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Health Disparities called a ‘National Embarrassment’
By: George E. Curry
NNPA, Editor-in-Chief
Originally posted 3/10/2005

WASHINGTON (NNPA) – Racial and ethnic disparities in health care is “a national embarrassment” that won’t be solved without a comprehensive plan that addresses issues ranging from the federal government’s role in reducing disparities to increasing the number of African-Americans, Latinos and Asian-Americans enrolling in medical school, according to four key CEOs in the health care industry or foundations.

In a joint forward to a special issue of Health Affairs magazine dedicated to racial and ethnic disparities, which was published Wednesday, the four leaders said, “Any effort to reduce and eliminate disparities in health must be comprehensive to be effective. It must include strategies that address the ‘triple whammy’ confronting communities of color in the United States: 1) disproportionately low levels of access to health care, 2) relatively low levels of health care quality when such care is made available, and 3) the adverse social and economic conditions faced by people if color in their own communities.”

The forward was signed by Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation; William C. Richardson, president and CEO of the W.K. Kellogg Foundation; Robert K. Ross, president and CEO of the California Endowment and John W. Rowe, chairman and CEO of Aetna insurance company.

In 2002, the Institute of Medicine issued a report titled, “Unequal Treatment” that revealed that African-Americans and Hispanics receive a lower quality of heath care than Whites. The special report and the attention given to it by four national leaders are intended to keep the medical community focused on the problem.

They noted in the forward that extraordinary progress was made in the United States during the 20th Century. Life expectancy improved from 49 years at the start of the century to 80 years at its close, the infant mortality rate fell by more than 90 percent between 1915 and 1977 and most communicable diseases were either eradicated or greatly reduced because of improved sanitation and widely available immunizations.

At the beginning of the 21st Century, however, racial and ethnic barriers still prevail. The leaders observed:

1) The infant mortality rate for Black babies remains nearly two-and-one-half times higher than for Whites; although rates have decreased for both population groups, the gap remains largely unchanged compared with three decades ago;

2) The life expectancy for Black men and women in the United States remains at nearly one decade fewer years of life compared with their White counterparts;

3) Rates of death attributable to heart disease, stroke, and prostrate and breast cancer remain much higher in Black populations;

4) Diabetes disease rates are more than 30 percent higher among Native Americans and Hispanics than among Whites and

5) Black and Hispanic Americans receive a lower quality of health care than their white counterparts, even when other factors, such as insurance status and income level, are controlled for.

“Solving this national embarrassment will not be easy,” the leaders said. “At the outset, it must be clear that the strategies for eliminating disparities in health care and health status will, by necessity, be different.”

The special issue of the magazine carries articles on such topics as federal policy levers for quality improvement, the private sector’s role and response and the need for what is being called cultural competence.
Neil Calman, president and CEO of the Institute for Urban Family Life in New York, observed: “The failure of high-profile efforts by the Association of American Medical Colleges (AAMC) to increase the number of minority medical school graduates nationwide to 3,000 by the year 2000 makes it clear that new strategies are required.

“Federal and state governments have largely ignored the potential of their influence over medical school through public funding and the accreditation process.”

He noted that although people of color are more than 25 percent of the U.S. population, they are only 11 percent of medical graduates.

“Studies have found that patients are more satisfied with their care when there is racial and ethnic concordance between patients and physicians,” Calman wrote.

The article by David R. Williams, a professor of epidemiology at the University of Michigan, and Pamela Braboy Jackson, a sociology professor at Indiana University, focused on the social aspects of the disparities in health.

“Racial disparities in health in the United States are substantial,” they wrote in the magazine. “The overall death rate for blacks today is comparable to the rate for whites thirty years ago, with about 100,000 blacks dying each year who would not die if the death rates were equivalent.”

Trends for some diseases have gotten worse, Williams and Jackson wrote.

“Death rates from coronary heart disease were comparable for blacks and whites in 1950, but by 2000, blacks had a death rate that was 30 percent higher than that for whites,” they report. “Death rates from heart disease declined markedly from 1950 to 2000 for both racial groups, but because the decline for whites (57 percent) was more rapid than for blacks (45 percent), both the relative and absolute racial differences were larger in 2000 than in 1950.”

For cancer, the disparities are even worse.

“Blacks moved from having a lower cancer death rate than whites in 1950 to having a rate that was 30 percent higher in 2000,” the two professors wrote. “Cancer death rates for whites have been relatively stable over time, with the mortality rate in 2000 being almost identical to the rate in 1950.

“In contrast, cancer mortality for blacks has been increasing, with the rate in 2000 being 40 percent higher than in 1950. Over time, lung and ovarian cancer death rates increased for both racial groups, while mortality from colorectal, breast, and prostate cancer markedly increased for blacks but was less stable or declined for whites.”

Not all authors agree on the cause of the disparities.

An article by Ichiro Kawachi, Norman Daniels and Dean E. Robinson argues that racial explanations alone are insufficient.

“Racial disparities should not be analyzed without simultaneously considering the contributions of class disparities,” they say. “…Whenever possible, class-based differences in health status ought to be examined within racial groups.”

That’s the kind of debate the four national leaders had hoped for.

Writing in the forward, they said: “This issue of Health Affairs provides the ingredients necessary to launch a meaningful national dialogue on eliminating health and health care disparities. To be meaningful, the dialogue must intensely and broadly engage diverse stakeholders –immediately and into the next decade.
The status quo of disparities in health and health care is simply unacceptable. We must – and we can – do better.”

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