Administering health education programs as a resource and advocate

Health Program Bronx

Racial Disparities in the Healthcare System

America's healthcare system is one of the most visible indicators of the broad array of social, economic and racial inequalities that still impact American life. For racial minorities such as African-Americans and Latinos, health outcomes are disproportionately worse than they are for white patients. This denotes a core inequality that goes to the root of our society. Outreach, education and advocacy programs such as the one described here in relation to minority populations living in the Bronx helps to provide a valuable case demonstration of this public health issue.

Collaborating Organizations:

The pressing racial issues that are evidenced in our imbalanced healthcare system serve as the impetus for the agenda and actions taken up by the REACH Bronx organization. This action-group is actually described as a coalition of groups and demonstrates the considerable push from a wide variance of parties to bring greater socioeconomic equality to such impoverished urban settings. According to Calman's (2005) article, the project came together under the mobilization of a broad cross-section of groups. Calman tells that "nearly forty community groups representing the 280,000 residents of four ZIP codes in the South Bronx, including social service agencies, health care providers, housing development corporations, an afterschool program, and faith-based institutions, have joined to address these health disparities." (Calman, p. 492)

Among these community groups would be those involved in the prevention and treatment of heart disease and diabetes, two causes of mortality that disproportionately impact poor African-American and Latino communities. Moreover, this collective of smaller groups would gain much of its resource support from broader endorsing agencies. Accordingly, Calman reports that the Centers for Disease Control and Prevention channeled a sizeable grant to the coalition under the auspices of its Racial and Ethnic Approaches to Community Health (REACH). Additional funding and political support for the Bronx-based program would come from the New York State Department of Health's Office of Minority Healthy. Other local funders, not identified by name in the report, would help to provide resource and monetary support.

Factors Influencing Decision-Makers:

One key factor influencing both those in the coalition and these broader agencies responsible for providing funding support is the sometimes inestimable impact that sociological disparities can have on the health consequences for racial 'minorities.' This is a driving imperative for a program that centers on improving the distribution of health knowledge with an emphasis on self-advocacy. This area is cited as one of the most troubling areas of distinction between white and black patient populations and has a significant bearing on the quality of treatment that individuals will tend to receive. On this point, Calman remarks that surveyed participants in a study of quality of health treatment as a function of racial differences have expressed significant feelings of mistrust and resentment. The need to remove some of these barriers between patients and healthcare providers is a prominent one and a driving factor for decision-makers.

Calman indicates that "the participants expressed the belief that self-advocacy is important to obtaining necessary, appropriate health care, but many found it difficult to carry out. Some did not understand how to advocate for the best care because they did not know what care they needed." (Calman, p. 492)

Perhaps more than any single factor driving decision-makers, the need to provide minority populations with an understanding of the value of self-advocacy and with the tools to engage in self-advocacy both emerge from this discussion as practical and attainable through such outreach programs.

Levels of Influence for Health Related Behavior:

One of the most critical levels of influence on health related behavior is that which pertains to the notion of health belief. Belief is often one of the most powerful determinants of how an individual will respond to emergent health concerns. This correlates not just to how individuals pursue individual health concerns but, further, extends to how individuals interact with the broader health system. The belief amongst minorities that options do not exist for healthcare access or coverage may prevent interaction with the system at critical levels.

To this end, the Calman text refers to the nature of an outreach and education program that begins with a call for universal health insurance coverage. To an extent, health behavior relating to the seeking of health insurance coverage is often impacted by a belief that no access exists for those of limited means. Calman notes that "there must be increased outreach and a simplified enrollment process for existing government health insurance programs so that all eligible people can participate. Long and complicated application forms, confusion about eligibility, and being made to answer personal questions are among the top reasons for not enrolling cited by Medicaid eligible survey respondents." (Calman, p. 493)

The array of reasons given for not attempting constructive interaction with the healthcare system speak to the power that the factor of belief can have on health behaviors. According to the mission provided by the Bronx Health REACH, there is significant cause to believe that a push toward a change in the beliefs of minority groups can have a substantial impact on health behavior. However, it is also the case that the segregationist practices and limited access to knowledge on healthcare rights have contributed to what is founded sense of distrust for many minority groups. Thus, practices must change at the healthcare operational level in order to effectively bring about changes in the perceptions of patients.

Selected Educational Resource:

Perhaps the most important premise to emerge from the present research is that concerning the continued disparity that occurs as a function of race in the U.S. To an extent, the actions of the civil rights era have helped to obscured continued and severe differences in standards of living as they occur in such contexts as the healthcare system. It is thus that the Bronx Health REACH website offers some crucial educational resources for the visitor's consideration. Indeed, the Resource Center provides a bevy of links detailing racially driven health disparities, such as that entitled Take Action on Health Disparity! (http://www.bronxhealthreach.org/resource-center/educational-materials-and-toolkits/health-disparity/)