Archive for the ‘Pediatric Health Care Disparities’ Category

New Children’s Hospitals and Clinics Report Highlights Minnesota’s Declining Immunization Rates

Tuesday, March 8th, 2011

By Patricia Stinchfield, RN, MS, CPNP, Director of Pediatric Infectious Disease & Immunology Infection Control

Patsy Stinchfield

The case of measles detected last week in Minnesota revives strong memories for me of Minnesota’s measles outbreak in the early 1990s. Child health care providers back then will never forget the panic among parents, the babies on ventilators, and the ones who did not survive.

We pay close attention when there is a case of measles because the disease is so highly contagious that even just one case is considered epidemic. While state health officials are still monitoring the confirmed case reported last week, it serves to show that vaccine-preventable diseases continue to be a problem. And that problem may well be due to a worrisome trend we see occurring not just in Minnesota but across the country.

Declining immunization rates.

This trend has the attention of Children’s Hospitals and Clinics of Minnesota. As part of our series of reports on the health of Minnesota’s children called “Children’s Check-Ups,” we decided to take an in-depth look at immunization rates among Minnesota’s children, where they were slipping and why. Our report, called “Check-Up 2: Vaccinations and the Challenges Confronting Minnesota Children,” is now released and can be found at www.childrensmn.org/about-us/childrens-check-ups-series.

We found that Minnesota’s immunization rate for children ages 19 months to 35 months dropped 3.6 percentage points from 2007 (80.5 percent) to 2009 (76.9 percent). As a result, Minnesota’s rank in immunization dropped to 20th place in 2009 from the seventh in 2007. We saw similar drops in vaccinations against measles, mumps and rubella (MMR), diphtheria, tetanus and whooping cough (DTaP and Tdap), and chickenpox vaccine.

Quite simply, the lower the immunization rate, the more likely the disease will spread. Even a one percentage point drop is cause for concern when you consider that it means that more than 4,200 young Minnesota kids are left unprotected.

Last year, we saw a resurgence of whooping cough in Minnesota, which threatens to recur this year. Our report notes declines in whooping cough vaccination rates among young kids, and a poor showing among adolescents for the booster shot version.

We found two powerful forces contributing to declining immunization rates. The first is disparities in care, often linked to poverty, which limits access to vaccines among certain populations. The second is a growing mix of complacency, misinformation and misunderstanding that keeps parents from protecting their children against vaccine-preventable disease.

I had the opportunity to talk about these issues during Minnesota Public Radio’s Midmorning program on Tues., March 8. You can download the podcast here. We hope our report, by providing a clear, factual and in-depth look at these issues, can serve as a resource to inform parents, government leaders, health care providers and advocates about these issues, and to spark a meaningful and productive discussion of how to better protect our kids. They are counting on us to protect them.

Additional Resources:

  • Patsy Stinchfield, joins Good Enough Moms hosts Marti Erickson and Erin Erickson to discuss why vaccinations are important, how they have prevented the spread of disease in the U.S. and how being immunized also protects the people around us. Listen to the podcast

Got Interpreters?

Thursday, May 27th, 2010

Imagine this:

You are a refugee in a foreign land where they speak a different language.  Your child is sick and you must seek health care.  Without an interpreter your ability to communicate is minimal or non-existent and you are not quite sure what the doctor is saying.  You are sent to the pharmacy with the prescription, but get lost on the way because you can’t read the hospital signage.  Going home takes forever because you misread the bus schedule.  It takes you many days to schedule your child’s needed surgery because of the language barrier with the appointment desk staff, and also because – as a single parent holding two jobs just to make ends meet – you are incredibly short on free time.  The day before surgery you receive a reminder call and even though you don’t quite understand the caller, you say, “yes, yes, OK” because you are trying to be polite.  The day of surgery arrives and by sheer luck a nursing assistant who speaks your language discovers that your child ate a full breakfast that morning.  The surgery is canceled, you receive several “dirty” looks and are sent home to reschedule.

This scenario and many similar ones were unfortunately quite common until recently.  It is only in the last 10-15 years that we in health care started using trained interpreters to communicate with patients and families who have limited proficiency in English.  At Children’s, these days may seem now like a distant past, as we have had a tremendous growth in this area.  Manager of our interpreter services Michelle Chillstrom tells me that we currently have 35 staff interpreters.  Our most frequent languages are Spanish, Somali and Hmong, but the list of languages that are routinely interpreted at Children’s is long – 43 in the past year.

Watch this short video by HRET to get the feel for what a health care encounter might look like at Children’s if we didn’t have interpreters:

Boris Kalanj is the Director of Health Care Equity and Cultural Competence at Children’s Hospitals and Clinics of Minnesota. Read his bio.

You’ve Improved!

Monday, April 19th, 2010

Eating VegetablesThere was a time in my childhood when I had gained a bit of weight. Yesterday, browsing through the faded photographs, I tried to imagine how today’s American pediatricians might respond upon seeing my own heavier image as a child. Most would almost certainly find me overweight, perhaps counsel my parents about exercise and healthier eating. The way it was, my pediatrician back then – in mid-1970s Former Yugoslavia – playfully pinched my cheek and exclaimed, “You’ve improved!” She was not joking. She really meant I looked better, healthier.

I reveal this personal story to point out how our values about body image, including obesity, are socially defined. Throughout much of human history, and certainly still in many cultures and countries of the world today, being “over”weight is actually preferred to being skinny. Many people don’t view extra weight as a health concern – just the opposite! For example, in a place where hunger has been omnipresent in the recent past, a larger body may still be viewed as a sign of good health, good fortune, strength and attractiveness.

When it comes to body size, large or small, poverty has always been a defining factor. Historically, having a lower income often meant you suffered food deprivation and malnourishment. If you were poor throughout much of human history, chances are you were engaged in hard physical labor, all the while experiencing a shortage of food.

In recent times, a counterintuitive reversal of that historical pattern has occurred, particularly in societies such as ours where food has become plentiful and cheap. The “new” pattern is that poverty actually leads to obesity. Studies show that the likelihood of being overweight in the poorest 25% of the population is twice that of people in the wealthiest 25% of the population. Children living in poverty have limited access to healthy foods and greater exposure to high-calorie and fatty “junk” food. Supermarkets are scarce in poor areas and the gap is usually filled with fast food restaurants and convenience stores.

If I were poor, I might also have a harder time being physically active. I might not have discretionary income to join a health club. My neighborhood may not be safe or otherwise conducive to exercise, or I may have to hold two or even three low-wage jobs to support my family, leaving me with little or no leisure time. My child’s school may lack the necessary facilities and have fewer organized sports. Neighborhood safety issues might prevent students from walking or biking to school.

In sum, there are many social and economic conditions that play a defining role in children’s health, including childhood obesity.

Trying to change the behavior and choices at the level of an individual child and family is certainly necessary. However, solutions to such intractable socioeconomic problems as overweight in children must go beyond that. They must include interventions at the level of these same social and economic conditions that are the root causes of poor health.

Children’s healthcare organizations such as Children’s Hospitals and Clinics of Minnesota are uniquely positioned as leaders of multilevel changes necessary to achieve health in children. Our substantial clinical expertise is at its highest impact when it’s leveraged through community partnerships and positive influence on policy and systems change.

A creative recent example of community partnership that comes to mind is a small urban garden program that Children’s TAMS ran last summer.  Six young people worked with a Latino Health Educator to plan, plant, tend, harvest, cook and enjoy the fresh food that they grew themselves in a community garden plot in our neighborhood.  It engaged these youth in healthy physical activity and community connectedness, while teaching them life-long skills that promote healthy behavior.   The program was based on the innovative local Youth Farm and Market Project.

Boris Kalanj is the Director of Health Care Equity and Cultural Competence at Children’s Hospitals and Clinics of Minnesota. Read his bio.

Introductions: Boris Kalanj

Tuesday, March 23rd, 2010

Dr. Culbert With a Patient Did you know that more than 50% of patients who seek care at Children’s are nonwhite; 20% speak a language other than English in the home; and greater than 40% are from low-income families, insured through Medicaid?

In this blog, I will write about these and other groups who are often referred to as “underserved” – lacking either in access to health care, its quality, or both.

I will explore some of the social issues that help define Children’s in our community.  You can expect me to write about health care disparities – differences in quality and outcomes of health care due to personal characteristics such as ethnicity, primary language, location, and socioeconomic status.  I will also write about cultural competence and attention to diversity in health care organizations as some of the key methods for reducing disparities.  There are many topics that can be discussed in this context, and I look forward to hearing about issues that particularly resonate with you.

I started at Children’s nine years ago as manager of its then-nascent program of interpreter services.  Over the years, my role has evolved into responsibilities for broader organizational cultural competence.  Currently, as Director of Health Care Equity and Cultural Competence, I collaborate with others to identify, understand and eliminate health care disparities, particularly within care provided at Children’s. (more…)