1. Module V: Discrimination & Stigma
Rev 1/27/2016 1
County of Riverside Department of Public Health
Health Equity Committee
2. Review training packet
Sign-in sheets
Continuing education
units
Cell phone policy
◦ Disable, silence, or place on
vibrate all communication
devices
Restrooms and exits
2
Housekeeping
3. Remember: THINK BIG!!!
Listen for Understanding
Confidentiality
◦ Sharing is encouraged
◦ What is said here, stays here
Safe Zone
◦ We all come from different
backgrounds, and have
different opinions
◦ We expect respectful
participation
3
Standards & Expectations
4. 4
Name
Branch
Location
ICEBREAKER
Tell us about the best vacation
you’ve EVER taken.
Share with us a fun experience
you’ve had recently.
Introduction
5. 5
Agenda
• Review of Modules I-IV
• Perceived Discrimination and
Stigma
• Lesbian, Gay, Bisexual and
Transgender Populations
• Boomer and Elder Populations
• People with Disabilities
• Discussion & The ASK Model
6. Our discussion today will be
focused on three groups:
o LGBT
o Aging
o People with Disabilities
By the end of this session, participants will be able to recognize
and address the perceived discrimination and stigma among
these three groups.
Participants will discuss ways we can avoid and undo
discrimination among the groups discussed today.
6
Objectives
7. How does stigma operate where you live,
work, play or go to school?
Who constitutes the “us” and the “them”?
7
Things to Think About
8. Module I
◦ Public Health History & System
◦ Core Functions and Essential Services of Public Health
Module II
◦ Cultural Competency & Acceptance
Module III
◦ Deconstructing Racism
Module IV
◦ Social Determinants of Health
Module V
◦ Discrimination & Stigma
Module VI
◦ Community Capacity Building
8
Public Health: Improving Health for All
9. 9
There are 3 core functions
of Public Health
◦ Assessment
◦ Policy Development
◦ Assurance
There are 10 essential
services in Public Health
One or more of the
essential services fit into
your job
Module I - Recap
11. Historic and institutionalized racism has greatly contributed to
negative social determinants.
11
Module III: Deconstructing Racism
These determinants limit access to
the services illustrated in Module I
and
highlight the need for cultural
competency (Module II) in the
provision of services.
16. Stigma has been associated with elevated risk for many
mental & physical health problems, including:
16
Alcohol, drug, and tobacco
dependence
Depression
Anxiety Disorders
Suicide ideation and attempts
Obesity
Heart Disease & Stroke
Health Affects of Stigma
17. 1/27/2016DRAFT 17
Adapted from: Making Partners: Intersectoral Action for Health, 1988 Proceedings and outcome of a
WHO Joint Working Group on Intersectoral Action for Health. The Netherlands.
HealthEquity
Public Health’s Job
Personal
Health
Burden
Public Health Responsibility vs. Personal
Responsibility
18. Many people belong to multiple stigmatized
groups, adding to their daily levels of stress.
These can include:
18
• Ageism
• Sexism
• Homophobia
• Transphobia
• Racism
• Classism
• Ableism
• Anti-Semitism and other
forms of religious
oppression
Intersections of Oppression
20. We need two volunteers to act as outside observers for this activity the
observers will report to the group what you witnessed.
Everyone else: The facilitators will place a “label” on your shoulder so you
can’t see it (please don’t peak).
After everyone has been “labeled” you will move around the room and
engage in conversation with other participants.
With each participant, react as a member of society might react to a
person with the label the participant is wearing.
It is important to talk with other participants clearly, conveying societal
attitudes toward the label they are wearing without telling them what their
labels are.
1/27/2016DRAFT 20
21. Were you able to correctly identify your label?
How did it feel to be treated in a stereotyped
way?
What was the experience like for you?
Were you puzzled or surprised by how you
were treated?
1/27/2016DRAFT 21
22. 1/27/2016DRAFT 22
“While many minority groups are the target for prejudice... and discrimination... in
our society, few persons face this hostility without the support and acceptance of their
family as do many gay, lesbian, and bisexual youth.”
Virginia Uribe and Karen Harbeck
“The barriers that LGBT people face in accessing health services- ranging from
disrespectful treatment to denial of care – contribute to poor health outcomes”
Nils Daulaire, Assistant secretary for global affairs,
U.S. Department of Health and Human Services
23. What do the initials
LGBT stand for?
What does gender
identity mean?
What is the
difference between…
sexual orientation
and
gender identity?
23
Who are L, G, B, T people?
24. From all racial/ethnic groups
From all religions and spiritual traditions
From all geographic regions
Across the entire lifespan
Of all abilities
Across the entire political spectrum
From all levels of health and illness
24
Who are L, G, B, T people?
25. In Riverside County
◦ At least 92,000 people (~4.2% of population) are LGB
◦ Between 2,358 - 7,075 people (0.1% - 0.3% of
population) are transgender
◦ 3rd largest minority group in Riverside County
25
At a glance…
29. 29
The Cost of Stigma
***Rates of attempted suicide among Gay, Lesbian, Bisexual
and Transgender men and women are 2 to 8 times that of
heterosexual and gender conforming people.
30. ◦ Real and feared rejection and
discrimination at home, work,
school.
◦ Plagued by hetero-normativity
and gender-normativity
◦ HIV/AIDS stigma
◦ Internalized oppression
◦ Medical classification as a
disease
◦ Religious beliefs that link sex
and sin
The Cost of Stigma
Robs LGBT people from
genuine authenticity.
“Coming out” is a life-long, constant challenge.
31. Heaped on top of typical
stressors of living and coping
in the world
All LGBT belong to at
least one other culture
All other cultures/groups
include some LGBT
Chronic, persistent and in
many cases, lifelong.
Arises from mutable social
and cultural structures and
processes rather than from
individual risk factors or
choices
Minority Stress
32. 32
“ I don’t think it was in the dictionary when I was young”
− Anna from Project Visibility
LGBT and Aging
34. 1/27/2016DRAFT 34
Our society must make it right and possible for old people not to fear the young or be
deserted by them, for the test of a civilization is the way that it cares for its helpless
members.
Pearl S. Buck
35. In the most general
sense, persons 65+
tend to be
considered the
“senior” population.
People who were
born during the post
World War II baby boom
between the years 1946
and 1964.
Older, old adults are
85+
Younger, old adults
are 55+ Baby Boomers
(Younger, old adults)
35
How do we define Aging?
36. From all racial/ethnic groups
From all religions and
spiritual traditions
From all geographic regions
Of all abilities
Across the entire political
spectrum
From all levels of health and
illness
36
The Aging Community
37. Riverside County projected growth
rate of 100.0-149.9% !
The elderly population is
expected to grow more than
twice as fast as the total
population and this growth will
vary by region.
The older adult age group will
have an overall increase of
112% during the period from
1990 to 2020.
More than half of California’s
counties will experience over a
100% increase in this age
group.
37
At a glance
38. Demographic changes create an urgent need
Two factors—longer life spans and aging baby boomers—will combine to double the
population of Americans aged 65 years or older during the next 25 years to about 72
million. By 2030, older adults will account for roughly 20% of the U.S.
population. - The CDC
Chronic conditions present a strong economic incentive for
action More than a quarter of all Americans and two out of every three older
Americans have multiple chronic conditions, and treatment for this population accounts
for 66% of the country’s health care budget.
- The CDC
38
Why might this be an issue?
39. More and more Americans
are living to be age 100
and over.
The Times, published an
article stating that health
officials predict by 2050,
more than 800,000
Americans would be pushing
into their second century of
life.
39
Health and Social Support System
40. Job discrimination
Harassment
“Suddenly Stupid”
Suddenly weak
Sexless/asexual
Abuse
Built and social environment
“Going to crash the
healthcare system”
Social isolation
40
Stigma and Aging
42. Four factors found to determine the “Boomer impact”
on healthcare:
42
Chronic Illness, Injury and
Healthcare Needs
1. An increase in utilization of the
healthcare system
2. Increased prevalence of chronic disease
3. Different needs and patient
expectations
4. More services and technologies
available to them as compared to
previous generations.
43. Redefining Senior Centers
Livable Communities
Transportation- Ability to get around on their
own (adaptive devices)
Independence- Minimal assistance from loved
ones or professionals
Health and Longevity- Manage illness and
chronic disease
Affordable Care/Coverage
Age in Place- Remain at home and in
community for as long as possible
43
Future Needs of Aging Boomers
44. 44
“It is vitally important to distinguish between disability as a natural part of the
human condition and disability-related health disparities that can lead to compromised
care, ill health, institutionalization and premature death.”
45. Hearing
Vision
Movement
Thinking
Remembering
Learning
Communicating
Mental Health
Social Relationships
45
Disabilities
46. Medical models view disability as an extension of a
physiological condition requiring treatment or
therapy.
Social models view disability as the result of
societal forces on impairment, and suggest that
changes to social norms and practices would reduce
restrictions.
As a demographic category, disability is an attribute
with which individuals may broadly identify, similar
to race or gender.
Certain federal programs narrowly define disability
as the impairment or limitation that leads to the
need for the program’s benefit
46
Who are people with Disabilities?
There is no one single definition
Adapted from: Brault, M.W., 2012
47. From all racial/ethnic groups
From all religions and spiritual traditions
From all geographic regions
Across the entire lifespan
Across the entire political spectrum
From all levels of health and illness
47
Disabilities
48. Think Back to Module 4
48
Disabilities – Shift in Paradigm
Requiring
medical
management
with the goal
of “fixing” the
problem
(medical
model)
Moved from
a paradigm
that viewed
disability as
a medical
problem
Between
multiple
individual
characteristics
(social model)
to a paradigm
that views
disability as a
product of
interactions
49. Overall, adults with a disability were:
Less likely than those without disabilities to report
excellent or very good health (27.3% vs. 60.3%)
More likely to report being in fair or poor health
(40.1% vs. 9.8%).
49
Disability No Disability
College 18 - 34 13.9 21.8
Employed 35.4 74.5
Living in poverty 21.1 11.3
Disabilities – Local Data
51. Disabled students almost
twice as likely to be
suspended
Proportion of missing teeth
to filled teeth higher among
persons with intellectual
disabilities.
Diagnostic overshadowing
Professional misconceptions
51
Disabilities
Barriers to Good Health
52. Social Determinants:
Inaccessible physical
environments
Social assumptions
and prejudices
Inflexible policies and
procedures
52
Hint: Not from the disability!
Where do health disparities among people
with disabilities arise from?
53. Listen to and respect
the wishes of the
person/family being
helped.
Provide assistance in
ways that lead to less
dependence (more
autonomy)
53
Competence vs. Incompetence
Offer empowerment to
obtain the information
needed to take control
and actively participate
in their own health.
Remove barriers to
participation by people
with disabilities
Millie’s Story
54. KEEP THINKING!
THERE ARE MANY MORE FACTORS
WE NEED TO CHANGE !
SAY:
1. People with disabilities
2. Brain injury
3. Congenital disability
4. He has a mental health
condition/diagnosis
5. She has a learning disability
6. He receives special ed.
services
7. Children without disabilities
INSTEAD OF:
1. The handicapped or disabled
2. Brain Damaged
3. Birth defect
4. He’s emotionally
disturbed/mentally ill
5. She’s learning disabled
6. He’s in special ed.
7. Normal or healthy kids
1/27/2016DRAFT 54
58. When health professionals know about many
different populations they can provide
better care, make better decisions, and
make better referrals.
◦ Each health professional is
responsible to learn about the populations
for whom they provide services or develop
policies.
◦ Background knowledge about
population health issues can assist both
people who receive services and their service
providers to focus their questions for each other.
◦ Dialogue from a position of mutual
understanding is necessary to bring about
equitable health care.
Public Health Culture
60. List 3 things
you are personally ready and willing to do
to assure that your care
for the
LGBT, Aging and Disabled communities
is the BEST it can be.
60
Are you ready?
61. Module I: An Overview of Public Health
Module II: Cultural Competency & Acceptance
Module III: Deconstructing Racism
Module IV: Health Inequities & Social
Determinants of Health
Module V: Discrimination & Stigma
Module VI: Community Capacity Building
61
Next Steps for Public Health:
Improving Health for All
62. To enroll in a module or if you have an interest in
facilitating please contact:
DOPH Staff Development Office
951-358-7141
If you have questions about content please contact:
Epidemiology & Program Evaluation Branch
951-358-5557
62
Contact Information
Hinweis der Redaktion
Facilitator Notes:
Announce location of the restrooms, exits, etc.
Instruct everyone to sign in (regular and CEUs)
Remind them water is available
Instruct them to turn off cell phones or place on vibrate
If participants must take calls, step outside of the training room
Mention where to obtain refreshments; location of vending machines, etc.
If you normally don’t speak up much, try to offer your ideas and thoughts. Throughout this training series sensitive topics are discussed so you want to convey to participants that it is 1) an important part of moving forward in achieving our mission of optimal well-being for all Riverside County residents; 2) take care of yourself. The facilitators can talk to you during breaks if you need to talk.
Since we will be spending several hours together and talking about sensitive issues, we want to make sure we have some ground rules in place so that everyone feels more comfortable.
Think back to some teams you have worked with that have worked well together. What ground rules did they follow?
Let the participants know that if needed, they can propose additional ground rules throughout the day.
If someone is violating a ground rule (such as having side conversations), gently remind them that the group put forth the ground rules and that we should all try to respect them.)
Let participants know that they are able to step out for a few minutes if needed.
Step up; step down (if you are normally talkative, give others room to talk). If you are usually quiet, try to offer your ideas and thoughts
Under Other: Breaks are scheduled, but if there is a pressing need, feel free to step out for a few minutes and then return.
Remember, everyone in the room today has been uniquely affected by these topics and may have very different perspectives regarding them.
It is important that each participant respects these differences even if you disagree with them. Each person in this room is unique based upon their own personal history.
Let the participants know that no we are not going to undo racism today but we will take steps at understanding its roots and its affects today.
By the end of the session participants will be able to:
define/describe stigma and perceived discrimination
Describe how stigmatization impacts community health
Contribute ideas on what DOPH can do to reduce barriers faced by stigmatized groups
About 20 minutes.
Notes from Monday February 3rd 2014: Look at studies about control and stress. Discuss from the video control and threat (CEO/Custodian)
Although the expression of outright discrimination has been greatly reduced in recent decades, more subtle and chronic forms of discrimination are still very real for certain groups in our society. A number of comprehensive literature reviews find substantial evidence—from both
laboratory and community studies— for the harmful health effects of discrimination across a range of mental health outcomes including depression, psychological distress, anxiety, and well-being (e.g., D. R. Williams, Neighbors, & Jackson, 2003; Paradies, 2006). Perceived
discrimination has also been linked to specific types of physical health problems, such as hypertension, self-reported poor health, and breast cancer, as well as potential risk factors for disease, such as obesity, high blood pressure, and substance use (see, e.g., D. R. Williams &
Mohammed, 2009, for a review). – [cut and paste from Pascoe and Richman, 2009]
Stigma/Invisibility
Perceived discrimination leads to psychological and physiological stress responses and health behaviors.
Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors
In addition, evidence suggests that this relationship may occur through the mechanisms of stress responses and health behaviors.
External sources: e.g., negative attitudes of health care professionals and others in society may affect accessing health services
Internal sources: e.g., internalized oppression, may increase use of unhealthy coping strategies and accumulated stress.
Who here knows the story of Sisyphus? Greek King punished by the gods. Forced to roll a boulder up a hill forever. On this slide our personal health burden is our personal boulder. You still need to push your rock (your own health burden) but public health’s job is to reduce the slope as much as possible and reduce it for everyone not just for some.
As the note indicate accordion effect to reduce slope of the angle
Ageism
Sexism
Homophobia
Transphobia
Racism
Classism
Ableism
Anti-Semitism and other forms of religious oppression
NPR story – RWJ and Havard School PH joint study on Latinos
In Riverside County, especially outside of the Palm Springs region we often need to go back to basics by first describing what is LGBT?
Riverside County has one of the largest LGBT populations in the country (Gates, 2006; Gates &
Cooke, 2011). Members of the lesbian, gay, bisexual and transgender (LGBT) community are our
neighbors, co-workers, friends and family and they experience disproportionately poor health
outcomes and poor health status.
Despite progress gained in equality for LGBT people over the last four decades, national data
suggest that members of the LGBT population continue to experience poorer health outcomes
than their heterosexual counterparts (Harcourt, 2006). To understand these health disparities it is
important to look at the social determinants of health. Social determinants of health are the
economic and social conditions under which people live, work and play that affect their health
(U.S. Department of Health and Human Services, 2009; Centers for Disease Control and
Prevention, 2012a; Lick et al., 2013).
Stress from societal stigmatization, systematic harassment and discrimination, and a lack of
cultural competency in the health care system place LGBT people at higher risk for violence and
illnesses such as cancer, mental illness, and other diseases. They are more likely to smoke, drink
alcohol, use illicit drugs, and engage in other risky behaviors (Table A). We cannot estimate the full
extent of LGBT disparities due to a lack of data collection on sexual orientation and gender identity
at national, state, and local levels (IOM, 2011; Lick et al., 2013).
We have chosen to use the shorthand LGBT when talking about the shared influences of stigma among lesbian, gay, bisexual, and transgender people.
It is important to be explicit in what is meant by LGBT people or the LGBT community. The
acronym LGBT refers to Lesbian, Gay, Bisexual, and Transgender. Although all of the different
identities within “LGBT” are often grouped together (and share the commonality of discrimination
based on sexism), there are speciic needs and concerns related to each identity.
Defined as “not exclusively heterosexual” lesbians, gay men, and bisexual men and women (LGB)
include people who openly identify as LGB, among other terms, and those who don’t use such
labels but experience same-sex attraction or engage in same-sex sexual behavior. LGB people
come from every culture, ethnicity, education and income level, health status, and lifestyle (IOM
2011 page 12; Meyer 2001).
Transgender people are defined according to their gender identity and presentation, not their
sexual orientation. Transgender people are individuals whose gender identity differs significantly
from what is traditionally associated with their birth sex. Transgender individuals can have
different sexual orientations (IOM 2011, page 12; Mayer, et al., 2008). Though the experiences of
transgender persons are substantially different from cis-gender (gender-conforming) lesbians, gay
males, or bisexual women and men, they are subject to many of the same discriminatory practices,
harassment, and violence, as lesbians, gay men, and bisexual men and women. Further, fear of
rejection by family and friends makes the “coming out” process similar for all these groups
(Hughes & Eliason, 2002).
LGBT stands for lesbian, gay, bisexual and transgender. The initials LGBT or GLBT are not agreeable to everyone that they encompass.
These definitions are meant to be used as reference to better understand the populations under discussion and should not be used to assume another person’s identity. It is important to respect an individual’s self-identification.
Self-concept related to gender: how well do I fit into male/female, and feminine/masculine expectations for my culture?
Gender identity is established early in life, as children identify their own gender around age 3, and the gender of others around 6.
Transgender is an umbrella term that describes people whose gender identity is not congruent with their physical bodies or sex assigned at birth.
Transgender: Describes people who identify with or express a gender different from the sex assigned to them at birth.
Sexual orientation: A person’s emotional, physical and sexual attraction and the expression of that attraction with other individuals. Some of the better-known labels or categories include “bisexual” (or “multisexual”, “pansexual”, “omnisexual”), “lesbian”, “gay” “homosexual” , or “heterosexual”.
Queer: Used as an umbrella identity term encompassing lesbian, questioning people, gay men, bisexuals, non-labeling people, transgender folks, and anyone else who does not strictly identify as heterosexual. “Queer” originated as a derogatory word. Currently, it is being reclaimed by some people and used as a statement of empowerment. Some people identify as “queer” to distance themselves from the rigid categorization of “straight” and “gay”. Some transgender, lesbian, gay, questioning, non-labeling, and bisexual people, however, reject the use of this term due to its connotations of deviance and its tendency to gloss over and sometimes deny the differences between these groups. [http://internationalspectrum.umich.edu/life/definitions]
Same-gender-loving: A cultural (particularly among African Americans) term that affirms the same sex attraction between men and women. [Healthy Black Communities, http://www.hbc-inc.org]
Genderqueer: A term which refers to individuals or groups who “queer” or problematize the hegemonic notions of sex, gender and desire in a given society. Genderqueer people possess identities which fall outside of the widely accepted sexual binary. Genderqueer may also refer to people who identify as both transgender AND queer, i.e. individuals who challenge both gender and sexuality regimes and see gender identity and sexual orientation as overlapping and interconnected. [http://internationalspectrum.umich.edu/life/definitions]
Homosexual: A person who is primarily and/or exclusively attracted to members of what they identify as their own sex or gender. A clinical term that originated in the late 1800s. The terms “lesbian, bi and gay” are preferred by many in the LGBT community.
LGBT, LGBTQ, LGBTQA, TBLG: These acronyms refer to Lesbian, Gay, Bisexual, Transgender, Queer, and Ally. Although all of the different identities within “LGBT” are often lumped together (and share sexism as a common root of oppression), there are specific needs and concerns related to each individual identity. [http://internationalspectrum.umich.edu/life/definitions]
Bisexual: People who are romantically and/or sexually attracted to, and/or partner with people of more than one gender.
Gay and Lesbian: Refers to individual people who are romantically and/or sexually attracted to, and/or partner with people of the same gender; lesbians partner with women and gay men partner with men.
I think image stolen from Press Enterprise
It may seem obvious but people often need to be reminded.
Riverside County has one of the largest LGBT populations per capita in the nation. Estimates place the size of the Riverside County lesbian, gay and bisexual (LGB) population between 70,747 - 235,822 people. The most recent population based survey places the (LGB) population at 4.2% of the general population or over 92,000 individuals. The transgender population of Riverside County is estimated to be between 2,358 and 7,075 individuals.
Throughout California LGBT smoke at significantly greater rates than heterosexuals (21.8% vs. 14.3%).
Across California LGB report binge drinking in the past year at greater rates than their heterosexual peers (41.2% vs. 33.7%).
In California, nearly 1 in 10 lesbians (9.1%), and gay men (8.7%) self-reported a cancer diagnosis.
In California, lesbians and bisexual women 30 years old and older receive mammograms and Pap tests less often than heterosexual women.
In California, nearly a quarter of all lesbians (24.1%) and bisexual women (24.8%)report having an asthma diagnosis.
In the Inland Empire, a higher percentage of bisexual men (45%) and women (42.1%) report that they are disabled than heterosexual men and women (27.7% and 30.5%) or gay men and lesbians (30.1% and 22.4%). This disparity is seen throughout the state.
Notes from Monday February 3rd 2014: Looks at lifetime experience. Top graph is National data. This slide may have too much information in it, possibly break into two slides?
High rates of:
Alcohol, tobacco and drug use
Depression, anxiety, suicide
Body image and eating disorders (men more than women)
Domestic violence
Specific risks for disease among certain sub-groups (e.g. higher risk of breast cancer among lesbians, anal cancer among gay men)
Notes from Monday February 3rd 2014: Define binge drinking
Binge drinking used to mean drinking heavily over several days. Now, however, the term refers to the heavy consumption of alcohol over a short period of time.
Men 5 or more drinks in a “short period of time”
Women 4 or more drinks in a “short period of time”
Perceptions of discrimination and whether one can access quality health services have been shown to not only affect whether and how individuals seek medical care and interact with medical professionals but affect health outcomes as well (Harcourt, 2006; When Health Care Isn’t Caring,
2010).
Societal discrimination has a direct impact on the mental health of LGBT men and women. A social
context of oppression leads to social and family alienation, reduced levels of social support, low
self-esteem, and symptoms of psychological distress. For racial/ethnic minority LGBT the social
impact on mental health is amplified due to the intersection of racism and heterosexism
(Hatzenbuehler 2010).
Hatzenbuehler and colleagues (2010), studying the impact of institutional discrimination such as
bans on marriage equality on the mental health of LGB populations, found that the prevalence of
mood, anxiety and substance use disorders increased in states enacting such bans and decreased
in states that did not. They conclude “living in states with discriminatory policies may have
pernicious consequences for the mental health of LGB populations.” Other studies have highlighted
the detrimental effects of discrimination on health (McLaughlin et al, 2010; Diaz et al,
2001; Lick et al., 2013).
In another study examining the impact of homophobia, poverty and racism on the mental health of
Latino gay and bisexual men Diaz et al (2001) found high prevalence rates of psychological
symptoms of distress including suicidal ideation (17%), anxiety (44%), and depressed mood
(80%).
Notes from Monday February 3rd 2014:
Remove QI
Possibly give examples of personal experience… When someone asks “Does your husband/wife…”
Response to “I’m a Christian…or I don’t believe in…, but”: The issue/concern/point is that it does not matter if you agree/disagree; it has an impact on the person/s
Notes from Monday February 3rd 2014: Possibly move this definition to slide 13.
This video will explore how stigma impacts the lives of older LGBT adults.
Project Visibility Video 14 minutes
Change quote
Eleven of these counties, will have growth rates of over 150%.
The Sandwich Generation
Boomers are in their 40, 50, and 60’s
Their children are in their late teens or early 20’s
Their parents and in their 70’s, 80’s and older
Parents are living longer, sometimes with health issues and children are taking longer to leave home.
The number of parents living with their adult children increased 63% since 2000
1 in 8 middle-aged American is caring for at least one child and a parent under the same roof.
Grandparents are raising grandchildren
According to the 2010 Census, approximately 4.8 million live in their grandparents homes. In many cases, Boomers are shouldering the financial and emotional costs of care giving.
Demographic changes create an urgent need
The growth in the number and proportion of older adults is unprecedented in the history of the United States.
Chronic conditions present a strong economic incentive for action
During the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses
Demographic changes create an urgent need
The growth in the number and proportion of older adults is unprecedented in the history of the United States.
Chronic conditions present a strong economic incentive for action
During the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. These also cost us more to treat as they are usually maintained for a life time.
Demographic changes create an urgent need
Two factors—longer life spans and aging baby boomers—will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population.
The CDC
Chronic conditions present a strong economic incentive for action
More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget.
The CDC
This new population of centenarians are far from the frail, ailing, housebound people one may
expect. The majority of them are mentally alert and relatively free of disability, and they
remain active members of their communities. This may simply represent a new model of
aging, one that health experts are hoping more of us can emulate, both to make our lives
fuller and to ease the inevitable healthcare burden that our longer-lived population will
impose in coming decades.
Richeson and Shelton article: A social psychological perspective on the stigmatization of older adults.
http://www.communitychoices.info/adrc/docs/riverside/RiversideADRCBOOMER%20REPORT_October2010.pdf
The 2007 American Hospital Association (AHA) report states that Boomers will have more impact than ever on the United States healthcare system. The challenge is more patients will be added to an already underfunded system, with estimated costs running into billions of dollars.
Because health professionals, advocates, and other individuals use the same term in different contexts, disability does not often refer to a single definition. Medical models view disability as an extension of a physiological condition requiring treatment or therapy. In contrast, social models view disability as the result of societal forces on impairment, and suggest that changes to social norms and practices would reduce restrictions.4 As a demographic category, disability is an attribute with which individuals may broadly identify, similar to race or gender. In contrast, certain federal programs narrowly define disability as the impairment or limitation that leads to the need for the program’s benefit—such as the Social Security Disability Insurance program’s income support for individuals who are not able “to engage in any substantial gainful activity.”5 The agencies and organizations that provide benefits to, advocate for, or study these populations, each refer to their targeted group as people with disabilities; but because of the differences in definitions, an individual may be considered to have a disability under one set of criteria but not by another. (Brault, Matthew W., “Americans With Disabilities: 2010,” Current Population Reports, P70-131, U.S. Census Bureau, Washington, DC, 2012
How Does ADA Define Disability?
The Americans with Disabilities Act (ADA) has a three-part definition of disability. Under ADA, an individual with a disability is a person who: (1) has a physical or mental impairment that substantially limits one or more major life activities; OR (2) has a record of such an impairment; OR (3) is regarded as having such an impairment.
A physical impairment is defined by ADA as "any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine."
Neither ADA nor the regulations that implement it list all the diseases or conditions that are covered, because it would be impossible to provide a comprehensive list, given the variety of possible impairments. http://www.ada.gov/pubs/adastatute08.htm#12102
See healthy people 2010 (2020). Because disability status has been traditionaly equated with health status, the health and wellbeing of people with disabilities has been addressed primarily in a medical care rehabilitation, and long-term care financing contexts. Four main problems from this approach 1, all people with disabilities automatically have poor health, 2, public health should focus only on preventing disabling conditions, 3, a standard definition of “disability” or “people with disabilities” is not needed for public health purposes, and 4, the environment plays no role in the disabling process.
Notes from Monday February 3rd 2014:
Notes from Monday February 3rd 2014:
FOR EXAMPLE -Assuming that everyone must be able to independently fill out forms, undress unaided, transfer to high examination tables,
and communicate in spoken English to receive standard health care services.
Often invisible in health disparities conversations (see Nosek & Simmons 2007)
Disproportionately prevalent among people wit disabilities: diabetes, hypertension, depression, and sleep disorders.
Health disparities versus secondary conditions
Notes from Monday February 3rd 2014: Kathy Snow
Millie’s Story
It was difficult to understand Millie. Her speech was laborious because of cerebral palsy and even worse because calcium deposits on her vertebra affected her neck muscles. The staff at Rehab was kind, but in a hurry. Many had been trained in another country and spoke English as a second language. However, the language difference was less important than the attitudes the caregivers brought with them. Their previous experiences and expectations led them to think that anyone with difficulty communicating had significant cognitive limitation. Millie tried to ask them to warn her before they lifted her stiff hands so she could prepare herself. They smiled and nodded but didn’t understand. So they picked up her hands without warning. Millie yelled loudly. Millie’s mom would visit and the nurses would ask her how Millie felt. Mom reassured the nurses they were doing a good job, but she didn’t tell them to listen to Millie. Even Millie’s mother was a part of the cultural divide; her own culture discouraged being critical of caregivers and sought to avoid confrontation. So Millie yelled.
Finally Millie complained to a friend, “They only see the physical, not inside you.” They decided to provide a little education. They wrote down all the words Millie had to say and posted them on the walls of Millie’s room. They wrote ideas like, “When you don’t understand, ask me to repeat. Two or more times if necessary.” They wrote, “No pureed food!” They wrote, “Millie is not deaf or dumb. She respects your intelligence, please respect hers.” Over time, her room was covered in words. The staff was amazed. They began to respect her, and working together Millie finally left the hospital. She never reached her goal of walking again, but she did regain her self-respect and dignity.
Adapted from: Johnson, J., Guinan M., Brown, S.E., and Shearer, V. (2011). Disability, Culture, and Health Disparities. Impact Newsletter.
11:28 minutes
Skill Building ??
Assume competence.
Fallen Fox, MMA Fighter (M to F Transgender)
Stephen Hawking, Former Professor of Mathematics at the University of Cambridge (1979 – 2009). Now Director of Research at the Center for Theoretical Cosmology at Cambridge. (he is also 71)
Jason Collins, First openly gay NBA player.
Ruth Flowers aka “Mamy Rock” 73 year old from the UK. She is one of Europe's top DJs.
Erik Weihenmayer, first (only so far) blind person to have reached the summit of Mount Everest (2001) and the tallest peak on each continent.
Talking Points: Bullet One: When health professionals know about many different populations they can provide better care, make better decisions, and make better referrals.
Bullet Two: Each health professional is responsible to learn about the populations for whom they provide services or develop policies.
Bullet Three: Background knowledge about the health issues facing LBGT, elder and people with disabilities can assist both people who receive services and their service providers to focus their questions for each other.
Bullet Four: Dialogue from a position of mutual understanding is necessary to bring about equitable health care.
ASK REFLECTION QUESTIONS: adapted from Lipson, Juliene G. & Dibble, Suzanne L. (2005) Culture & Clinical Care, San Francisco, UCSF Nursing Press
Awareness
1. Think about your health care setting from the perspective of a new LGBT, elder or disabled patient or client. . . .
Would the new client find welcoming signs? What are they? Are there potential barriers to creating a
welcoming environment?
2. What did you learn about LGBT, elder or disabled cultures in your youth? How about college? Your health care training
program? What gaps in knowledge do you have, if any?
3. What LGBT, elder or disabled issues make you uncomfortable?
Sensitivity
1. How could you alter the health care environment in which you work to convey a more welcoming
message to LGBT, elder or disabled clients?
2. Think of a time when you thought someone you took care of was LGBT, elder or disabled. Write a short description
of what you recall about your interactions with this person. How might your interaction have changed if you knew more about LGBT, elder or disabled issues and cultures?
3. Think of a joke that you have heard about LGBT, elder or disabled people. What would be a sensitive and appropriate response if you heard this joke told in a group at work?
Knowledge
1. What have you learned today that you did not already know? How can you use the information
in this chapter in your work setting?
2. What questions do you have about LGBT, elder or disabled cultures that this module did not answer? Make a list
of these questions, and check for resources to find the answers to the remaining questions. Show your facilitators your questions.