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.