HHS: Reducing disparities should be part of health reform

Some physician leaders are pushing for changes as a new report cites racial and ethnic gaps in care.

By Susan J. Landers — Posted July 13, 2009

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Low-income Americans and members of racial and ethnic minority groups continue to experience disproportionately higher rates of disease, fewer treatment options and reduced access to care, according to a report released June 9 by the Dept. of Health and Human Services.

According to the report, 48% of African-American adults have a chronic disease compared with 39% of the general population. Eight percent of white Americans develop diabetes, while 15% of African-Americans and 14% of Hispanics develop the disease. Hispanics were a third less likely than whites to receive counseling on obesity, and African-Americans were 15% more likely to be obese than whites.

Health officials said the findings show the need for action to eliminate health care disparities.

"Now it's time for Democrats and Republicans to come together to pass reforms this year that help reduce disparities and give all Americans the care they need and deserve," HHS Secretary Kathleen Sebelius said in a statement. "Minorities and low-income Americans are more likely to be sick and less likely to get the care they need. These disparities have plagued our health system and our country for too long."

The report contained no surprises for Carolyn Barley Britton, MD, president of the National Medical Assn., which represents African-American physicians. The association has been tracking the health of African-Americans during the past 10 years and found that disparities have gotten worse in some areas.

"Rates of HIV infection have worsened, and the obesity and diabetes data are very serious," Dr. Britton said.

Calls to end disparities

Some groups are urging health care leaders and lawmakers to consider such disparities as they draft health system reforms. Among them is the Commission to End Health Care Disparities, which was established five years ago by the American Medical Association and the NMA. The National Hispanic Medical Assn. later joined the commission.

The commission has urged President Obama to assess all health reform proposals for their potential to eradicate disparities. "We are committed to the elimination of health care disparities and look forward to working with you on this critically important effort," the commission wrote in an April letter to the president.

Members of the Congressional TriCaucus, formed by the Black, Hispanic and Asian-Pacific congressional caucuses, introduced the Health Equity and Accountability Act of 2009 on June 9 outlining the groups' priorities for health reform. Key among them is the elimination of racial and ethnic disparities. They recommend addressing cultural concerns such as credentialing for medical translators and ensuring adequate reimbursement for language and translation services.

The HHS report said African-Americans are more likely to develop and die from cancer than members of any other racial or ethnic group. It cited data from a 2008 Commonwealth Fund report showing that African-American men are 50% more likely than white men to have prostate cancer and colorectal cancer.

Half of Hispanics and more than a quarter of African-Americans do not have a regular doctor, compared with one in five whites, the report said.

Dr. Britton said African-American physicians generally practice in communities with a majority of African-American patients, and they often enter primary care, leaving a lack of specialists.

"We have some areas of the country where the African-American specialists can be counted on one hand," she said.

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An example of health disparities

A Health and Human Services report found that disparities in health care are apparent in the use of preventive services among some groups. Lower screening rates can lead to diagnoses at more advanced stages, with higher mortality rates.

Source: "Health Disparities: A Case for Closing the Gap," Dept. of Health and Human Services, June 9 (link)

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External links

"Health Disparities: A Case for Closing the Gap," Dept. of Health and Human Services, June 9 (link)

American Medical Association on eliminating health disparities (link)

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