We need increased federal and state funds to reduce racial/ethnic disparities in healthcare


The state of racial and ethnic disparities in health care continues to be problem for the U.S., and as such, federal and state funding is needed for targeted education, outreach, prevention and testing campaigns, and getting patients into treatment in a timely manner.

In 2000, Healthy People 2010 was published to provide a health prevention framework for the U.S., as a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Addressing health disparities was the 2nd overarching goal of the report. But sadly, here in August 2010, we have fallen short of the goal, as Healthy People is being updated for 2020.

Today, minority populations are still disproportionately affected by many diseases including:

• Cancer – 50-200% greater mortality for “treatable” cancers if not detected early
• Chronic Kidney Disease – 200-400% greater prevalence
• Diabetes
• Heart Disease
• HIV/AIDS – 200-400% greater mortality rates
• Immunization gaps
• Mental health issues
• Obesity

(according to the Alliance of Minority Medical Associations)

According to the 2009 Congress-mandated annual quality and disparities reports issued by the Agency for Healthcare Research and Quality , “…we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access.”

The drivers behind racial and ethnic disparities in health care and outcomes are varied, stemming from long-term socioeconomic disparities, access to care and language and cultural barriers. There are even environmental pollution/contamination effects that have been noted, as many landfills and other contaminating sites tend to be concentrated in areas populated by the poor and disenfranchised. An overview of the drivers and impact of disparities can be reviewed via a brief video from Kaiser Permanente.

Many believe that access to health care is the primary determinant of disparities. However, I believe that with increased access to care for all U.S. citizens, there is the possibility that with more Americans participating in the system and a predicted shortage in primary care physicians, there may actually be an decrease in the available health care for minorities. Given the expected growth in minority populations over the coming years, disparities will become a more critical issue. As such, federal and state funding should be increased to support & expand initiatives specifically targeted at reducing disparities.

The Congressional Black Caucus Health Braintrust posits that increased expenditures to achieve health equity represent “good” debt, in that it adds value for individuals, communities, the U.S. workforce, defense and the nation as a whole. Especially as compared to the “bad” debt of the current Iraq war investment (of $9 million/month).

Even a small percentage of the funds spent on the war overseas could have an impact on health disparities. The U.S. needs to wage battle on the variety of chronic and acute conditions that affect everyday Americans, but especially minority groups that suffer disproportionately. So all people are encouraged to contact their state and federal legislators regarding policies and state budgetary items that can reduce disparities, and call for increased investment in this area that will affect all Americans in the years to come.


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9 Responses to “We need increased federal and state funds to reduce racial/ethnic disparities in healthcare”

  1. Kristin Lohr Says:

    This is great post highlighting what I think is perhaps the greatest challenge facing our health care system today. Primary care seems to be a dying concentration in the US, as patients are increasingly relying on expensive specialty care. However this is not an option for those who are not insured, and they are often forced to rely instead on emergency rooms for basic care. Unless this is addressed I agree that we are only going to see these disparities in access to health care increase with time.

    I am currently in the process of applying to medical school and am very interested in specializing in primary care, however there is a lot of pressure for new doctors to choose other fields. Foremost in most students minds is knowing that you will emerge from school in a large amount of debt. This motivates many to choose a specialty that will allow them to diminish this burden as quickly as possible, and unfortunately primary care has a poor compensation rate compared to other areas.

    I think that one very effective way that we could apply federal and state funds to reduce racial and ethnic disparities in health care would be to offer incentives to medical students to choose primary care as a specialty. For students who want to go into this field but ultimately decide not to because of financial burdens, government funding to help repay loans in exchange for a set number of years of work in an under-served area could make all the difference.

  2. drah2010 Says:

    I agree with you. We definitely need more primary care physicians – – and the shortage will especially be seen in traditionally under-served areas. Unfortunately, we have reached the point where primary care isn’t seen as being “practical” for med school students when it comes to debt load vs. potential income. We can’t fault individuals for making practical decisions when so many other individuals do, but it highlights a gap in the system. Especially with more people in the health care system given health care reform plans.

    The other thing that will be important to watch is in the area of Electronic Health Records. There’s now a Medicare/Medicaid incentive program to drive adoption of EHRs among physicians & hospitals. The intent is to improve the quality of care by capturing information in a way that can be exchanged with relevant care providers to improve care coordination, among other things.

    There’s also required data elements that have to be captured discretely, like gender, race, ethnicity, etc. And the thought is that capturing data in discrete fields will allow a measurement & process improvement rigor in healthcare that has been applied in other industries (six sigma, etc). And while there’s certainly some value in that, even with incentives, it’s likely that physicians and hospitals in under-served urban & rural environments will lag in their adoption. Which could potentially broaden the disparity gap. But hopefully, interventions will be applied that can address these issues.

    Good luck to you in med school!

  3. Brownhilda Ngwang Says:

    I believe this topic is extremely important to the growth of our nation as a whole. By focusing and advocating this issue we can close the racial gap in these health issue. With the recent close of the Operation Iraqi Freedom campaign maybe the money that was used to finance millions of American dollars in a foreign country can be funneled back into our communities to resolve some of these health problems with early detection. By catching these diseases in the early stages we can actually decrease the amount of deaths. Now that a spot light has been shinned on the fact that landfills have been placed in a close proximity to the low income neighborhoods maybe politicians will be persuaded to discontinue such risky practices. Waste disposal can be relocated to a location that does not put any community in danger. This change will take some time to take effect that’s why it should be addressed and the appropriate plans should be considered today to ensure a healthy tomorrow. Creating a stronger country of healthy Americans.

  4. hmb10 Says:

    Eliminating disparities will require a multi-pronged approach. Access to healthcare serves is the determinant that receives the greatest attention. It is well understood that other factors impact healthcare. Distal determinants related to health care access include socioeconomic status, race and ethnicity.

    Race as social phenomena has significant impact on health care access. African Americans and American Indians/ Alaska Natives have the highest mortality rates in the United States. This is likely the result of a complex mix of overlapping sociocultural, political and economic factors and is not fully understood. Proximal determinants include health beliefs, social relationships, social capital and local delivery of services.

    Funds can be directed to improving access by increasing insurance coverage and available services b but does this ultimately improve the quality of life for the groups involved? The greatest strides will be made in eliminating disparities if we empower people to provide for themselves. That can only happen if we make the changes that are needed to improve the overall quality of life. Changes in education lead to improved socioeconomic status and the ability to obtain access to healthcare is critical. While I believe we must eliminate disparities, my sense is that the problem and the solutions are so much bigger than access alone.

  5. Ruben Frescas Says:

    This is an interesting and evolving issue, especially with the passage of the recent health care reform bill into law. First, I wanted to address the incentives issue. There is, and has been, a program that is government sponsored for medical students, residents and practicing primary care physicians to pledge to work in medically underserved areas, deemed health professional shortage areas, to receive incentive payment meant to assist with the loan burden. The National Health Service Corps (http://nhsc.hrsa.gov/) allows for this opportunity. Part of the problem amongst US medical students do not want to commit early on because it binds you to primary care. There is actually a publication released on this issue by the Robert Graham Center, an affiliate of the American Academy of Family Physicians (www.graham-center.org).

    The emphasis of the importance of primary care is not lost on the reform efforts. The concept of “medical homes” and focuses on prevention and continuity of care are also areas that have grown. I think that these issues will only continue to develop and hopefully lead to more open access – which leads to the point of making sure that the access reaches to bridge the health disparities gap. This requires a multidisciplinary approach, such as model systems in Colorado, to provide people with comprehensive health care and to ensure it is reaching people who need it most. Working in a clinic in one of Chicago’s prominent Hispanic communities through the public health system openned my eyes to the importance of accessing resources such as general surgery. Patients may have primary care, but when trying to get a surgery scheduled, the patient may be waiting six months to a year. What we have to do is focus on where the need is, and satisfy that need with the workforce we have available.

    When people ask, “why was the health care bill so long?” This is why, because the solution to the health care system is not straight forward, there are many issues to contend with and development that will need to evolve. Hopefully though, we will make strides to reach our goals through these and similar policies.

  6. patgorres Says:

    This is a very important and defining issue for our time. Addressing health disparities amongst minorities extends far beyond the normal scope of typical health issues, as traditional “health policies” sometimes do not address other political and social policies that negatively affect minority health.

    One particular example is the set of policies that are responsible for the vastly disproportionate rates of incarceration of black men compared to other races. While these criminal policies may not affect health on the surface, they certainly impact health disparities primarily in that they reduce the source of resources for these communities. In addition, disproportionate rates of incarceration increase the susceptibility of the black community for the spread of HIV/AIDS and other diseases in prison, that are further disseminated into their communities.

    This is only a specific example of how other seemingly unrelated policies can have major downstream effects on health disparities.

  7. valerie harvey Says:

    Thank you for your insightful posting on such a critical issue. Unfortunately, despite numerous initiatives, including Healthy People 2010 health disparities continue to persist in the United States. From the perspective of an academic dermatologist, – I can testify that health disparities transcends all specialties and disciplines of medicine. For example, there is relatively little data regarding the structural and functional differences across the various racial and ethnic minority groups. As a result, there is a poor understanding of disorders that disproportionately impact these populations (i.e. keloids), which ultimately translates to an armamentarium of suboptimal treatments, and therefore poor patient outcome. Unfortunately, major stakeholders- such as the pharmaceutical companies- do not consider these disorders high priority given their low profit margins, and as a result the research remains stagnant as does our knowledge of certain disease processes.
    The realization of the elimination of health disparities will require a multifaceted approach- including the full participation of the minority community and increasing the number of minorities in the health care workforce. It will also require the cooperation various stakeholders (pharmaceutical companies) as they are major players in setting the policies.

  8. sberger4mph Says:

    Thank you for this post! The broad gaps in health outcomes and access remain staggering despite numerous efforts over the past decade. I agree with comments above that a renewed commitment to primary care is central to addressing this problem. Support for primary care practices and physician training must come from new political alliances galvanized around the efforts to improve health and rejuvenate our economy.

    As we’ve learned in this course, strategies effective at engaging and empowering communities can go a long way toward bridging health disparities. I think that in addition to creating very organized efforts, leaders in the community must be motivated to adopt these organized approaches – community members with an effective game plan and effective leadership committed to the game plan can succeed.

    I really appreciate your mention of the effect of pollution on the health of communities. The cardiovascular risks are very compelling (http://www.nejm.org/doi/full/10.1056/NEJMe068274). I believe efforts to incorporate more public health issues in the training of primary care physicians may serve dual purposes of recruiting more physicians to community health efforts and making the training itself more relevant and fun.

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