CDC confronts harsh reality: disparities in health care

Blacks have much higher rates of hypertension and HIV infection than whites, and teen pregnancies are three times higher among Hispanics compared with whites.

Men are nearly four times more likely than women to commit suicide, and white men are two to three times more likely to die in motor vehicle crashes than white women.

These are some of the health disparities highlighted in a Centers for Disease Control and Prevention report released Jan. 14 that examines how differences in income, race or ethnicity, gender and other social factors affect people's health. The report is the first in a series on health disparities and inequities that the CDC plans to release.

The goal is to provide local, state and federal officials with the data they need to take action to reduce gaps in health and health care, said Leandris Liburd, PhD, MPH, director of the CDC Office of Minority Health and Health Equity.

"The reality of racial and ethnic health disparities -- while not new in this country -- is also generally not known in the general population or well-understood," she said. "It's disheartening to see that advances in medicine that we've made have not benefited many people of color and low-income communities."

The 116-page report includes 22 essays in six general categories: social determinants of health, environmental hazards, access to care and preventive health services, mortality, morbidity, and behavioral risk factors. It comes in response to a pledge by CDC Director Thomas Frieden, MD, MPH, about a year ago to bring more attention to health disparities.

The report provides a snapshot of problems long-known by public health officials, said Rajiv Bhatia, MD, MPH, medical director of occupational and environmental health for the San Francisco Dept. of Public Health.

"It scratches the surface," he said. "It's impossible to put all of the information in one place. This information fills libraries."

Contributing factors abound

Health disparities present a particular challenge because there can be so many contributing factors, Dr. Liburd said. A person's health can be affected by their community, educational level and income. For example, many people live in communities without stores that sell fresh fruits and vegetables, or that are so plagued with crime that residents feel unsafe walking outside, she said.

Health officials can work to educate medically underserved communities about healthy lifestyle behaviors, but it won't help if people don't have access to quality health care, said Richard Warnecke, PhD, professor of epidemiology, public administration and sociology and director of the University of Illinois at Chicago Center for Population Health and Health Disparities.

Poor people are less likely to live in neighborhoods with safe parks and streets and often don't work jobs with benefits such as paid sick leave, Dr. Bhatia said.

Low-income neighborhoods have a tendency to transform, with different populations moving in and out periodically. That makes it difficult to establish long-term resources such as community health centers, Dr. Warnecke said.

Change requires multiple parties and agencies working together, including schools, businesses, churches and local governments, Dr. Bhatia said. In San Francisco, the health department has worked with schools to ensure that all students have access to the same foods, with planning agencies to reduce air and noise pollution and transportation officials to lower the area's high rates of pedestrian injuries related to motor vehicles.

Health disparities are well-documented, and it's time to dedicate more resources to finding and implementing solutions, Dr. Bhatia said. "We don't really have funding sources for the kind of open-ended collaboration that we have done in San Francisco," he said.

Dr. Liburd said the CDC plans to release updated reports on health disparities every two to three years. "We hope this data at the national level provides a benchmark from which we can monitor our progress in the years to come and help direct resources to the areas that need it the most."