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Last Reviewed: June 5, 2007
Content Source:
Office of Minority Health & Health Disparities (OMHD)

Eliminating Racial & Ethnic Health Disparities

"The future health of the nation will be determined to a large extent by how effectively we work with communities to reduce and eliminate health disparities between non-minority and minority populations experiencing disproportionate burdens of disease, disability, and premature death."
Guiding Principle for Improving Minority Health

Healthy People 2010 is designed to achieve two overarching goals: 1) Increase quality and years of healthy life; 2) Eliminate health disparities.
The Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry (CDC/ATSDR) has lead or co-lead responsibility for 18 of the 28 (64 percent) Healthy People 2010 focus areas, including all six areas identified in the Department of Health and Human Services (HHS) initiative to eliminate health disparities.  The second goal of Healthy People 2010, to eliminate health disparities, includes differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. Compelling evidence indicate that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations in all these categories and demands national attention.

The demographic changes that are anticipated over the next decade magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population; therefore, the future health of America as a whole will be influenced substantially by our success in improving the health of these groups. A national focus on disparities in health status is particularly important as major changes unfold in the way in which health care is delivered and financed.

Eliminating racial and ethnic disparities in health will require enhanced efforts at preventing disease, promoting health and delivering appropriate care. This will necessitate improved collection and use of standardized data to correctly identify all high risk populations and monitor the effectiveness of health interventions targeting these groups.

Eliminating health disparities will also require new knowledge about the determinants of disease, causes of health disparities, and effective interventions for prevention and treatment. It will also require improving access to the benefits of society, including quality preventive and treatment services, as well as innovative ways of working in partnership with health care systems, State and local governments, tribal governments, academia, national and community-based organizations, and communities.

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HHS has selected six focus areas in which racial and ethnic minorities experience serious disparities in health access and outcomes:

maroon square Infant Mortality
African-American, American Indian, and Puerto Rican infants have higher death rates than white infants. In 2000, the black-to-white ratio in infant mortality was 2.5 (up from 2.4 in 1998). This widening disparity between black and white infants is a trend that has persisted over the last two decades.1
maroon square Cancer Screening and Management
African-American women are more than twice as likely to die of cervical cancer than are white women and are more likely to die of breast cancer than are women of any other racial or ethnic group.2
maroon square Cardiovascular Disease (CVD)
Heart disease and stroke are the leading causes of death for all racial and ethnic groups in the United States. In 2000, rates of death from diseases of the heart were 29 percent higher among African-American adults than among white adults, and death rates from stroke were 40 percent higher.2
maroon square Diabetes
In 2000, American Indians and Alaska Natives were 2.6 times more likely to have diagnosed diabetes compared with non-Hispanic Whites, African Americans were 2.0 times more likely, and Hispanics were 1.9 times more likely.3
maroon square HIV Infection/AIDS
Although African Americans and Hispanics represented only 26 percent of the U.S. population in 2001, they accounted for 66 percent of adult AIDS cases4 and 82 percent of pediatric AIDS cases reported in the first half of that year.5
maroon square Immunizations
In 2001, Hispanics and African Americans aged 65 and older were less likely than Non-Hispanic whites to report having received influenza and pneumococcal vaccines.6

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These six health areas were selected for emphasis because they reflect areas of disparity that are known to affect multiple racial and ethnic minority groups at all life stages. The representative near-term goals within these six areas are drawn from Healthy People 2000, the Nation's prevention agenda: targets for reducing disparities have been developed in consultation with representatives from target communities and experts in public health. Reliable national data is also available to track our progress on these near-term goals in a timely fashion. The leadership and resource of the Department will be committed to achieving significant reductions in these disparities by the year 2010. These disparities occur for a variety of reasons, including unequal access to health care, discriminations, and language and cultural barriers.

In addition, the following diseases and conditions disproportionately impact racial and ethnic minorities:

maroon square Mental Health
American Indians and Alaska Natives appear to suffer disproportionately from depression and substance abuse. Minorities have less access to, and availability of, mental health services. Minorities are less likely to receive needed mental health services. Minorities in treatment often receive a poorer quality of mental health care. Minorities are underrepresented in mental health research.7
maroon square Hepatitis
In 2002, 50 percent of those infected with Hepatitis B were Asian Americans and Pacific Islanders.8 Black teenagers and young adults become infected with Hepatitis B three to four times more often than those who are white
.9 One recent study has found that black people have a higher incidence of Hepatitis C infection than white people.10
maroon square Syphilis
Some fundamental societal problems, such as poverty, inadequate access to health care, and lack of education are associated with disproportionately high levels of syphilis in certain populations. Cases of primary and secondary syphilis in 1999 had the following race or ethnicity distribution: African Americans 75 percent, whites 16 percent, Hispanics eight percent, and others one percent. Syphilis reflects one of the most glaring examples of racial disparity in health status, with the rate for African Americans nearly 30 times the rate for whites.11
maroon square Tuberculosis (TB)
Of all the TB cases
reported from 1991-2001, almost 80 percent were in racial and ethnic minorities. Asian Americans and Pacific Islanders accounted for 22 percent of those cases, even though they made up less than four percent of the U.S. population.12

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CDC created OMH in 1988 in response to the 1985 Report of the Health and Human Services (HHS) Secretary抯 Task Force on Black and Minority Health which revealed large and persistent gaps in health status among Americans of different racial and ethnic groups. Since September 2001, OMH has engaged its partners in anticipating, preparing, and responding to the needs of racial and ethnic minority populations during public health emergencies. OMH provides leadership in setting priorities and monitors and evaluates programs geared toward eliminating the disproportionate burden of disease, illness and disability among racial and ethnic minority populations through research, enhanced health practices, health promotion and services.

OMHD has,

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Prepared CDC briefing materials and testimony for the special hearing on Eliminating Racial and Ethnic Health Disparities that was held jointly by the Congressional Black Caucus (CBC), Congressional Hispanic Caucus (CHC), and the Congressional Asian Pacific-American Caucus on April 12, 2002.

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Lead CDC & ATSDR Planning Activities for the CHC 2002 National Hispanic Leadership Summit held August 16-17, 2002 in San Antonio, Texas. Also, OMH coordinated agency-wide efforts to develop and produce the following CDC & ATSDR materials to participants of the Hispanic Health Leadership Summit:

  1. One-pagers in English and Spanish that summarize agency program activities targeting Hispanic populations.
  2. In collaboration with the National Center for Health Statistics (NCHS), OMH developed a Health Status Chart book for Hispanic or Latino populations in the United States. The book identifies health disparities for Hispanics that included data by ethnic group, reported socio-economic status, health status, health access and utilization, chronic conditions, risk factors, and births and deaths.
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Coordinated the CDC & ATSDR briefing for the Chair of the Congressional Black Caucus Health Braintrust focusing on African-American health disparities in the United States with particular emphasis on Region IV. The CBC requested a technical briefing from the CDC in order to refocus and re-energize efforts in the southeast to address disparities. In collaboration with the NCHS, OMH developed A Demographic and Health Snapshot of African Americans in Region IV in comparison to the rest of the nation for the CBC Health and Environmental Justice Braintrust held in Charleston, South Carolina on June 6-7, 2002.

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Provided funding to support minority health activities with the American Indian Higher Education Consortium (AIHEC), Hispanic-Serving Health Professions Schools (HSHPS), Minority Health Professions Foundation (MHPF), and Morehouse College/ Public Health Sciences Institute (MC/PHSI).

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Conducted a series of Regional Tribal Consultation meetings across the country. During these meetings, tribal leaders provided input and guidance to CDC regarding the design of its tribal consultation policy and shared their views on critical public health issues in Indian country.

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Published papers and abstracts on high priority agency health promotion and prevention activities, delivered lectures, convened and moderated plenary sessions and workshops at national symposia.

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Supported an Interagency Agreement with the Department of Defense/Center for Disaster and Humanitarian Assistance Medicine to fund the Healthy Living in the Pacific Islands Initiative. The University of Hawaii will conduct Nutrition Assessments in Children and Young Adults Living in the Pacific Islands. Results from the project will be used to address emerging health problems affecting Pacific Islander populations.

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As the Office moves toward its goals, many challenges lay ahead. OMH is working with CDC/ATSDR leaders on a strategic plan to address health disparities. As part of the plan, the office will coordinate leadership activities and strengthen infrastructure within CDC/ATSDR to improve minority health.

For Additional Information:
  National Center for Chronic Disease Prevention & Health Promotion (NCCDPHP)
    REACH Program
    Health Disparities A Selected Bibliography
National Center for HIV, STD, and TB Prevention (NCHSTP)
Division of Tuberculosis Elimination (DTBE)

The mission of the Division of Tuberculosis Elimination (DTBE) is to provide leadership in preventing, controlling, and eventually eliminating tuberculosis (TB) from the United States, in collaboration with partners at the community, state, and international levels.
    NCHSTP, Division of Sexually Transmitted Diseases (DSTD)
Syphilis Elimination

This plan is intended to serve as a resource and blueprint for the many partners vital to the success of this effort.  Eliminating syphilis in the U.S. requires commitment, investment, and collaboration at all levels. Leaders must be involved in designing and delivering syphilis services and have the opportunity to share ownership in interventions that improve the health status of their communities.
National Center for Infectious Disease (NCID)
Viral Hepatitis

The Division of Viral Hepatitis is the Public Health Service component that provides the scientific and programmatic foundation for the prevention, control, and elimination of hepatitis virus infections in the United States, and assists the international public health community in these activities.
  National Center for Health Statistics (NCHS)
    Trends in Racial and Ethnic-Specific Rates for the Health Status Indicators: United States, 1990-98.
    Midcourse Assessment of Healthy People 2010 Goal II (PPT) 2006
  CDC/ATSDR Office of Urban Affairs
Minority Health Program
  Department of Health and Human Services (HHS)
Office of Minority Health
  Agency for Healthcare Research & Quality (AHRQ)
Fact Sheet: Addressing Racial & Ethnic Disparities in Health Care

Demographic Trends
  U.S. Census Bureau
Brief on Poverty
  Health Resources and Services Administration (HRSA)
Office of Minority Health
    Cross-Cultural Communication in Health Care: Building Organizational Capacity Satellite Broadcast June 4, 2003
Indian Health Service (IHS)

National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute, (NHLBI).

  National Institutes of Health (NIH)
National Center on Minority Health and Health Disparities (NCMHD)
  American Public Health Association (APHA)
Community Solution to Health Disparities Database
  Kaiser Network
    Compendium of Cultural Competence Initiatives in Health Care Health Web Casts
    Race, Ethnicity & Medical Care: A Survey of Public Perceptions and Experiences
    Minority Graduates of U.S. Medical Schools: Trends, 1950-1998
  Maternal & Chlid Health (MCH) Library
Racial and Ethnic Disparities in Health
Using Race, Ethnicity, and Language Data to Eliminate Health Disparities
Immigrant Workers at Risk: The Urgent Need for Improved Workplace Safety and Health Policies and Programs

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  1 National Center for Health Statistics (NCHS), 2002.
2 National Center for Health Statistics (NCHS), Health, United States, 2002, Table 30.
3 National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 2000.
4 NCHS, Health, United States, 2002, Table 54.
5 NCHS, Health, United States, 2002, Table 55.
  6 Morbidity and Mortality Weekly Report (MMWR), 2002, p.1020.
7 Mental Health: A Report of the Surgeon General, 1999.
8 Department of Health and Human Services.
9 Marwick C, Mitka M (1999). Debate revived on hepatitis B vaccine value. JAMA, 282(1): 15�.
  10 Committee on Infectious Diseases, American Academy of Pediatrics (2000). Hepatitis C. In LK Pickering et al., eds., 2000 Red Book: Report of the Committee on Infectious Diseases, 25th ed., pp. 302�6. Elk Grove, IL: American Academy of Pediatrics.
11 National Center for HIV, STD, and TB Prevention (NCHSTP) Division of Sexually Transmitted Diseases.
12 NCHSTP Division of TB Elimination.

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