Yesterday
Despite tremendous improvements to improve the health and longevity of
the American people, statistical trends indicted a persistent disparity in key
health indicators among certain subgroups of the population.
The Task Force on Black and
Minority Health was established in April 1984 by Secretary of Health and
Human Services Margaret Heckler to study these significant health disparities.
This was the first comprehensive, coordinated HHS study to investigate the
longstanding disparity in the health status of blacks, Hispanics, Asian/Pacific
Islanders, and Native Americans - including American Indians, Alaska Natives -
and Native Hawaiians, compared to the non-minority population.
The Task Force analyzed mortality data from 1979 to 1981, identifying
six leading causes of death that together accounted from more than 80 percent
of the deaths among blacks and other minority groups. As a result, six leading
causes of death were recommended as priority areas for intensive action and
study by the HHS: cancer, cardiovascular disease and stroke, chemical
dependency (measured by deaths due to cirrhosis), diabetes, homicide and
accidents (unintentional injuries) and infant mortality.
The Surgeon General’s Report
on Mental Health (1999) documented the existence of mental health
disparities, noting that while mental illness is at least as prevalent among racial
and ethnic minorities as in whites, minorities have less access to and are less
likely to use mental health services, and receive poorer quality mental health
care. Consequently, minority communities have a higher proportion of
individuals with unmet mental health needs.
Healthy People 2010 ( ) builds upon initiatives pursued over the past two decades and focuses
HHS efforts on two goals: 1) increasing quality and years of healthy life; and,
2) eliminating health disparities. The NIH co-leads the coordination of the mental
health and mental disorders focus area of Healthy
People 2010.
Today
Racial and ethnic
minorities are the fastest growing communities in the
The U.S.
Bureau of Census projects that by 2050 the non-white Hispanic population will
comprise just 50.1 percent of the total
U.S.
population.
Yet, in many
respects racial and ethnic minorities, the urban and rural poor and other
medically-underserved individuals continue to have poorer health and remain
chronically underserved by the health care system. Consequently, the future
health of
America
is at risk.
Disparate health
status can be attributed to a complex interaction among multiple factors.
Socioeconomic differences are largely responsible for the widening differences
in health status among racial and ethnic lines. But, even after controlling for
socioeconomic status, there seem to be other factors that further influence
health disparities, including gender, genetics, environment, and racial bias.
Access, utilization, and quality of medical care contribute to these
inequities. And, language and culture pose additional barriers to good health
for racial and ethnic minorities and other medically-underserved
individuals.
Barriers to mental
health care include the cost of care, societal stigma, and the fragmented
organization of services. Additional barriers include the client’s fear
and mistrust of treatment.
In 2000, the Congress
established the NCMHD to lead, coordinate, support and assess the NIH effort to
eliminate health disparities. The NCMHD promotes minority health and the health
of other health disparity populations; and leads, coordinates, supports, and
assesses the NIH effort to eliminate health disparities. The NCMHD-funded research advances the understanding
of the development and progression of diseases and disabilities that contribute
to health disparities. The NCMHD programs focus on expanding the nation’s
ability to conduct research and to build a diverse, culturally-competent
research workforce to eliminate health disparities. Numerous NCMHD-funded
health education campaigns are bringing useful health information to diverse communities.
And, the NCMHD collaborates with other NIH Institutes and Centers, the Agency
for Health Care Research and Quality (AHRQ), and the Health Resources and
Services Administration (HRSA) to address health disparities by: providing
funding to improve the health of minorities and other medically-underserved
populations and to conduct health disparities research; training members of
health disparity populations as research; and providing educational loan relief
for health professionals committed to conducting research concerning health
disparities.
The rise of mental health disparities has become an
enduring legacy of Hurricanes Katrina/Rita. Inpatient
and crisis psychiatric facilities were destroyed during Hurricanes Katrina/Rita.
No psychiatric crisis units have reopened. There are not enough mental health
professionals to meet resident’s behavioural health . As a result, existing mental health disparities in
New Orleans have been exacerbated. Mental
health is perhaps the most significant challenge now facing the
New Orleans health care
system.
Before Hurricanes Katrina/Rita, nearly one-quarter of state residents, including almost one-third of
Louisiana’s children, lived in
families with incomes below the federal poverty level. One-fifth of non-elderly
residents had no health insurance. Twelve percent of the children were
uninsured. As a result he state had the fourth highest emergency department use
per capita among all states in 2004.
The largely poor, uninsured
and African-American residents of
New Orleans
were served by the Medical Center of Louisiana at New Orleans (MCLNO), which
included
Charity
Hospital,
University
Hospital, and affiliated clinics. In the
New
Orleans area, the MCLNO provided 83% of inpatient and
88% of outpatient uncompensated care costs in 2003. Most of the region’s psychiatric,
substance abuse, and HIV/AIDS care was provided by the MCLNO. The MCLNO housed
most of the region’s inpatient mental health beds.
Two years after the storm, approximately half of
New Orleans’ physicians no longer practiced
in the area. More than half of all hospitals that existed before the hurricanes
were closed. Nineteen percent of the
city’s residents felt their physical health was worse than before the
storm. Thirty-six
percent indicated that their access to health care had been compromised.
Almost one-quarter of individuals
from the
New Orleans
area reported that post-Katrina stress affected their temper, alcohol
consumption, and marital relations. Mental health clinics report higher rates
of depression, post-traumatic stress disorder, substance abuse, acute
psychosis, domestic violence, and even suicide. At some facilities, it is
estimated that 50 to 60 percent of adults and 20 percent of children are
clinically .
The NCMHD HHS efforts to provide relief to the devastated
Gulf
Coast
region. The Regional Coordinating Center for Hurricane Response at the
Morehouse School of Medicine, Atlanta, Georgia, coordinates collaborative
efforts throughout the Southeast to implement: 1) electronic health records, 2)
telemedicine − with a focus on telepsychiatry, 3) health screenings, and
3) ongoing community surveillance and follow up to improve health care outcomes
and reduce health disparities among low-income communities and populations.
And, in
Texas the Houston Area Community& Clergy Outreach Subcommittee, an interdisciplinary alliance of physicians,
clergy and churches, and educational institutions, developed one of many
non-traditional partnerships to provide mental health services to individuals
who had been displaced by the storm.
Other NCMHD mental health
disparities collaborations include: NCMHD
mental health disparities co-funded projects discussion here.
Tomorrow
The NIH is
committed to research that seeks to better understand health disparities and to
develop new diagnostic, treatment, and prevention strategies that will
eliminate health disparities.
Guided by the NIH Strategic Research Plan and Budget to
Reduce and Ultimately Eliminate Health Disparities and other initiatives,
the pace of creating and translating new knowledge from research into
prevention and treatment strategies to improve public health is expected to
increase as are the number of scientists from underserved communities.
|