Transitioning to a Diagnosis and Plan

00:01 We're gonna be discussing caring for diverse populations as as well as cultural humility now.

00:07 And this is a subject that's particularly important to me personally.

00:11 I've worked in my clinical practice in the same community health center for the past 20 years, and we are the largest safety net health care provider for our area.

00:22 In addition, I'm very interested in health disparities, because I think until we really address health disparities and provide culturally humble care to our patients, we're not gonna provide an optimal patient experience, and we also won't really get the outcomes we want to in terms of patient's taking physician's advice, adhering to treatment regimens, and incorporating lifestyle changes that really makes a difference, so we're gonna some spend time discussing some different definitions which aren't usually covered within the medical school curriculum but are important for patient care and USMLE as well.

00:57 And then we'll be talking about health disparities.

00:59 Going through some statistics.

01:01 How they really go from birth to grave.

01:04 And then finally, we will talk about implicit bias, something that we all share, and something that we can still do something about.

01:11 All right, so let's start with a definition, and you know, first, I think that when we think about health disparities, a lot of times we divide it by race and ethnicity.

01:20 It's important to understand that race is a social construct,vv not a biological category.

01:26 While human genetic variation exists on a geographic continuum, there is no genetic basis for racial categories.

01:34 However, we do need to understand that some clinically relevant genetic variants occur at different frequencies in different populations.

01:42 For example, the APOL1 variants that increase kidney disease risk are more common in people of West African descent.

01:52 Different cystic fibrosis mutations occur at varying frequencies across populations.

01:58 And variants affecting how people metabolize certain medications, like warfarin, also differ across populations.

02:05 Ethnicity, I think it's a definition that brings a lot closer.

02:10 So we're talking about a social group that's characterized by a distinctive social and cultural tradition, maintained from generation to generation, a common history and origin and a sense of identification within the group.

02:22 While some genetic variants occur at different frequencies in different populations due to geographical and historical factors, these biological differences are specific to particular genes or traits and do not support the concept of distinct racial or ethnic categories.

02:39 For example, a population may have a higher frequency of certain variants affecting drug metabolism or disease risk, but this does not mean they are biologically distinct in any broader sense.

02:51 These features may be reflected in their experience of health and disease.

02:55 So this is a definition I think that I can certainly relate to a lot better than race alone, because it's about values, and it's about practices.

03:04 It's about habits, and it's passed down from generation to generation.

03:08 And yes, there is probably some link to genetic heritage but not necessarily so.

03:14 So this is something that I feel like I can grab hold of, it's going to very much be a part of my clinical encounter and my patient's health care.

03:21 And it also reflects the definition of culture.

03:25 So there's a lot of definitions of culture out there.

03:27 There's a lot of definitions of race and ethnicity.

03:30 These I think are really strong ones, but it doesn't mean they're the only ones.

03:35 Culture can be defined as the shared values, beliefs and practices of a particular group of people which are transmitted from one generation to the next and are identified as patterns that guide the thinking and action of the group members, and that's called culture.

03:48 It really reflects I think what we just discussed and that's ethnicity, the two are often linked and very, very important to consider in health care.

03:57 Because when you don't, you wind up with health disparities.

04:01 It's crucial to note that while some genetic variants affecting health occur at different frequencies in different populations, health disparities result primarily from social, economic, and environmental factors.

04:15 This includes systemic inequities in healthcare access and delivery, socioeconomic status, and exposure to environmental stressors.

04:24 Let's look at how life expectancy has changed across different populations in the United States, particularly focusing on the impact of COVID-19. particularly focusing on the impact of COVID-19. This graph shows life expectancy data from 2019, before the pandemic, and 2021, during the COVID era.

04:42 First, notice that even before COVID-19, we had significant disparities in life expectancy.

04:48 Asian Americans had the highest life expectancy at 85.6 years, while American Indian and Alaska Native populations had the lowest at 71.8 years - a gap of nearly 14 years.

05:02 The COVID-19 pandemic worsened these pre-existing disparities. Look at the red bars compared to the green bars for each group.

05:10 Every population experienced a decline in life expectancy, but the impact wasn't equal. American Indian and Alaska Native communities experienced the steepest decline - 6.6 years - bringing their life expectancy down to 65.2 years, similar to the U.S. average in 1944.

05:31 Hispanic Americans saw the second-largest decline of 4.2 years, followed by Black Americans with a 4.0-year decline.

05:41 In contrast, white Americans experienced a smaller decline of 2.4 years, and Asian Americans had the smallest decline of 2.1 years.

05:52 This unequal impact reflects underlying societal inequities in healthcare access, working conditions, and living conditions.

06:01 Many marginalized communities had higher exposure risks due to essential worker status, crowded living conditions, and limited access to healthcare and vaccination.

06:12 This graph shows the rates of low birthweight infants - those weighing less than 2,500 grams at birth - across different populations. The overall U.S. rate is 8.9%, but notice the significant disparities. Non-Hispanic Black mothers experience the highest rate at 14.7%, nearly double the national average. Hispanic mothers have a rate of 9.8%, while Asian mothers show rates of 8.5%.

06:44 These differences aren't due to biological factors, but rather reflect inequities in healthcare access, socioeconomic conditions, and environmental factors affecting maternal health.

06:56 Understanding these disparities helps us target interventions to improve birth outcomes for all populations.

07:03 Looking at childhood obesity rates in the U.S., we see significant variations across different population groups.

07:09 The overall national rate is 19.7%, meaning about one in five American children are affected by obesity.

07:18 However, this average masks important disparities.

07:22 Hispanic children show the highest rate at 26.2%, followed closely by Non-Hispanic Black children at 24.8% - both significantly above the national average.

07:35 Non-Hispanic White children have a lower rate at 16.6%, while Non-Hispanic Asian children show the lowest rate at 9.0%. These differences aren't biological but reflect social and environmental factors like access to healthy foods, safe spaces for physical activity, and community resources.

07:58 What makes these disparities particularly concerning is their long-term impact.

08:03 Obesity during childhood is a strong risk factor for obesity in adulthood. This, in turn, leads to higher rates of serious health conditions like diabetes, hypertension, and heart disease - all factors that contribute to early mortality.

08:19 The prevalence of transgender individuals is estimated at 1% among those assigned male or female at birth, translating to approximately 25 million people worldwide.

08:31 As healthcare providers, it’s crucial to understand this growing population’s unique needs and challenges.

08:38 There are many different terms out there. To give you some orientation, you can look at our download section.

08:45 This slide highlights the significant health and social disparities faced by transgender communities.

08:52 Transgender individuals experience a poverty rate of 29.4%, more than double the general population's 11.8%.

09:02 Violence is a major issue, with 47% experiencing sexual assault and 57 murders documented in 2021. Economic vulnerability is evident, with 12% engaging in sex work for income.

09:17 Health disparities are stark, as 14% of transgender women are living with HIV, a figure that rises to 44% among Black transgender women. Additionally, 33% report negative experiences in healthcare, leading 23% to avoid care altogether. These figures underscore the systemic barriers and discrimination that contribute to these disparities, emphasizing the urgent need for affirming healthcare and equitable support systems.