Citiwire.net

For Release Friday, August 21, 2009
Citiwire.net

Over 80 percent of Americans, according to a recent Time magazine poll, say they’re “satisfied” with their health care plans. But as the discussion escalates and special interest groups struggle over health care system reform that broadens insurance coverage, we’re missing the voices of a major population segment. Check with Americans of color and a disturbing picture emerges: they’re receiving less effective health care, experiencing worse health outcomes, than the population at large.

We know from repeated surveys that our minorities–African Americans, Hispanic/Latinos, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and Pacific Islanders–experience higher rates of infant mortality, cardiovascular disease, diabetes, HIV Infection/AIDS and cancer than Americans in general. They also face higher rates of disability, chronic disease and premature death.

Why? The picture is explained by inadequate access to health care, and in some well-documented instances, inferior or poor quality care. But check further and you find inequities attributable to limited access to opportunity, chronic subjection to racial discrimination, limited educational achievement, barriers to living wage employment, and isolation in neighborhoods of concentrated poverty. Unsafe housing and vviolence-afflicted neighborhoods explain generational cycles of chronic disease and premature death more fully than access to medial care alone.

If the country is to reform its health care significantly, it’s can’t stop with issues of improved efficiency, affordability and insurance coverage. Demography is destiny and we know that our population is rapidly becoming more diverse, that minorities’ population growth significantly exceeds that of whites. We can’t improve America’s health without improving minority group health; achieving health equity will require more than reformed health care insurance.

Indeed, the underlying premise of the Department of Health and Human Services’ “Healthy people 2010 Agenda” is that the health of a person is inseparable from the health of the larger community. Delores Acevedo-Garcia and her colleagues at Harvard’s School of Public Health have developed a data system, Diversity Data, that compiles overwhelming evidence demonstrating correlations between residential segregation by race and many poor health outcomes, including infant mortality and childhood obesity.

Some fear that broadening the current health care debate to include health equity just makes a daunting challenge all the more difficult. Yet there’s a harsh fact: the United States is not just a global laggard among advanced nations in offering universal health care access; it also lags behind many on the fronts of health equity and addressing the social determinants of health.

Responding to the World Health Organization Commission on Social Determinants of Health, the European Union has recently moved to design and implement a multi-year approach to the issue. Its title, significantly, is DETERMINE, with an on-line resource, the European Health Portal for Action on Health Equity. In addition to the EU efforts, Brazil, Chili, Canada, Iran, Kenya, Mozambique, Sri Lanka, Sweden and the United Kingdom have all become partners with the World Health Organization (WHO) in affirming their countries’ commitment to make progress on health equity and the social determinants of health.

Many public health advocates in the United States have worked tirelessly to insert prevention and community health initiatives into the current health care reform legislation proposals. Their efforts are to be commended. But it is time for the United States to partner seriously with other world nations to focus on health equity issues. Michael Marmot, WHO Commission Chair, reminds us correctly:

“Central to the Commission’s recommendations is creating conditions for people to be empowered to have the freedom to lead flourishing lives…. We rely too much on medical interventions as a way of increasing life expectancy. A more effective way of increasing life expectancy and improving health would be for every government policy and program to be assessed for its impact on health and health equity, to make health equity a marker for over all government performance.”

That’s the central lesson. And it makes all the more difference for the United States, because we know that in less than two decades, the majority of children in this country will be children of color. In their provocative 2002 book, The Miner’s Canary, Harvard Law Professors Lani Guinier and Gerald Torres show how issues of race aren’t just a case of equity for its own sake, but also point to conditions in American society that endanger us all. Nowhere is this metaphor more salient than in the health reform debate. We must see health disparities as the canary in the mine, recognizing the danger that we all face if we do not work for health equity and address, with fresh vigor, the social determinants of health.

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