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Last Reviewed: June 5, 2007
Content Source:
Office of Minority Health & Health Disparities (OMHD) |
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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.
HHS has selected six focus areas in which
racial and ethnic minorities experience serious disparities in health
access and outcomes:
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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](https://webarchive.library.unt.edu/web/20080920045848im_/http://www.cdc.gov/omhd/NavBars/images/buttons/maroonsquare.jpg) |
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 |
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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](https://webarchive.library.unt.edu/web/20080920045848im_/http://www.cdc.gov/omhd/NavBars/images/buttons/maroonsquare.jpg) |
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 |
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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 |
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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 |
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:
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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](https://webarchive.library.unt.edu/web/20080920045848im_/http://www.cdc.gov/omhd/NavBars/images/buttons/maroonsquare.jpg) |
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](https://webarchive.library.unt.edu/web/20080920045848im_/http://www.cdc.gov/omhd/NavBars/images/buttons/maroonsquare.jpg) |
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 |
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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 |
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. |
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 |
|
CPEHN
Using Race, Ethnicity, and Language Data to Eliminate Health
Disparities |
|
AFL-CIO
Immigrant Workers at Risk: The Urgent Need for Improved Workplace
Safety and Health Policies and Programs |
Sources:
|
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. |
|
|