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Browsing by Subject "health equity"

Now showing 1 - 7 of 7
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    Addressing Institutional Racism in Healthcare: A Case Study
    (2020-10) Banks, Barbra
    The extent of health inequities plaguing our nation is well-documented, with Black Americans continuing to experience the largest gaps (U.S. Department of Health and Human Services, 2014). Healthcare organizations cannot achieve racial health equity until they are willing to address institutional racism. With the magnitude of health inequities, particularly racial inequities, healthcare organizations addressing institutional racism as a part of their health equity efforts becomes even more critical. This case study offers an in-depth description of a Midwestern urban hospital birth center’s year-long equity education program, posing the question, “How does a large, urban hospital address institutional racism as a part of their health equity strategy?” Results show three outcomes of the department’s intervention to address racial health inequity and institutional racism: 1) the central features of the intervention’s framework and approach proved instrumental in individual development and change, 2) through double- and triple-loop learning, the department effectively addressed and began to dismantle institutional racism, and 3) the convergence of events leading to the intervention offered a “ripe” time for the creation, planning, and execution of the equity education program. Implications from this study contribute to healthcare, workplace diversity and inclusion, and human resource development scholarship and practice.
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    All Care is Health Care: How Healthcare-Legal Partnerships Are Challenging the Biomedical Paradigm
    (2018-05-05) Bhatnagar, Prashasti
    This project comprehensively examines how healthcare-legal partnerships (HLPs) are challenging the biomedical paradigm. I explore this in clinics through rich semi-structured interviews with HLP advocates (social workers, healthcare administrators, nurses, lawyers, and physicians) and focus groups with patients. In this paper, I will highlight the ways in which on-site legal services in clinics help in breaking down barriers that limit access to care and thus reduce anxiety and stress in patients. I will also argue that while helpful, HLPs continue to operate under a neoliberal biomedical model-based health care system and hence, do not provide a comprehensive solution to the complex health needs of patients. Health issues are not just legal issues; they are social issues that need to be addressed using a structural care approach.
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    Diagnosis, treatment, and survival among older women with breast cancer: the effect of pre-existing mental illness.
    (2021-04) Bhattacharya, Manami
    BackgroundPeople with a mental illness die 8-25 years earlier than people without a mental illness. Among women, decreased life expectancy is partially due to higher mortality from breast cancer; women with mental illnesses experience up to 367% increased hazards of mortality after breast cancers compared to women without mental illnesses. Yet, with timely detection and appropriate treatment breast cancer is very survivable. ObjectivesThis research focuses on how a pre-existing diagnosis of mental illness affects breast cancer outcomes across the cancer continuum, focusing on differences in stage of diagnosis, receipt of guideline-concordant care, and survival. I also examine whether outcomes vary by type and severity of mental illness. Finally, I evaluate whether the impact of mental illness varies by race, arguing that having marginalized identities associated with multiple forms of oppression may worsen outcomes. MethodsThis project uses the linked Surveillance and Epidemiology and End Results (SEER) cancer registry and Medicare claims (SEER-Medicare), a data national source that captures a significant proportion of breast cancer cases nationally among women over 65 years old. Mental illness is defined and categorized as having a diagnosis of serious mental illness (schizophrenia, bipolar disorder, depression with psychosis, and other psychotic disorders); depression or anxiety; and other mental illnesses excluding cognitive disabilities, in the two years prior to cancer diagnosis. Outcomes examined include AJCC staging, receipt of NCCN guideline-concordant care, focusing on surgery, radiation, and chemotherapy, and months of survival. A total of 96,034 women were included, though sample sizes vary depending on the analysis. ResultsPre-existing mental illnesses are common for women diagnosed with breast cancer. Overall, I found that 28.6% of women in this study had at least one diagnosis of a mental illness in the two years prior to their breast cancer diagnosis and 1.7 % had a serious mental illness. Women with SMI are more likely to be diagnosed with Stage II or III breast cancers than women without mental illnesses and women with depression or anxiety are less likely to be diagnosed with Stage IV cancers. In terms of treatment, I find that among women with AJCC stage I-III cancer, where either a mastectomy or breast conserving surgery and a full course of radiation is recommended, women with SMI less likely to receive surgery than women without. Women with mental illnesses (regardless of type) have a higher risk of not completing radiation after breast conserving surgery. Among women with AJCC stage I-III triple negative or HER2+ cancers, women with SMI are more likely to not complete surgery, radiation, and chemotherapy. Finally, I find that women with mental illnesses (regardless of type) have higher risks for mortality after cancer from both breast cancers and other causes, and that this risk is not entirely explained by stage of diagnosis and treatment received. Differences in survival are greatest for persons with SMI. I also investigated whether the effects of mental illness on cancer outcomes vary by race/ethnicity and find evidence that Black and Hispanic women may have especially high risks for later staging of breast cancer, incomplete treatment, and higher mortality. ConclusionsBreast cancer and mental illness are both common illnesses facing older women in the United States. This work provides new insights into issues of equity around breast cancer outcomes for older women with mental illnesses and provides entry points for considering interventions that will improve outcomes. This work also provides information for areas where inequities among Black and Hispanic women with mental illnesses experiencing breast cancer should be investigated further.
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    Fairness Estimation For Small And Intersecting Subgroups In Clinical Applications
    (2024-03) Wastvedt, Solvejg
    Along with the increasing availability of health data has come the rise of data-driven models to inform decision-making and policy. These models have the potential to benefit both patients and health care providers but can also exacerbate health inequities. Existing "algorithmic fairness" methods for measuring and correcting model bias fall short of what is needed for health policy in several ways that we address in this dissertation. First, in clinical applications, risk prediction is typically used to guide treatment, creating distinct statistical issues that invalidate most existing techniques. Second, methods typically focus on a single grouping along which discrimination may occur rather than considering multiple, intersecting groups. Third, most existing techniques are only usable for relatively large subgroups. Finally, most existing algorithmic fairness methods require complete data on the grouping variables, such as race or gender, along which fairness is to be assessed. However, in many clinical settings, this information is missing or unreliable. In this dissertation, we address each of these challenges and propose methods that expand the possibilities for algorithmic fairness work in clinical settings.
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    Influences on Support for Health and Social Policy Reform: Exploring Religiosity and Media as Contributors to Public Understanding of Health Equity
    (2023-07) Tait, Margaret
    A number of public health organizations have advanced goals of promoting health equity, or the opportunity for everyone to have a fair and just opportunity for health. While studies have explored influences on public understanding of disparities, or health differences that are closely linked with economic, social, or environmental disadvantages, few have considered influences on public understanding of health equity and support for policies that promote health equity. In this dissertation, I consider the influence of religious identity and media on public understanding of health equity and support for policy using survey data and media content. First, I use data from the National Survey of Health Attitudes, a nationally representative and probability-based survey that includes questions gauging respondents’ agreement with health equity beliefs. Next, I report the results of a survey-based experiment assessing the effects of messages that appeal to health equity on individuals’ support for policy. I fielded this experiment among a sample of individuals who identify as Christian, a prominent religious tradition in the U.S., and individuals who do not identify as religious. Finally, I analyze the content of public service announcements (PSAs) about the COVID-19 vaccine and reveal the extent that PSAs included messages that may have appealed to health equity. As part of this study, I explore community-level factors such as disease prevalence and politics that may have predicted PSA airings. I discuss the implications of these findings for health and social policy, health equity, and future research.
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    Violence Prevention as a Public Health Goal in Ramsey County, MN: Paths Forward for Equitable, Community-Centered Priority Setting Processes
    (2021-05) Dorman, Amy R.
    Public health priority setting processes through Community Health Improvement Plans at the local level are designed to be community-centered. Yet, debate continues around whether objective, data-driven decision-making or subjective, person-driven decision-making should be most influential in the priority setting processes of local health departments. When marginalized communities and health issues like domestic and sexual violence are often not adequately represented in quantitative data, questions around the equity of objective, data-driven decisions are crucial to consider. While subjective, person-driven decision-making may provide space for conversations that lift up populations and issues that data-driven processes miss, the power and privilege of those in the room – and who has the power to invite participants into the room in the first place – are paramount. This qualitative study discovered that the prioritization of violence prevention as a public health goal in Ramsey County, MN depended largely upon individual actor power (subjective) rather than data-driven (objective) factors. Opportunities remain for increased community member engagement and co-creation of public health policies through a priority setting process that acknowledges the power and privilege of individual actors who are invited and able to participate in the priority setting process. A path forward to health equity in local health department procedures and programs must center community input through continuous community member participation, relationship building, and increased accessibility of the public health priority setting process.
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    Violence Prevention as a Public Health Goal in Ramsey County, MN: Paths Forward for Equitable, Community-Centered Priority Setting Processes
    (2021-05) Dorman, Amy, R
    Public health priority setting processes through Community Health Improvement Plans at the local level are designed to be community-centered. Yet, debate continues around whether objective, data-driven decision-making or subjective, person-driven decision-making should be most influential in the priority setting processes of local health departments. When marginalized communities and health issues like domestic and sexual violence are often not adequately represented in quantitative data, questions around the equity of objective, data-driven decisions are crucial to consider. While subjective, person-driven decision-making may provide space for conversations that lift up populations and issues that data-driven processes miss, the power and privilege of those in the room – and who has the power to invite participants into the room in the first place – are paramount. This qualitative study discovered that the prioritization of violence prevention as a public health goal in Ramsey County, MN depended largely upon individual actor power (subjective) rather than data-driven (objective) factors. Opportunities remain for increased community member engagement and co-creation of public health policies through a priority setting process that acknowledges the power and privilege of individual actors who are invited and able to participate in the priority setting process. A path forward to health equity in local health department procedures and programs must center community input through continuous community member participation, relationship building, and increased accessibility of the public health priority setting process.