The Deadly Deception:
https://www.youtube.com/watch?v=RYOBYPiVfoI
What part of the film, The Deadly Deception, stood out to you most?
Have you observed more current examples of those practices?
Have you, or someone you know, ever delayed seeking medical or mental health care?
a) What were the reasons to delay care?
b) How did the situation get resolved?
c) What resulted from delaying care?
What overall consequences could occur when people are prevented from accessing health care?
Prevention vs. Intervention, which one is more important/impactful?
How do you think privilege (or the lack of it) plays a role in one’s access to health care?
Is access to health care a fundamental human right or should it be a luxury afforded only by people with financial means and connections? Please discuss implications!
Health: a complete state of physical, mental, and social well-being, not merely the absence of disease or infirmity (chronic illness and physical or mental weakness associated with age).
Health Behaviors: behaviors undertaken by people to enhance or maintain their well-being.
ï‚— What are your health behaviors?
 How do race, ethnicity, sex/gender, wealth, immigration status, sexuality/gender identity influence one’s health behaviors?
This should be 2-3 pages in length, double-spaced, and docx format .
Equitable Access to
Health and Mental Health Care
1.
2.
3.
What part of the film, The Deadly Deception, stood out to
you most?
Have you observed more current examples of those practices?
Have you, or someone you know, ever delayed seeking
medical or mental health care?
a) What were the reasons to delay care?
b) How did the situation get resolved?
c) What resulted from delaying care?
4.
5.
6.
7.
What overall consequences could occur when people are
prevented from accessing health care?
Prevention vs. Intervention, which one is more
important/impactful?
How do you think privilege (or the lack of it) plays a role in
one’s access to health care?
Is access to health care a fundamental human right or should
it be a luxury afforded only by people with financial means
and connections? Please discuss implications!
ï‚— Health: a complete state of physical, mental,
and social well-being, not merely the absence
of disease or infirmity (chronic illness and
physical or mental weakness associated with
age).
ï‚— Health Behaviors: behaviors undertaken by
people to enhance or maintain their well-being.
ï‚— What are your health behaviors?
ï‚— How do race, ethnicity, sex/gender, wealth,
immigration status, sexuality/gender
identity influence one’s health behaviors?
ï‚— Health Psychology: the study of
psychological influences on how people stay
healthy, why they become ill, and how they
respond when they do get ill.
ï‚— Health Belief Model: a set of assumptions
that suggests that one’s health behavior is
affected by one’s perception of a personal
health threat as well as by how a particular
health practice would be effective in
reducing the personal health threat.
Health disparity – Differences in health outcome,
including incidence, prevalence, mortality, burden of
disease, and other adverse health conditions that are closely
linked with social, economic, and environmental
disadvantage…often driven by the social conditions in which
individuals live, learn, work, and play. (U.S. Department of
Health and Human Services, 2011; NIH2014)
Examples of Major Health Disparities among
Ethnic Minority Populations:
ï‚— Ethnic minorities are more likely to be diagnosed
with late-stage breast cancer.
ï‚— Many racial and ethnic minorities and persons of
lower socioeconomic position are more likely to
die from HIV.
ï‚— Minorities also account for a disproportionate
share of new AIDS cases.
Examples of Major Health Disparities among
Ethnic Minority Populations:
ï‚— Native American elders with diabetes are more
than twice likely to die compared to older Whites.
ï‚— Cancer death rates are increasing among
Hispanics and Native Americans despite an
overall decrease among Whites and all other
racial/ethnic groups.
ï‚— African Americans have an 80% higher rate of
stroke-related deaths, and a 50% higher rate of
mortality due to heart disease, compared to
Whites.
Examples of Gender Differences in Health
Disparities:
ï‚— African American women have a shorter life
expectancy than do White women by 5 years.
ï‚— African American women are more likely to die from
breast cancer, yet more White women are diagnosed.
ï‚— HIV-related death rates are 12X higher for Black
women than for White women.
ï‚— Among Native Americans and African Americans
younger than 45yo, death rates were 47% and 42%
higher respectively, than would be expected on the
basis of death rates for Whites.
Examples of Disparities in Substance Abuse:
ï‚— Men have a higher prevalence than women, but the
gender gap is larger among the Asian/Pacific Islander
populations than among the total U.S. population.
ï‚— Individuals in low-income family households have a
higher prevalence of substance abuse, and Hispanics
and non-Hispanic Blacks have a higher percentage of
families with low-income households.
ï‚— There is some evidence that substance use (alcohol,
tobacco, and illicit drug use) may represent a major
contributor to the health disparities between Hispanics
and non-Hispanic Whites.
ï‚— Racism:
ï‚— Institutionalized Racism:
inequitable access to social,
educational, and material resources
ï‚— Direct and Indirect Effects on
Health Status: From access to
healthy diets and appropriate
medical care, to increased stress,
limitation of psychosocial resources,
positive/negative emotions
associated with health behaviors.
ï‚— Addiction: Moral issue vs. disease
ï‚— Other examples?
ï‚— Poverty
ï‚— Impacts childhood brain development
ï‚— Allostatic load (physiological costs due to chronic stress):
Hypertension, elevated blood sugar and cortisol levels,
increased rates of heart and metabolic diseases
ï‚— Costs associated with access (transportation, phone/internet,
education, etc.)
ï‚— Structural Barriers
ï‚— Language barriers
ï‚— Cultural competence of health care providers
ï‚— Geographical locations and concentration of providers
ï‚— Access to the Health Care System
ï‚— Affects quality of care received
ï‚— Communication challenges
ï‚— Effective utilization of treatment
ï‚— Differential Treatment
ï‚— Clinicians lack cultural competence
ï‚— Misdiagnoses increase
ï‚— African Americans have suffered substandard health care,
which has led to higher death rates for African Americans
in the categories of HIV/AIDS, cancer, and heart disease.
ï‚— Minorities are more likely to receive less desirable surgical
procedures, such as amputations, at a rate of up to 3.6X
greater than their White Medicare peers.
ï‚— African Americans are sicker and die more often from
treatable, preventable illness than any other ethnic group
in the United States.
ï‚— Nearly 60% of Whites receive annual vaccinations for
influenza versus 36% of African Americans, and 44% of
Hispanics.
Sickle Cell Anemia
(Primarily a Black Disease)
Cystic Fibrosis
(Primarily a White Disease)
Affects about 1 in 500 Blacks
Affects about 1 in 3,000 Whites
Affects about 78,000 total Blacks Affects about 77,000 total Whites
More deadly than cystic fibrosis
Less deadly than sickle cell
anemia
Total money spent on research:
$95 million in 2004
Total money spent on research:
$117 million in 2003
ï‚— Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010 was signed into law by the Obama
Administration
ï‚— Key components include:
ï‚— Pre-Existing Conditions: Health insurance companies cannot
refuse coverage or charge an individual more if they have a “preexisting condition†or a health problem the individual had before
the date that new health coverage starts
 Young Adult Coverage: If an individual’s plan covers children, they
can now add or keep children on their health insurance policy
until the kids turn 26 y.o. (children can join even if they’re
married, not living with parents, attending school, not financially
dependent on parents, and if they’re eligible to enroll in their
employer’s plan)
ï‚— Preventive Care at no cost (no copayment, co-insurance, or
deductible to receive recommended preventive health services,
such as screenings, vaccinations, and counseling)
. . . the primary reference manual used in all mental health
fields to classify mental disorders. Published by the American
Psychiatric Association, this manual is currently in its fifth
edition (2013).
 Prevalence – the current rate of a particular disorder at
a given point in time.
 Incidence – the number of new cases of a disorder
diagnosed in a given period of time.
 Lifetime Incidence – the number of cases of a disorder
that occur during one’s lifetime.
Total
Sample %
Female %
Male %
Anxiety disorders
31.2
36.4
25.4
Mood disorders
21.4
24.9
17.5
Impulse control disorders
25.0
21.8
28.6
Substance disorders
35.3
21.6
28.6
Any disorder
57.4
56.5
58.4
Disorder
Hispanic
%
NonHispanic
Black %
NonHispanic
White %
Anxiety disorders
24.9
23.8
29.4
Mood disorders
18.3
16.0
21.9
Impulse control disorders
17.9
14.5
15.3
Substance disorders
16.1
10.8
14.8
Any disorder
43.7
38.5
47.6
Disorder
Ethnic/Racial Group
Illicit Drugs %
Binge/Heavy
Alcohol %
Substance
Abuse or
Dependence %
Black/African American
10.5
20.1
7.4
White
9.5
24.0
8.4
Hispanic/Latino
8.8
24.1
8.6
All Asians
3.1
12.4
4.6
Native Hawaiians or Pacific
Islander
14.0
24.7
11.3
American Indian or Alaska
Native
12.3
23.5
14.9
Multiracial
17.4
19.6
10.9
ï‚— Lack of representation/small sample size of some
groups
ï‚— Within-group heterogeneity
 Generation
 Acculturation
 Linguistic ability
 Socioeconomic status
ï‚— Diagnostic accuracy
ï‚— DSM diagnoses may not cover the range of disorders
experienced by other groups.
 Women have higher levels of “internalizing†disorders
whereas men have higher levels of “externalizingâ€Â
disorders.
ï‚— Women have a higher incidence of eating disorders
than do men.
ï‚— Differences may be due to power differentials, with
women having less power and men having more power
and privileges, which may influence health behaviors.
ï‚— Differences may be due to socialization.
. . . “ways that cultural groups, experience, understand,
and communicate suffering, behavioral problems, or
troubling thoughts and emotions†(American
Psychiatric Association, 2013, p. 758).
Underutilization of
mental health services
ï‚— Barriers to treatment
Culture-bound values
Class-bound values
Language variables
ï‚— Experience with racism
ï‚— Culturally sensitive
therapeutic approaches
ï‚— Multicultural competence
ï‚— Cultural matching
ï‚— Culture-specific therapies
 A counselor’s awareness of their own
cultural values and biases
 Understanding the client’s worldview
ï‚— Developing culturally appropriate
intervention strategies and techniques
ï‚— Consider more equitable practices
ï‚— Clinic locations accessible by public
transit or offers free parking
ï‚— Appointments after typical work hours or
on weekends
ï‚— Childcare, sliding scale fees, etc.
1.
2.
3.
4.
5.
6.
What are your health behaviors?
Can you provide other current examples of health care
disparities beyond those discussed in class?
Have you experienced barriers to health or mental health
care due to cultural differences?
Have your health concerns been dismissed possibly due
to your status (woman, ethnicity, educational level,
sexual orientation, etc.)?
Do you feel comfortable challenging your health care
providers if what they recommend does not fit with your
believes?
What kind of culturally competent practices would you
like to see in your health care provider?
Plans for Last Class
ï‚— No Class on Nov 28 (Thanksgiving Holiday)
ï‚— Dec 5 will be our last day of classes!
ï‚— Please complete the following readings:
ï‚— Johnson Ch 8 & 9
ï‚— Mio Ch 10
ï‚— Final Journal (5-pages, APA format with a title page, page
numbers) Due Dec 7 by 11:59pm
ï‚— This should be a review and summary of the key course
concepts discussed and incorporate course terminologies and
concepts to explore what they have learned throughout our
class.
ï‚— Please find prompt questions and guidance in the syllabus
description of this assignment.
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