Soon to be...Dr. Mieses!: New York City

We have come a long way since HIV was labeled the “gay disease.” This label was spawned from fear of HIV, and based on the observation that the first cases of HIV appeared in gay men in the early 1980’s. However, this label was not only discriminatory but also inaccurate as intravenous drug users also became infected. Furthermore, by the mid 1980’s children (usually those born to drug users) began to show symptoms of Acquired Immune Deficiency Syndrome (AIDS). Some people also contracted the virus via blood transfusions. Despite our best efforts and advances in medicine, HIV/AIDS still affects roughly 34 million people worldwide; people from many different ethnic groups and religions, with different socioeconomic backgrounds and sexual preferences. However, disparities still exist. According to AIDS.gov, in the United States, 61% of new HIV cases in 2009 were via male-to-male sexual contact; the ethnic groups most severely affected were Blacks/African-Americans and Latinos (even among females). What do all of these statistics tell us? We need to do a better job.

Lesbian, gay, bisexual, and transgender individuals (LGBT) experience various health disparities, not just those related to HIV/AIDS. This effect is compounded if the person belongs to multiple minority groups (for example, Latino and gay or female and transgender). Many studies have shown a direct correlation between the number of minority groups one belongs to and the discrimination he or she faces. This discrimination, in addition to identity issues and problems fitting in or strained relationships with unsupportive friends and family, can lead to many mental health problems. These problems include depression, anxiety, substance abuse and suicide. According to Youth Pride, Inc., gay and lesbian youth are three times more likely to attempt suicide and suffer higher rates of verbal abuse and isolation than their heterosexual counterparts. Additionally, LGBT youth are more likely to be isolated, homeless and be victims of physical and sexual abuse. All of this contributes to poor physical and mental health …and so the cycle continues.

Disparities surrounding access to proper medical care also exist for LGBT individuals. Bias or cultural incompetence within the health care system create barriers to care. Lesbian and bisexual women are not screened as often for breast and cervical cancer. Transgender individuals are less likely to have health insurance. Marriage inequality and a lack of equal rights for LGBT domestic partners (compared to married individuals) also exacerbates these problems. The Patient Protection and Affordable Care Act (ACA), seeks to alleviate some of these problems by improving access to health care for all Americans, guiding state Medicaid agencies on financial protections for same-sex couples and improving health data collection for the LGBT community and other minorities.

In commemoration of the Stonewall Riots in New York City in 1969, June is celebrated as LGBT Pride Month. Since the 1960’s the LGBT community has increased its visibility as a social group and successfully demanded rights it was not previously afforded. However, discrimination, inequality and health disparities still exist. Individuals from all walks of life can play a part in resolving these issues. Strive to be accepting of others and encourage leaders and lawmakers to enact legislation that will ensure equality for all.

Friday, April 13, 2012

National Minority Health Month: Child Asthma

According to the CDC, 7 million children suffer from asthma nationwide. According to the New York City Department of Health and Mental Hygiene, children in New York City were almost twice as likely to be hospitalized for asthma as children in the United States as a whole. Even more alarming, in recent years, the Bronx has been the New York City borough with the highest overall rates of asthma hospitalizations, deaths and prevalence among children as well as adults. Clearly, disparities exist.

Asthma is a chronic lung disease that can cause the airways to become inflamed and narrow. This can result in coughing, wheezing and tightness of the chest which may make it difficult to breathe. Asthma attacks are often triggered by illness, strenuous activity and the environment; smoke, allergies, pets, mold, dust and pollution can be a trigger. Cockroaches can also trigger asthma attacks, as many children are allergic to the material associated with decaying roaches, and live roaches' excrement. Partners Healthcare, a team of doctors, nurses, respiratory therapists and other health care professionals, cites cockroaches as a bigger trigger than pet dander and dust. Though asthma cannot be cured, it can be treated with regular long-acting medications, and fast-acting medications in the event of an attack.

Children with asthma tend to have family members with asthma, implying that the condition is inherited. However, it is difficult to establish a link between inheritance and an entire race because race is a social construct that cannot be clearly defined by genetics. Asthma can be inherited by any child, regardless of their ethnic background, depending on the child's family history. However, asthma affects children from ethnic minority groups at disparate rates. For example, non-Hispanic black children have a higher prevalence of asthma and die at higher rates from asthma than non-Hispanic white children. Hispanic children have a higher prevalence of asthma compared to non-Hispanic white children.

Many ethnic minority children tend to live in areas in which smoke, mold, dust, pollution and roach infestation may be a problem. These triggers can greatly exacerbate asthma. Due to a lack of health insurance or a regular primary care physician, minority children suffering from asthma may be forced to use a hospital's emergency department for care. Also, due to lack of insurance and/or family instability, it may be difficult for children to regularly take required long-acting asthma medication, as prescribed. One study actually examined the degree to which instability within a family can negatively impact a child's health. Investigators found that family instability is related to poor child health, including asthma.

Additionally, cultural boundaries may contribute to disparities if they result in poor communication between the physician and patient or sub-par care. Poorly controlled asthma has also been linked to poorer performance in school (for example, more absenteeism), and may even help explain the academic achievement gap that exists among children from different ethnic groups. The aforementioned factors contribute to health disparities but are really symptoms of much greater social injustices. In order to rectify the problem, we must more closely examine our society.