By AMERICAN HEART ASSOCIATION NEWS
Thirty years after a groundbreaking report about health disparities among African-Americans and other minorities, doctors and public health leaders say the nation has much more to do.
Former Health and Human Services Secretary Margaret Heckler commissioned The Report of the Secretary’s Task Force on Black and Minority Health, released in August of 1985. Now known as the Heckler Report, it was the first federal acknowledgement that eliminating health disparities should be a national priority.
The report documented persistent health gaps that accounted for 60,000 excess deaths each year, with 80 percent of those deaths occurring in six main categories, including cancer, cardiovascular disease, diabetes and homicide.
Its publication and the attention it received helped trigger three decades of work that increased awareness about the wide gaps in health outcomes among many minority communities. It prompted research studies such as the Jackson Heart Study, the largest study in history to investigate the genetics around high blood pressure, heart disease, strokes and diabetes in African-Americans.
And it was the catalyst for the creation of the U.S. Department of Health and Human Services Office of Minority Health. Later, six HHS agencies, including the Centers for Disease Control and Prevention and the Food and Drug Administration, and many states and territories would also add offices focused on minority health. Also created was the National Institute on Minority Health and Health Disparities, which delves into the science and research of health gaps.
In 2011, HHS released a strategic plan to create “a nation free of disparities in health and healthcare.” It includes goals and targets on specific strategies for everything from access to care to data collection. The same year, the agency released a National Stakeholder Strategy for Achieving Health Equality, incorporating ideas, suggestions and comments from thousands of people and groups across the country.
The work is daunting. Consider the challenges many communities still face:
- Although overall infant mortality rates have fallen over time, African-American babies are twice as likely to die as white babies, according to CDC statistics.
- African-American women are far more likely to be obese than white women: 54 percent compared to 33 percent. Overall, 47.8 percent of African-Americans, 42.5 percent of Latinos, 32.6 percent of whites and 10.8 percent of Asian-Americans were obese between 2011 and 2012, according to a report based on CDC statistics.
- Although mortality due to heart disease for African-Americans was cut in half from 1980 to 2010, cardiovascular diseases still account for the largest proportion of inequality in life expectancy. A CDC report “Health Disparities and Inequalities” in 2011 showed African-American, Hispanic, Asian-American and American Indian and Alaska Native populations suffer higher mortality rates than other populations.
- African-Americans have much higher rates of hypertension and diabetes. More than 40 percent of African-American men and 43 percent of African-American women were diagnosed with high blood pressure from 2007 to 2012. That’s compared with 30 percent of white men and 28 percent of white women.
- Compared to non-Hispanic whites, Hispanics are 1.7 times and American Indians are 2.5 times as likely to be diagnosed with diabetes.
“The burden of chronic disease continues to be a significant issue,” said J. Nadine Gracia, M.D., director of HHS’ Office of Minority Health. “While we can point to progress, the unfortunate reality is communities of color die from preventable illness in higher numbers.”
Much of the work today is about weaving public-private coalitions to do battle in the newer frontiers of childhood obesity; access to healthy foods; health gaps in sexual minority communities; and in the root causes of poverty, housing, education and other “social determinants of health.”
This “has to be our focus for future generations. … We are in the midst of a remarkable movement to turn the page and accelerate our momentum,” Gracia said.
She and American Heart Association executives recently met to figure out ways to tackle those issues.
“I think we have done very well in recognizing the types of initiatives we need to implement to improve the cardiovascular health of all Americans,” said recent AHA President Elliott Antman, M.D., who was part of the teleconference. “My dream is if we do this right, we will erase from our vocabulary the word ‘underrepresented.’ ”
Current AHA President Mark Creager, M.D., said the organization has a two-pronged attack on health inequities: culture and science.
“A major part of the strategic planning and our direction is to create a culture of health,” said Creager, director of the Heart and Vascular Center at Dartmouth Hitchcock Medical Center.
From the individual to the larger community and then to all levels of government, he said the AHA aims to improve environments – where people can have access to healthy food, safe places to exercise and good education.
The second prong, science, goes to the foundation of the AHA’s work, Creager said. For instance, the AHA is funding a number of Strategically Focused Research Networks, research collaboratives of three or four centers that focus on a theme, a kind of “Manhattan Project” around health issues, such as healthcare disparities, prevention of cardiovascular disease and high blood pressure, he said.
Creager said the AHA “put our money where our mouth is” by recently awarding $15 million over four years to investigators from the Medical University of South Carolina, Morehouse School of Medicine, Northwestern University and the University of Colorado, Denver, to look at heart disease and stroke in minority populations.
Gracia said everyone has a “moral and economic imperative” to erase health and healthcare gaps. She said health inequalities among minorities have caused illness and premature deaths that cost the United States $1.24 trillion. (The figure is from a 2009 report from the nonprofit Joint Center for Political and Economic Studies, which looked at costs from 2003 to 2006.)
“Our work is not yet done,” Gracia said. “Whether we look 30 years from now and see whether we rose to meet this opportunity depends on all of us. This is not an effort that the federal government can do alone, that the public sector can do alone.”
Margaret Heckler, who led the HHS from 1983 to 1985 and lends her name to the groundbreaking report, encouraged people to act.
“We are all part of this human family,” Heckler, 83, said at a summit earlier this year. “We are brothers and sisters, each of whom deserves the same respect, civility and opportunity as the other. Through our education, knowledge and medical information, we now have each one of us a role to play. We now have tools necessary to make the changes needed in our world.”