Just Read: In DC, there’s up to a 14 year life expectancy gap between blacks and whites that hasn’t changed in 15 years

The life expectancy of a black male in Washington, DC as of 2009 is the same as a man in North Korea as of 2012. For a white male, the life expectancy is higher than Israel, lower than Switzerland.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Male – 46576 on Flickr.com

The life expectancy of black females in Washington, DC as of 2009 is in between The Russian Federation and Syria or Iran as of 2012. It’s higher than North Korea, which is 73 years. For white females in Washington, DC, it’s just below the highest life expectancy in the world, Japan.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Female – 46577 on Flickr.com

Yikes.

This article caught my eye because of my recent trip to Anacostia, in Washington DC’s Ward 8, where health disparities are extremely tangible (underscore): The People of Washington, DC’s Anacostia are Building a Culture of Health | Ted Eytan, MD

They are not just tangible in Anacostia, they’re visible on my walk to work through the city, where I pass through about 8 years of life expectancy. Just do a search of “#activetransportation” on my Twitter feed to see photos of what this looks like; it’s obvious.

This paper, published in this month’s Health Affairs (Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82) is an analysis of the disparity in life expectancy between whites and blacks in all 50 states and the District of Columbia, using census data.

It confirms what I see on my walk to work, and adds another piece of data that I don’t see, which is that this disparity has continued, unchanged, for the last 15 years:

The estimated state-specific racial gap in life expectancy among males in 1990 ranged from 14.4 years (95% CI: 13.3, 15.4) in the District of Columbia to 0.0 years (95% CI: −5.2, 5.3)

For females, the District of Columbia and New Hampshire also had the largest (10.4 years; 95% CI: 9.5, 11.2) and smallest (1.2 years; 95% CI: −3.9, 6.2) gaps, respectively, in 1990. In 2009, despite overall improvement at the national level, the enormous racial gap in the District of Columbia remained almost completely unchanged for both males (+0.4 years; 95% CI: −1.1, 1.8) and females (+0.2 years; 95% CI: −1.1, 1.6). Life expectancy there remained dramatically more unequal than in every other state.

And then if you compare the change in life expectancy for women (men show the same trend), it’s been constantly disparate since 1990.

And then there was New York

New York State has shown a different trajectory, as you can see from this chart. There has been a massive upgrade in life expectancy for black men and women compared to their white counterparts, narrowing the gap the greatest.

The largest decrease in the gap for males occurred in New York (−5.6 years; 95% CI: −6.0, −5.1), largely because of a dramatic increase in black life expectancy, from 63.9 years to 75.4 years. This was a gain of 11.5 years; the national average gain was 6.5 years.

I’ve written about this previously (New Yorkers Living Longer Than Ever, Outpacing National Trend, a look at the data | Ted Eytan, MD). It’s real. And since I’ve written about it, a review of what happened in New York has been published just this year (Preston SH, Elo IT. Anatomy of a Municipal Triumph: New York City’s Upsurge in Life Expectancy. Popul. Dev. Rev. 2013). A lot of New York’s success has come from identification and treatment of HIV, as well as the same for drug and alcohol related injury/death. It’s worth a read for sure.

Our cities are changing, we just need to make the change happen for all

A few more really important DC datapoints:

  1. Population in 1950: 802,178
  2. Population in 1990: 606,900, 70 % black
  3. Population in 2010: 601,723, 50 % black
  4. Population in 2013: 646,449

In this map you can see where the black and white population live. The green color represents black residents, the blue represents white residents:

You can grab and manipulate this map yourself at the continually awesome CommunityCommons.org (@CommunityCommon)

I cross the “dividing line” in the middle when I walk to work. Ward 8 (Anacostia) is in the lower right. Every other map you could draw, from bikeshare rentals to income to education is going to show the same disparity. With this visual, it’s not hard to tell why an “enormous” disparity still exists between black and white people.

I still see proclamations of Washington, DC as the “third thinnest” state, which badly misrepresents the huge disparities here and harms our ability to understand the health of our community.

Why this is not good

There is good news, which is that life expectancy for both black and white men and women has increased in Washington, DC (by 4+ years for both black and white women, by 8+ years for black and white men).

A significant inequality still exists and that’s a problem. This means that the opportunity of black men and women to achieve their life goals starting with a long life is blunted compared to white men and women.

Diversity brings with it a torrent of innovation. If this trend does not change, we’ll learn less every day, and enjoy our community and the world a lot less. And why would we want to do that?

We share our community with incredible leaders who don’t support the status quo:

I’m with Ruby. We are going to change everything :) .

Permission to reproduce the images courtesy Health Affairs (@Health_Affairs)

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TEDMED Blog : Examined Lives: An MD on living and helping to guide the evolution of transgender health

I’ve done more than 10,000 surgeries and they had little emotional impact on me because I was shut down. There’s no emotional attachment. I know I did it; I earned a good living; I remember things people wrote and cakes people made for me, but there’s no attachment.  It’s only after I transitioned that everything has been more real and alive and colorful.  We do know that the memories that most vivid and are easiest to retrieve are those with the most emotional content to them, but you need to be receptive.

Wonderful interview of Dana Beyer, MD. Thanks, TEDMED (@TEDMED) team for listening – the best use of technology ever.

via TEDMED Blog | The future of health & medicine is here too.TEDMED Blog | The future of health & medicine is here too..

Don’t forget to catch the special Google + Hangout today at 2:00 pm – Great Challenges : Transgender Health : An Evolution to Understanding.

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The E Pluribus Unum Prize and Learning about Language Access in Health Care

Gayle Tang, Senior Director, National Diversity and Inclusion, accepts the award on behalf of Kaiser Permanente (View on Flickr.com)

Although I am one to mention all of the things I wasn’t taught in medical school, interacting with a professional language interpreter was something I was taught in medical school, and it had a huge impact on me. This goes to show that even the briefest of training early in one’s career can make a big difference…

Last week, I got to observe Kaiser Permanente receive the E Pluribus Unum Prize Corporate Leadership Award. As quoted from: Kaiser Permanente Share | Kaiser Permanente Recognized with Corporate Leadership Award for Providing Culturally and Linguistically Appropriate Health Care and Services

The Migration Policy Institute (@MigrationPolicy) has awarded Kaiser Permanente with the prestigious E Pluribus Unum Prizes’ Corporate Leadership Award, recognizing the organization’s leadership in immigrant integration and providing culturally and linguistically appropriate health care and services.

National Diversity and Inclusion Conference – Earns the Badge View ‘Patients Included’ on Flickr.com

Recently, I helped facilitate a panel of our members at our National Diversity and Inclusion conference, which included a member with limited english proficiency. It was a great experience for me. Gayle Tang (pictured above) and colleague Jane Tong Delore L.Ac, provided professional interpretation in the setup and during the session. As with so much other work I have done with diverse populations, it is great to see the impact of involving a person fully in an experience, whether it be to prepare for a session on stage or to engage in their health.

Even though I was taught about professional interpretation in medical school, I think an unintended perception that was left was that this type of service is costly and slows things down. The reality of my experiences and this work is that respect and accommodation at the outset results in a more accurate diagnosis and effective treatment approach, which means speeding the time to recovery, and more importantly to life. Just like the other vulnerable populations I have worked with…

In prep for the panel, I recalled a quote from 1966’s “A Fortunate Man,” (Now Reading: A Fortunate Man: The Story of a Country Doctor, by John Berger | Ted Eytan, MD) which provides an important reminder about the value of respect in the era of HIT (in the decade of the patient).

It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient.

You can read more about the Qualified Bilingual Staff Model & Program at its website. Thanks, Gayle and the Kaiser Permanente National Diversity and Inclusion team for connecting doctors, nurses, and staff to experiences that teach us that while our patients have a lot of differences, they have a lot of needs in common, and they are a lot smarter than we sometimes give them credit for :).

2013 E Pluribus Unum Prizes Awardee Panel Discussion from Migration Policy Institute on Vimeo.

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ok glass : help me be more patient centered

These are images from the Google Glass Tech Focus that we filmed at the Kaiser Permanente Center for Total Health (@kptotalhealth) on July 11, 2013 (see: Photo Friday: Technology Focus Broadcast , featuring Google Glass | Ted Eytan, MD), which are actually mockups because Google Glass (@GoogleGlass) can’t do this automatically .. yet. Now that I’ve had some time to work with Glass, I can see a situation where a QR code might be presented on the exam room monitor or somewhere else in the workflow to allow the practitioner quick access to electronic health record details, or of course through voice commands (but I think QR might be quicker..).

There is a lot of discussion about using Glass for surgery and high tech health care (and there’s nothing wrong with that, I love surgeons and was trained by excellent ones as a family physician), so we created a scenario that involves using technology to connect us to patients better.

In the image above, you can see that the device is helping the clinician/practitioner know how the patient would like to be addressed, including the correct pronoun (whose incorrect use can be a source of disempowerment for vulnerable populations, especially trans people – see Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities | Ted Eytan, MD ), occupation, languages spoken, and where the patient lives.

These may seem like obvious pieces of knowledge for us to have to the lay community, however, I have observed many a clinician visit where the physician/nurse/clinician doesn’t ask or inquire about what the patient does during the day, where they live, or what their “health” environment is like. At the same time, I have seen the converse (and have always asked myself), and see how it changes the interaction to be much more tailored to the patient’s life goals rather than their biologic status.

You’ll see the next screen shows a map of Mrs. Smith’s neighborhood and the location of the nearest farmer’s market, again going beyond health care and supporting total health of Susan and her family. (Credit to Washington, DC’s MV Jantzen (@mvs202) for creation of cool Google Map / USDA Farmer’s market mashup. Innovation is everywhere around this city.

Could wearable technology help remind/support the human side of the relationship in the exam room and beyond? See what you think. Thanks to Yen Greene (@yengreene), the operations manager of the Center for Total Health for acting in the role of Mrs. Susan Smith, and Stephanie Nguyen (@nguyenist) of Washington, DC’s Silica Labs (@silicalabs) for her awesome graphic artistry. Comments welcome.

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UC Davis Health asks LGBT patients to share info for tailored care

UC Davis Health asks LGBT patients to share info for tailored care – Business – The Sacramento Bee.

There’s a groundswell of concern in the medical community that lack of sexual orientation and gender identity information might be impacting care of lesbian, gay, bisexual and transgender patients.The UC Davis Health System responded to those concerns Thursday, saying it will become the first academic health system in the nation to incorporate that information as standard demographic elements within the electronic health records of its patients.

As I mentioned previously in this post (see: Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities | Ted Eytan, MD), there is work to be done to improve electronic health records’ abilities for vulnerable populations, including people who are trans. Nice to see UCDavis (@UCDavis) move ahead on this work.

For more information, you can access Ed Callihan, MD’s presentation to the Intitute of Medicine here.

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dys4ia – A game for the health system, to heal itself

From the author:

dys4ia is an autobiographical game about the period in my life when i started hormone replacement therapy. it’s a story about me, and is certainly not meant to represent the experience of every trans person.

When people talk about games for health they often talk about games to impact the health of an individual person. This is a game about the health of a health care system, that sometimes isn’t caring:

A recent non-peer reviewed report on transgender discrimination showed some 28% of respondents had experienced harassment in a clinic setting and that 2% had been subject to physical abuse.

The game is flash based, use the arrow keys to play, and see things from the perspective of a person as they interact with the health system. Go through all the four levels. You’ll see that just a little more listening and caring, which sadly is not the norm for this population, can go a really long way.

When I posted this on Facebook, Robin Deane said:

Anything that engages someone in a more open-minded format helps! …and, for me, highlighting the challenge of the psych gatekeepers and a supposedly like-minded community stood out! In the end, my trauma was ‘relieved’ through my association with similarly situated individuals…they really get the credit for launching me like a rocket!! :))

That’s the job of physicians in this generation, to launch rockets. Holding people back is the domain of 20th Century medicine.

Make sure you get to the ending, there’s something valuable and worthwhile in helping people become who they are; everyone deserves the opportunity.

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Duke OKs student health insurance coverage for sex reassignment | The Chronicle

Duke OKs student health insurance coverage for sex reassignment | The Chronicle

The additional coverage will have a “minimal” impact on cost to students, Wasiolek said. The coverage will cause a 0.3 percent increase to student costs.

Overall, student health care premiums will increase by a total of 8 percent next year, Wasiolek said.

“The plan premium is increasing 8 percent next year, with 4 percent of that increase resulting from taxes associated with the Affordable Care Act,” she said. “The remaining 4 percent is attributed to health care cost trend and benefit enhancements.”

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