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NEW HEALTH AFFAIRS ISSUE ASSESSES PROGRESS MADE
IN ELIMINATING HEALTH DISPARITIES

Former Surgeon General Estimates That 83,570 African American Deaths Could Be Prevented Annually

BETHESDA, MD - Three years after the release of the Institute of Medicine’s landmark report on disparities in health care, efforts to narrow gaps in racial and ethnic disparities have not had much of an impact. A new study by former U.S. Surgeon General David Satcher, released today in the March/April 2005 issue of Health Affairs, estimates that 83,570 deaths could be prevented each year if the United States eliminated the black-white mortality gap.

Dr. Satcher examined U.S. mortality rates for African Americans and whites between 1960 and 2000. While the infant mortality rate for African Americans improved overall, the black-white gap during those years actually worsened for infants and for African American men age 35 and older. Blacks suffered 40.5 percent more deaths — 83,570 deaths — than would have been expected if they were white, according to the study.

Satcher’s study is one of several included in the March/April 2005 issue of Health Affairs that assesses progress made since the IOM issued its landmark report, Unequal Treatment. Released today at the National Press Club, papers in the journal identify gaps in health and health care that still exist, and they offer a blueprint for eliminating disparities. In addition to the Satcher study, the issue includes articles by Senate Majority Leader Bill Frist (R-TN), Sen. Edward Kennedy (D-MA), Robert Wood Johnson Foundation (RWJF) President Risa Lavizzo-Mourey, and other leading health researchers.

Although the African American infant mortality rate dropped by two-thirds over four decades, from 44.3 per 1,000 in 1960 to 14.1 per 1,000 in 2000, the mortality gap between black and white infants worsened in those years, according to Satcher.

He identified four reasons that contributed to the gap between black and white males: health care access expansions have consistently excluded nonelderly, nondisabled adult men; black men have not experienced the same improvements in income inequality; there was a spike in gun-related deaths between 1983 and 1995; and the death rate related to HIV infection disproportionately affected communities of color.

“Despite concerted efforts, differences in health status and treatment have persisted for decades. Health care leaders must make solutions to these problems a top priority in our efforts to improve the quality of health care for all Americans, ” said Risa Lavizzo-Mourey, M.D., M.B.A., president and chief executive officer of the RWJF, which was one of four funders of this thematic issue of Health Affairs. “All efforts must be comprehensive in nature, and will need to happen on all fronts: at the federal and state levels, at teaching hospitals, in clinics and at private-sector health plans,” she continued. Other organizations that provided financial support for the issue included the Aetna Foundation, California Endowment, and W.K. Kellogg Foundation.

A foreword signed by Lavizzo-Mourey; William Richardson, president and CEO of the Kellogg Foundation; Robert Ross, president and CEO of the California Endowment; and John Rowe, chairman and CEO of Aetna, stresses five points that must be considered in order to move toward eliminating disparities. They are:


—Development and implementation of long-range, coherent, and coordinated strategies
—Collection and reporting of data by race and ethnicity
—Improving health care providers’ awareness of the problem, strengthening culturally competent health care approaches, and improving the diversity of the health workforce
—Research into community-based approaches to advance health promotion and disease prevention in communities wracked by poverty and racism
—Leadership on the issue from a wide variety of stakeholders, including government, funders, and organizations that represent health care constituents

Articles in the March/April issue of Health Affairs address the role government and policy should play in helping to close gaps in care, the importance of collection and reporting of data by ethnicity and race, the merits of expanding public programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP), and whether states are equipped to create and implement minority health policy report cards.

Studies of note include:

Disparities and Quality Improvement: Federal Policy Levers, by Nicole Lurie, Risa Lavizzo-Mourey, and Minna Jung. This study assesses the role that federal and state governments, as the largest U.S. health care payers, should play in collecting race/ethnicity data, defining race/ethnicity categories, disseminating cultural standards, and enforcing various policies aimed at eliminating disparities.

Overcoming Disparities in American Health Care, by Sen. Bill Frist. Senator Frist asserts that U.S. efforts to eliminate disparities must be part of a broader effort to transform health care and thus must focus on improving the quality of care delivered to all patients. He calls for a broader view of health disparities that also considers socioeconomic status and geography.

Democrats Respond to Redress Disparities, by Sen. Edward M. Kennedy. According to Senator Kennedy, Congress must address the challenge of increasing minorities’ access to health care and improving the quality of care that they receive before any progress can be made in reducing disparities. He calls for expanding Medicaid and SCHIP as first steps.

The Role of Health Insurance Coverage in Narrowing Racial/Ethnic Disparities in Health Care, by Marsha-Lillie-Blanton and Catherine Hoffman. The study assesses whether access to health insurance contributes to racial/ethnic disparities in health care. According to the authors, significant differences in whether a person has a regular source of care could be reduced if Hispanics and African Americans were insured at levels comparable to those of whites.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.

 

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©2005 Project HOPE–The People-to-People Health Foundation, Inc.