Race Matters Health CareExperts say eliminating racial and ethnic health disparities is the civil rights issue of our day

WASHINGTON
When the National Academies' Institute of Medicine released its report earlier this year documenting that minorities, regardless of income, education and access, were discriminated against in health care, many African Americans in the medical and health care fields simply yawned. "Tell me something I don't know" was the overriding sentiment among Black health care professionals and the Black community in general. For years, these professionals have been arguing the same thing, pointing out racial and ethnic disparities in access to quality health care, as well as disparities in incidence rates, mortality rates and treatments for certain illnesses. And in many cases, they have attributed those disparities to racial discrimination.
"To assume that the health care delivery system is somehow immune from the social factors that have shaped this society is inaccurate," says Dr. Stephen B. Thomas, director of the Center for Minority Health at the University of Pittsburgh.
For Thomas, the issue of health disparities is one of several racialized issues such as affirmative action and school desegregation by which the nation is polarized. "It is the same kind of racism that we saw when Blacks were in the streets being attacked by dogs and fire hoses," says Thomas, evoking the civil rights movement of the 1960s. "The struggle for freedom that began with lunch counters and sit-ins and the right to live where you want, is now being waged in our hospitals, in our clinics, in our neighborhoods."
Such rhetoric signals a strongly held conviction by Thomas and others in the medical and health care fields that the problem of racial and ethnic disparities in health care is the key civil rights issue of today.
"It is the political issue of the 21st century," says Amri Johnson, a trained epidemiologist and CEO of WellSolve Health Research Network, an Atlanta-based company that works to increase diversity in the health research work force and industry. Providing 100 percent equity in access, treatment, care and information in health care is no longer an option, Johnson says.
In labeling health inequities a civil rights issue, Thomas, Johnson and others emphasize it is an issue that extends beyond those individual minority communities disproportionately affected by certain diseases to the entire nation, and even the world.
Just as economists contend that the growing disparity in wealth between nations weakens the entire world, Thomas says the disparity in health between the "super-rich" and those on the "bottom rungs" weakens the entire nation.
Johnson agrees. "It is not just an issue for educational institutions, or the government, or the private or public sectors," he says. "Everybody is going to either be hurt or benefit from this."
On the road to
reducing disparities
Recognizing the impact of health disparities on the entire nation, President Bill Clinton and the U.S. Department of Health and Human Services (HHS) launched the Initiative to Eliminate Racial and Ethnic Disparities in Health in 1998. The initiative targets six areas of health disparity, including cancer screening and management, cardiovascular disease, diabetes, infant mortality, HIV/AIDS and child and adult immunizations. HHS has adopted the ambitious goal of significantly reducing the disparities by 2010.
In each of the initiative's target areas, communities of color are disproportionately affected. For instance, African American men and women have a cancer death rate about 35 percent higher than Whites. African American women are more likely to die of breast cancer than women of any other racial or ethnic group, and the prostate cancer mortality rate for Black men is more than twice that of White men. Similarly, in 1999, rates of death from cardiovascular disease were 29 percent higher among African American adults than White adults, and death rates from strokes were 40 percent higher. African Americans are twice as likely, and Hispanics 1.8 times more likely, to have diagnosed diabetes. And African American babies are 2.5 times more likely to be victims of infant mortality.
The racial and ethnic disparities in HIV/AIDS are even more alarming, considering that in 2000 more African Americans were reported with AIDS than any other racial/ethnic group, according to the Centers for Disease Control and Prevention (CDC).
It is an increase that has intensified just in the past few years. In 1999, Blacks and Hispanics represented close to 67 percent of AIDS cases but only 25 percent of the total population, says Dr. Lauren Wood, who is a principal investigator at the National Institutes of Health's National Cancer Institute. But when we look back at 1986, she says, racial and ethnic minorities only represented approximately 40 percent of AIDS cases. In just less than 13 years Black and Hispanics now represent close to 70 percent, she says.
And the future face of HIV/AIDS, according to Wood and others, is that of adolescents, with minority females being disproportionately represented. A study published by the CDC in 1998 found that young disadvantaged women, particularly African American women, were being infected with HIV at younger ages and at higher rates than their male counterparts. As well, HIV prevalence among young African American women was 7 times higher than for young White women, and 8 times higher than for young Hispanic women.
"Don't happen to be a Black adolescent female living in an urban area," Wood says. "That's a trifecta that poses a huge epidemiological risk if you are sexually active for acquiring HIV infection."
High-risk behaviors, substance abuse and lack of awareness about HIV prevention are some of the reasons experts cite for the higher rates.
Although it is not one of HHS' target areas, the disparity in access to health insurance and coverage is a key concern for those dedicated to eliminating inequities in health care.
"Forty-five million Americans have no health insurance, and as many as 50 percent of those are minorities," says Aranthan S. Jones II, health legislative assistant for the Hon. Donna M. Christian-Christensen, the Virgin Islands delegate in the U.S. House of Representatives. The problem is aggravated by the fact that minorities that do have health insurance are more likely to be in lower-end plans, paying more out-of-pocket expenses, and less likely to be referred to specialists, he says.
Universal health care access is at the top of the agenda of the Congressional Black Caucus Health Braintrust, Jones says. The group has created an "uninsured coalition" led by Christian-Christensen, who chairs the CBC Health Braintrust, and Rep. John Conyers, D-Mich. The coalition is pushing several pieces of legislation, including HR 99, which calls for Congress to guarantee universal health care access by 2007, and HR 2743, which calls for an expansion of the Medicare and Medicaid framework to the entire nation.