SPRINGER BRIEFS IN PUBLIC HEALTH CHILD HEALTH Michelle A. Lopez Elissa Z. Faro Suzette O. Oyeku Jean L. Raphael Disparities in Child Health A Solutions-Based Approach 123 SpringerBriefs in Public Health Child Health Series Editor Angelo P. Giardino, Salt Lake City, UT, USA SpringerBriefs in Public Health present concise summaries of cutting-edge research and practical applications from across the entire field of public health, with contributions from medicine, bioethics, health economics, public policy, biostatistics, and sociology. The focus of the series is to highlight current topics in public health of interest to a global audience, including health care policy; social determinants of health; health issues in developing countries; new research methods; chronic and infectious disease epidemics; and innovative health interventions. Featuring compact volumes of 50 to 125 pages, the series covers a range of content from professional to academic. 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More information about this series at http://www.springer.com/series/10138 Michelle A. Lopez • Elissa Z. Faro Suzette O. Oyeku • Jean L. Raphael Disparities in Child Health A Solutions-Based Approach Michelle A. Lopez Elissa Z. Faro Pediatrics-Hospital Medicine Division of Academic General Pediatrics Baylor College of Medicine Albert Einstein College of Medicine Houston, TX, USA Bronx, NY, USA Suzette O. Oyeku Jean L. Raphael Division of Academic General Pediatrics Pediatrics-Academic General Albert Einstein College of Medicine Baylor College of Medicine Bronx, NY, USA Houston, TX, USA ISSN 2192-3698 ISSN 2192-3701 (electronic) SpringerBriefs in Public Health ISSN 2625-2872 ISSN 2625-2880 (electronic) SpringerBriefs in Child Health ISBN 978-3-030-03209-8 ISBN 978-3-030-03210-4 (eBook) https://doi.org/10.1007/978-3-030-03210-4 Library of Congress Control Number: 2018962001 © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface This book was written and co-edited by a group of academic pediatricians who share a common and passionate commitment to addressing the needs of vulnerable populations and ultimately eliminating health disparities among children. Our group strives to untangle the complex and multilayered factors influencing pediatric health disparities. We want others to understand the root causes of inequities in child health and strategies to ameliorate health disparities through clinical care, research, policy, and legislation. The intention of this first edition is to create a state-of-the-art resource for medical students, researchers, clinicians, health policymakers, admin- istrators, and other groups invested in taking a solutions approach to addressing disparities. Disparities in health and health care have received considerable attention over the past two decades. In 2002, the Institute of Medicine released the landmark report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” While health disparities as a field has made unprecedented progress, it has largely focused on adults. Less attention has been concentrated toward children. In this book, readers will find relevant and practical information on the subject of health disparities among children. The objectives of this monograph are to (1) describe how children differ from adults and the relevance to disparities, (2) review current data on pediatric health disparities, (3) provide a framework for addressing disparities among children, (4) describe interventions with the potential to reduce or eliminate health disparities, and (5) outline future avenues for an agenda to address pediatric disparities. Our overarching goal is to provide readers with the tools to successfully engage in addressing pediatric disparities. We truly hope to advance the readers’ knowledge and interest in health disparities and child health outcomes. Thank you for your interest in reading our work. Houston, TX, USA Michelle A. Lopez Bronx, NY, USA Elissa Z. Faro Bronx, NY, USA Suzette O. Oyeku Houston, TX, USA Jean L. Raphael v Acknowledgments The authors wish to express their appreciation to: • Janie Garcia, from the Section of Academic General Pediatrics at Baylor College of Medicine, for her editorial assistance • Angelo P. Giardino, MD, PhD, MPH, Series Editor, for having the vision to pro- mote critical topics in child health as part of the SpringerBriefs in Child Health Series • Janet Kim, MPH, Editor, Public Health at Springer, for her consistent encourage- ment to produce this monograph on Pediatric Health Disparities and offering it as part of the SpringerBriefs in Child Health Series vii Contents 1 Disparities in Child Health: A Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Jean L. Raphael and Michelle A. Lopez 2 Quality of Care in Pediatrics and Health Disparities: The Increasing Role of Quality Improvement Science . . . . . . . . . . . . . . 11 Jean L. Raphael, Elissa Z. Faro, and Suzette O. Oyeku 3 Community Health Worker Interventions . . . . . . . . . . . . . . . . . . . . . . . . 25 Michelle A. Lopez 4 Technology-Based Interventions to Address Pediatric Health Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Michelle A. Lopez 5 Pediatric Health Disparities and Place-Based Strategies . . . . . . . . . . . . 39 Jean L. Raphael 6 Healthcare Financing and Social Determinants . . . . . . . . . . . . . . . . . . . . 47 Jean L. Raphael 7 Future Directions for a Solutions-Based Approach . . . . . . . . . . . . . . . . . 53 Jean L. Raphael Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 ix Chapter 1 Disparities in Child Health: A Review Jean L. Raphael and Michelle A. Lopez Introduction Since the 2002 publication of the Institute of Medicine’s landmark document on health disparities Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, inequities in the US healthcare system have received unprecedented attention from clinicians, advocacy groups, and policy makers [1]. In Healthy People, a national health promotion and disease prevention initiative, the elimina- tion of health disparities has consistently been listed as an overarching goal [2]. The Agency for Healthcare Research and Quality has issued an annual national health care disparities report since 2003 [3]. In 2010, the National Center on Minority Health and Health Disparities was redesigned as an Institute, elevating the research agenda focused on eliminating health disparities. Researchers, professional organi- zations, and advocacy groups have made considerable efforts to incorporate address- ing health disparities into their strategic goals [4–6]. While health disparities increasingly comprise a focus for health care research, policy, and advocacy regarding adults, little attention is directed towards inequities in children although it is estimated that by 2025, half of all US children with be nonwhite [7]. Comprehensive health reports predominantly focus on adults, with assumptions that the factors contributing to disparities in pediatrics will mirror those of the adult population. In Unequal Treatment, only 5 of 103 studies cited specifically addressed disparities in pediatric health care [1]. Over the past decade, J. L. Raphael (*) Pediatrics-Academic General, Baylor College of Medicine, Houston, TX, USA M. A. Lopez Pediatrics-Hospital Medicine, Baylor College of Medicine, Houston, TX, USA © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2018 1 M. A. Lopez et al., Disparities in Child Health, SpringerBriefs in Public Health, https://doi.org/10.1007/978-3-030-03210-4_1 2 J. L. Raphael and M. A. Lopez the number of research studies addressing pediatric disparities has dramatically increased and covers a wide range of topics, including primary care, inpatient care, and chronic disease management [8–22]. While this outgrowth of research has vastly improved the knowledge around pediatric health disparities, there remains some debate about how to best move forward the discourse on addressing inequities in child health with the goal of innovative solutions-based strategies [23–25]. The goals of this monograph are to (1) describe how children differ from adults and the relevance to disparities; (2) review current data on pediatric health disparities; (3) provide a framework for addressing disparities among children; (4) describe inter- ventions with the potential to reduce or eliminate health disparities; and (5) outline future avenues for an agenda to address disparities in child health. Definitions Historically, disparities have been defined in the context of differences between racial or ethnic groups (Table 1.1). Unequal Treatment defines disparities in health care as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of inter- vention.” [1] Categories of racial groups include American Indian or Alaska Native, Asian, Black or African-American, Native Hawaiian or other Pacific Islander, and White. Categories for ethnic groups consist of Hispanic or Latino and Not Hispanic or Latino. These definitions have received considerable criticism for several reasons Table 1.1 Definitions related to health disparities Source of Term definition Definition Health Healthy Health difference affecting groups of people who have disparity People 2020 systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion Health equity Healthy Attainment of the highest level of health for all people. People 2020 Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities Health World Health Avoidable inequalities in health between groups of people inequity Organization within countries and between countries. Inequities arise from inequalities within and between societies Social World Health The circumstances in which people are born, grow up, live, determinants Organization work and age, and the systems put in place to deal with illness. of health These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics