rdpgBlue/Cardio/3pgGoalsCardio.htm>.

Laith Farid Gulli, M.D.

Nicole Mallory, M.S.

DR. ANTONIA NOVELLO (1944– )


(Gamma Liaison. Reproduced by permission.) (Gamma Liaison. Reproduced by permission.)

Born Antonia Coello was born in Fajardo, Puerto Rico, on August 23, 1944, the oldest of three children. At eight years old, she suffered two blows that she would carry all of her life. Her father, Antonio Coello, died, leaving her mother, Ana Delia Flores Coello, to raise her children alone until she later remarried Ramon Flores, an electrician. Novello was also diagnosed with a chronic condition called congenital megacolon, an illness in which her colon was overly large and not functioning properly, which required regular hospitalization. Although an operation would have helped Novello, it was not performed until she was 18 years old, and even after the surgery, complications followed her for years. Because of her childhood illness, Novello grew up wanting to be a doctor.

On October 17, 1989, President George Bush officially nominated Novello for Surgeon General. The fourteenth United States Surgeon General, Novello was sworn in on March 9, 1990. She remarked that "the American dream is well and alive…today the West Side Story comes to the West Wing." Novello was the first woman and the first Hispanic to be appointed Surgeon General of the United States. Noted for her philosophy of "good science, good sense" and for her approachability, Novello was dedicated to the prevention of AIDS, substance abuse, and smoking, as well as to the education of the American public. Her special concerns were for women, children, and Hispanics—populations often overlooked by public health services.

KEY TERMS


Prevalence—Number of existing cases relative to time.

Propensity—A greater risk for developing a disease.

Additional topics

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