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Racial and Ethnic Approaches
to Community Health (REACH U.S.)
Finding Solutions to Health Disparities

At A Glance 2009

Racial and Ethnic Disparities in Health: The Facts

Despite great improvements in the overall health of the nation, health disparities remain widespread among members of racial and ethnic minority populations. Members of these groups are more likely than whites to have poor health and to die prematurely, as the following examples illustrate:

• African Americans. Although breast cancer is diagnosed 10% less frequently in African American women than in white women, African American women are 34% more likely to die of the disease. African American adults are 1.9 times more likely than non-Hispanic white adults to have been diagnosed with diabetes. Although African American children aged 19 to 35 months had comparable rates of immunization for hepatitis, influenza, MMR (mumps-measles-rubella), and polio, they were slightly less likely to be fully immunized compared with non-Hispanic white children. In 2004, African Americans had asthma-related emergency room visits 4.5 times more often than whites. In 2005, non-Hispanic blacks were almost twice as likely as non-Hispanic whites to die of viral hepatitis.
   
• American Indians and Alaska Natives. American Indian and Alaska Native adults are 2.3 times more likely than white adults to be diagnosed with diabetes. American Indian women are 1.7 times more likely to die of cervical cancer than white women. In 2005, American Indians/Alaska Natives aged 18 to 64 years were slightly more likely than non-Hispanic whites to have received the influenza (flu) shot in the past 12 months. In 2006, American Indian/Alaska Native adults were 60% more likely than non-Hispanic whites to be diagnosed with asthma. Infant mortality rates among American Indians/Alaska Natives are 1.4 higher than among non-Hispanic whites.
   
• Asian Americans. Rates of cervical cancer among Vietnamese American women are higher than rates among any other ethnic group in the United States—5 times higher than non-Hispanic white women. Although rates of asthma are generally lower among Asian Americans than among white Americans, in 2003, asthma-related deaths were 50% higher among Asian Americans.
   
• Hispanics/Latinos. In 2004, Hispanic women were twice as likely as non-Hispanic white women to be diagnosed with cervical cancer. Although Hispanic children aged 19 to 35 months had comparable rates of immunization for hepatitis, influenza, MMR, and polio, they were slightly less likely to be fully immunized compared with non-Hispanic white children.
   
• Native Hawaiians/Pacific Islanders. In Hawaii, the rate of diabetes among Native Hawaiians is more than twice the rate among whites. Native Hawaiians are 5.7 times more likely to die of diabetes than whites living in Hawaii.

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CDC’s Leadership Role

For years, public health officials, program managers, and policy makers have been frustrated by the seemingly intractable problem of health disparities and have been at a loss for solutions. In response, CDC created Racial and Ethnic Approaches to Community Health (REACH U.S.), a program that continues to demonstrate that health disparities can be reduced and the health status of groups most affected by health inequities can be improved. REACH supports CDC’s strategic goals by addressing health disparities throughout infancy, childhood, adolescence, adulthood, and older adulthood. This program has developed innovative approaches that focus on racial and ethnic groups and is improving people’s health in communities, health care settings, schools, and work sites.

REACH U.S. supports community coalitions that design, implement, evaluate, and disseminate community-driven strategies to eliminate health disparities in key health areas. In Fiscal Year 2008, Congress allocated almost $34 million to support the REACH program. CDC provides training, technical assistance, and support to REACH communities to help them understand social determinants of health—resources that contribute to the length and quality of life of individuals by their distribution across populations—and their relationship to health disparities. As a result, REACH communities empower community members to (1) seek better health; (2) serve as catalysts for change to local health care practices; and (3) mobilize communities to implement evidence-based public health programs that address their unique social, historical, economic, and cultural circumstances.

Data Show REACH is Working

Data from the REACH Risk Factor Survey show that the REACH program is helping people to significantly reduce their health risks and manage their chronic diseases.

This survey assesses improvements in health-related behaviors and reductions in health disparities within REACH communities, which focus on breast and cervical cancer prevention, cardiovascular health, and diabetes management. Survey results include the following:

• Over a 4-year period, the cholesterol screening rates for Hispanics of all educational levels in REACH communities have steadily increased. In fact, the cholesterol screening rate for Hispanics in REACH communities with a high school education, which was previously below the rate for the national Hispanic population, has surpassed the national rate for this population. Hispanics with less than a high school education in REACH communities now have rates that are approaching that of all Hispanics nationally.
   
• In 2002, the percentage of African Americans in REACH communities who were screened for cholesterol was below the national average. By 2006, this percentage exceeded the national average.
   
• Since 2002, the cholesterol screening rate for Hispanics in REACH communities has greatly improved, quickly catching up to the national average. The cholesterol screening rate for Hispanics from REACH communities increased by 18% during 2002–2006.

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The Keys to Success

REACH has identified the following key principles and supporting activities for effective community-level work to reduce health disparities in racial and ethnic minority communities across the United States:

• Trust. Build a culture of collaboration with communities that is based on trust.
   
• Empowerment. Give individuals and communities the knowledge and tools needed to create change by seeking and demanding better health and building on local resources.
   
• Culture and History. Design health initiatives that are grounded in the unique historical and cultural context of racial and ethnic minority communities in the United States.
   
• Focus on Causes. Assess and focus on the underlying causes of poor community health and implement solutions that will stay embedded in the community infrastructure.
   
• Community Investment and Expertise. Recognize and invest in local community expertise and motivate communities to mobilize and organize existing resources.
   
• Trusted Organizations. Enlist organizations within the community that are valued by community members, including groups with a primary mission unrelated to health.
   
• Community Leaders. Help community leaders and key organizations forge unique partnerships and act as catalysts for change in the community.
   
• Ownership. Develop a collective outlook to promote shared interest in a healthy future through widespread community engagement and leadership.
   
• Sustainability. Make changes to organizations, community environments, and policies to help ensure that health improvements are long-lasting and community activities and programs are self-sustaining.
• Hope. Foster optimism, pride, and a promising vision for a healthier future.

Future Directions

REACH communities are demonstrating that health disparities among racial and ethnic minority groups can be reduced and effective strategies can have their greatest impact in low-income communities. CDC will use the ongoing successes of proven strategies to influence health care practices and polices throughout the public health system. In addition, it will fund at least 36 legacy communities to spread effective strategies to communities across the nation. Legacy communities will be funded as part of the Centers of Excellence in the Elimination of Health Disparities (CEED), and they will receive mentoring and support from CEED. CDC and REACH communities also will continue to collaborate to analyze local data and evaluate program strategies.

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Success Stories

Alabama: REACHing African American women in rural Alabama and across the Mid-South

In Alabama—and across the United States—African Americans are more likely to die of cancer than white Americans. In certain Alabama counties, more African American women die of breast cancer than white women. Additionally, the percentage of African American women aged 65 years or older who reported receiving a Papanicolaou test (Pap test) decreased within the past 3 years.

With support from CDC, the Alabama Breast and Cervical Cancer Coalition at the University of Alabama at Birmingham has engaged a variety of stakeholders, key leaders, and concerned citizens from community- and faith-based organizations, state health departments, grassroots agencies, and public and private health care organizations to promote awareness of and increase participation in breast and cervical cancer screening services in selected counties throughout the state. A core group of volunteers including trained community health advisors, nurses, other health care professionals, and clergy routinely disseminate culturally appropriate health information. They also conduct community-based outreach efforts to eliminate barriers for women navigating the complex health care system.

In Choctaw County, African American women were much less likely to get mammography screening compared with white women. During 1997–2006, the percentage of African Americans who received mammography screenings increased from 29% to 61%, surpassing by 13% the rate for white women who were screened.

During approximately the same time period in Dallas County, a lower mammography screening rate among African American women (30%) compared with white women (50%) was almost eliminated. According to data from the eight-county Alabama REACH program focus area, the gap in mammography screening rates between African American and white women decreased by 76%.

California: REACHing African Americans in Los Angeles

In South Los Angeles (L.A.) County, the age-adjusted death rates from heart disease and diabetes among African Americans are much higher compared with rates for Los Angeles County as a whole. Few resources exist, however, to support a healthy lifestyle for residents of South L.A. neighborhoods.

[A text description of this graph is also available.]

Community Health Councils of Los Angeles (CHC LA) completed a study on food choices in neighborhood supermarkets, grocery stores, and restaurants and examined resources for physical activity. The study’s findings revealed differences in the availability and quality of supermarkets and grocery stores found in South L.A. compared with L.A. County as a whole. Fewer markets serve more people in South L.A.—5,957 persons per store in South L.A. compared with 3,763 persons per store in L.A. County. The study also noted differences in the availability of healthy food choices.

CHC LA assembled a cross section of key stakeholders to form the African Americans Building a Legacy of Health (AABLH) coalition. This coalition works to promote healthy communities and reduce disparities in the rates of diabetes, heart disease, and stroke among African Americans living and working in South L.A. In 2006, the AABLH coalition found that only 41% of stores in South L.A. sold fresh produce compared with 71% of stores that sold fresh produce in L.A. County. A 2005 AABLH study also reported an abundance of fast-food restaurants in South L.A. Of the total restaurants in South L.A., 25.6% are fast food; of the total restaurants in L.A. County, only 11.2% are fast food.

An examination of opportunities for adult African Americans to engage in physical activity revealed that 35% of physical activity venues in L.A. County offer adult physical activity compared with 11% of similar venues available in South L.A. Adult physical activity opportunities were offered in 58% of L.A. County communities compared with 27% in South L.A. communities. These findings reveal resource inequities and inaccessibility factors that contribute to health disparities.

With CDC support, Community Health Councils of Los Angeles has engaged a multi-sector consortium to research and evaluate strategies to (1) promote land-use management and urban design policy, (2) increase physical activity opportunities and improve existing food venues through regulatory practices and policy development, and (3) develop policies and promote investments that support new nutrition sources.

Environmental improvements are beginning to take shape. The Community Redevelopment Agency of Los Angeles has developed an incentive package to attract grocery stores and sit-down restaurants to under-resourced communities. The Los Angeles City Council unanimously approved a proposal that would prohibit new fast-food restaurants in Council Districts 8 and 9 in South L.A. for at least 1 year.

South Carolina: REACHing African Americans in Charleston and Georgetown Counties

In South Carolina, African Americans are at greater risk than whites of developing diabetes and are at greater risk of developing diabetes-related complications such as heart disease, stroke, blindness, renal failure, and the need for an amputation. Diabetes is the sixth leading cause of death in South Carolina, claiming more than 1,600 lives each year.

The Medical University of South Carolina and the REACH Charleston and Georgetown Diabetes Coalition conducted a community needs assessment to improve diabetes self-management. The Coalition discovered that people with diabetes had high interest in using the Internet to find important information about managing their diabetes. However, 50% of older community members and 40% of people with less than 12 years of formal education needed help using the Internet. The coalition built a library partnership to support and sustain diabetes education across the community. The library partnership promotes use of online health information in the context of support systems already in place for the African American community.

Other strategies included creating walk-and-talk groups, providing diabetes medicines and supplies, creating learning environments where health professionals and persons with diabetes learn together, offering advice on how to buy and prepare healthier foods, and improving the quality of diabetes care.

Other disparities for African Americans with diagnosed diabetes have been greatly reduced. For example, during a 5-year time span, the percentage of African Americans who had their hemoglobin A1C (blood sugar) levels checked annually increased from 77% to 97%.The percentage who had their blood cholesterol level checked increased from 47% to 81%. Kidney testing increased from 13% to 53%, and foot exams increased from 64% to 97% in the same time frame.

Lower-extremity amputations among African Americans with diabetes also have decreased sharply. For example, in Charleston County, the percentage of amputations among African American males with diabetes who were hospitalized decreased by almost 54% over a 7-year time span. In Georgetown County, the rate of amputations for this same group decreased 54% over a 3-year time period.

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Related Materials

• REACH—At A Glance 2009 (PDF–4Mb)
• REACH—Success Stories (PDF–710Kb)
• CDC's REACH Web Site

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Page last reviewed: March 30, 2009
Page last modified: March 30, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion