Remarks to the Morehouse School of Medicine Health Conference

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Prepared Remarks of Claude Earl Fox, M.D., M.P.H.
Administrator, Health Resources and Services Administration

"Optimizing Outcomes in Primary Care"
Atlanta, Ga.

March 8, 2001

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Introduction

I am delighted to be here in Atlanta for this most important conference on how we can all work together to build healthier communities for the 21^st century. 

I commend Dr. Sullivan (President, Morehouse School of Medicine) for his leadership of this proud institution on its 25^th anniversary and thank him for this opportunity to discuss a topic near and dear to my heart.

As we explore today’s topic “Community Health and Healthy People 2010,” I want to emphasize the critical role that HRSA plays in ensuring access to quality health care and in the fight to end health disparities.  

A year ago, the Department of Health and Human Services released Healthy People 2010 – a document containing the Nation’s health goals for the next decade. It is a powerful tool bringing us together around two important goals: the assurance of access to quality health care for all Americans and the elimination of disparities that persist among different groups of people in their ability to get the care they need. These are ambitious goals, yet realistic and very necessary.

Both of these issues are at the core of the work of my agency – the Health Resources and Services Administration.

This year HRSA will invest $6.2 billion budget in programs and initiatives intended to increase the availability of vital health services for those who are underserved, no matter what their circumstance. Working in partnership with communities both large and small, urban and rural, all across America, we build networks of care that make it possible for millions of individuals and families to lead healthier, more productive lives.

Simply put – HRSA’s mission is to achieve 100 percent access to health care and 0 disparities for all Americans.

Statistics on Disparities

What do we mean when we discuss health disparities among racial and ethnic groups?  It means that African Americans, Hispanics, American Indians, Alaska Natives, and Pacific Islanders have higher rates of illness and death than the U.S. population as a whole.

Let me give you some statistics:

• The infant mortality rate among African Americans, American Indians and Alaska Natives is more than double that for whites;

• Death rates due to heart disease are more than 40 percent higher for African Americans than for whites;

• The cancer death rate is 30 percent higher for African Americans than for whites;

• The AIDS death rate among African Americans is more than seven times that of whites.

• Minority children ages 2-4 have more dental decay that white children.  American Indian children have 5 times more decay.   And among low-income children, most of the decay goes untreated.

Federal Role in Reducing Disparities

Will reducing these disparities be an easy task?  Of course not.  And we have no illusions as we begin our work toward our goals. 

We know that these health disparities often mirror inequalities in income and education among groups – so much so that income and education often serve as proxy measures for health status. 

In general, groups with higher rates of illness and death have higher poverty rates and less education.  Higher incomes allow access to medical care, better housing and safer neighborhoods.  More education gives individuals more access to information that promotes health-enhancing habits and behaviors.

Working to eliminate these differences is the right thing to do.  And there are many things we can and will do to meet our goals.

As Surgeon General David Satcher points out, one of the important goals of Healthy People 2010, is to move the nation toward a balanced community health system, one that:

• makes access to quality care available to all;
• that balances early detection of disease with health promotion and disease prevention; and
• that draws on the assets of the community, including homes, community schools, churches and other faith-based organizations, and civic and local groups.

Reducing disparities is more a matter of human cooperation than scientific inspiration.  Those of us who help set national health policy must reach out to create real and meaningful partnerships with community health officials and professionals.  Federal government officials must listen to them and learn from them.

In turn, we Feds will provide the resources, information and technical assistance local leaders need to make a difference in their own communities.  And we must help them successfully find their way through the increasing complexities of our health care system.

Our work at HRSA is a lifeline to local communities trying to build better health care services for their residents. Through a variety of programs and services, we improve the delivery of primary care to underserved individuals and families, enhance access to that care, and improve health status measures across the board.

HRSA’s Efforts to Build Access and Reduce Racial Disparities 

HRSA's primary health care programs form the backbone of the Nation's health care safety net.  By building primary care delivery systems in places where they are sorely lacking, HRSA, through its Bureau of Primary Health Care, works to improve the health of low-income residents in inner cities and in rural and isolated areas.

For more than 35 years, HRSA-supported health centers have been invaluable safety net providers. The Health Center program has built an extraordinarily successful track record of delivering cost-effective, high-quality primary health care to 9.5 million people at some 3,000 sites nationwide. One in every six low-income children, one in seven low income uninsured individuals, one in 10 Medicaid recipients, and one in five homeless people benefit from this program. About 41 percent of health center patients are uninsured; 34 percent are Medicaid recipients; and 64 percent are minorities.

Many of the health centers are involved in special initiatives to monitor and control diabetes, boost infant immunization rates, keep patients’ blood pressure under control, and reduce the number of low birth-weight babies.

Funding for community health centers is $1.2 billion in fiscal year 2001. And President Bush’s budget calls for $124 million in additional funding to increase the number of sites by 1,200 nationwide. The Administration’s long term goal is to double the number of people served at these centers.

Each year, millions of pregnant women, infants, and children are served by one of HRSA's maternal and child health programs. We work with states and local communities to create a seamless, community-based comprehensive system of health care for women and children that integrates health, social, education, mental health, and other services in efficient, cost-effective ways. And in all these programs, special attention is paid to families with low-income…those with diverse racial and ethnic heritage, and…those living in rural or isolated areas without access to health care.

HRSA also administers programs funded under the Ryan White CARE Act, which provides health and social services to low-income people with HIV/AIDS. 

FY 2001 funds for Ryan White total almost $1.8 billion – an increase of $213 million over last year. In January, we announced awards under Title 1 that target 51 high-incidence metropolitan areas. Atlanta received $15.9 million -- with $1.2 million targeted specifically to minorities under the Congressional Black Caucus Initiative.

Most of the Ryan White funds are spent under Title II of the Act, which provides grants to states for comprehensive care and for life-saving drug treatments. In 1998, 64% of Title II clients were minorities. 

Combating HIV/AIDS disparities among racial/ethnic groups may be our greatest challenge in years to come.

In 1998, white Americans were about 72 percent of the total U.S. population, but just 34 percent of newly reported AIDS cases.  African Americans – almost 13 percent of the U.S. population in 1998 – represented 45 percent of new AIDS cases. 

Tackling the growing problem of health disparities is the subject of a new document we recently released.

This document, titled Eliminating Health Disparities in the United States, details HRSA’s activities in this area. Many of the activities focus on clinical areas already established by Healthy People 2010 and HHS' 1998 Initiative for the Elimination of Racial/Ethnic Disparities in Health. These include: diabetes, cardiovascular disease, infant mortality, HIV/AIDS, immunizations, and cancer screening and management. Additional HRSA activities target oral health, mental health and substance abuse, asthma, cultural competence, diversifying the health care workforce, domestic violence, health care for people living along the U.S.-Mexico border, and health issues of lesbian, gay, bisexual or transgender populations. HRSA Associate Administrator Marilyn Gaston will speak more about these efforts in the next session.

HRSA Efforts to Increase Number of Minority Health Professionals

Another way HRSA works to build access and reduce health disparities is by promoting greater minority participation in the health professions.

HRSA invests more than $300 million annually in programs to increase the diversity of the health professions workforce and to make sure that those we train are willing to serve in places where services are scarce.  In fiscal year 2000, we issued 10 awards to Morehouse totaling more than $4 million to help in this effort.

Minorities total almost 30 percent of the U.S. population but only 15 percent of all medical school graduates in primary care specialties, 13 percent of dental school graduates and just 5 percent of medical school faculty.

Studies tell us that African American and Hispanic physicians are far more likely than other physicians to treat patients from their own racial/ethnic group.  Additionally, they are more likely than white physicians to treat Medicaid or uninsured patients. That is why HRSA is dedicated to building a health professions workforce that looks like America.  Because a workforce that looks like America will serve America better by increasing minority access to health care.  And greater access to health care will help reduce racial disparities in health outcomes.

A good example of what I’m talking about is our National Health Service Corps program that benefits both minorities and other health professionals by offering scholarships and loans in exchange for service in the Nation’s most underserved communities. Since 1972, more than 23,000 NHSC clinicians have provided critical health care services, spending all or part of their careers in communities without other sources of care and with profound health disparities.

Today, we have more than 2,500 NHSC providers serving in every state, the District of Columbia, Puerto Rico, and the Pacific Basin. More than 40 percent of NHSC scholarship program participants are ethnic or racial minorities.

This is a very brief summary of some of the things HRSA is doing to reduce racial and ethnic health disparities and improve the health of the  Nation. I encourage you to find out more about our efforts on the Internet at www.hrsa.gov

In Closing

As we continue our discussion at this conference about improving health outcomes for all our citizens, I urge each of you to take home the important message that citizen action does matter.

We can provide guidance and support at the federal level, but the future of public health still depends in large measure on the work you do at the local level. Good prevention and health monitoring strategies can only be carried out through the effective partnerships and collaborations that start in your own neighborhoods and communities.

There really is only one way to meet the public health challenges of our changing world – we must continue to work together to ensure quality care for all our citizens.

Thank you.

 

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