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Closing the gap 

Access is key to ending health disparities

A report released last week on persistent health gaps for racial and ethnic groups in North Carolina was long on description and short on prescription. The report--the second such study in four years by the state offices of Health Statistics and Minority Health and Health Disparities--showed that, overall, racial minorities have generally poorer health than whites in North Carolina.

The gaps are largest for African Americans and Native Americans. Latinos also have substantially higher rates for some measures of poor health. But because the state's Spanish-speaking population is younger and healthier than other groups, the study reports the incidence of chronic disease is lower among Latinos.

Specifically, African Americans have the highest rates of heart disease, cancer, diabetes and HIV. Compared to whites, Native Americans have a higher incidence of diabetes, smoking and lack of exercise. Latinos have higher teen pregnancy rates and higher percentages of adults without health insurance. (The complete report is available on the Center for Health Statistics' Web site, www.schs.state.nc.us./SCHS/pdf/RaceEthnicRpt.pdf .)

Such inequalities are not news to front-line healthcare providers--many of whom are eager for policymakers to begin focusing on solutions.

"If we attacked these disparities the way we attack natural disasters like hurricanes and tornados, we wouldn't have these problems," says Moses Carey, an Orange County commissioner and head of Piedmont Health Services, which runs six clinics for low-income residents in the Triangle and Triad. "The health community is not getting the support from the policymakers because this will cost money. And nobody likes to talk about spending more to address critical needs."

The state report is not all bad news. Areas where racial minority groups are better off than whites include lower rates of smoking, chronic lung disease and suicide among African Americans, and lower infant death rates for Latinas [see "The Paradox Lives," below]. And unlike in the past, when the state published health data by race for "white" and "minority" only, the new report makes use of population files from the National Center for Health Statistics and other methods for producing a more complete picture.

But simply raising the issue of racial disparities in health is still controversial in some quarters--as the study acknowledges. "Race is considered a marker of health problems, not as a risk factor or cause," it states. "We do not have a complete understanding of why race is associated with health problems, but low socioeconomic status, stress and racism are among the underlying causes of the poor health status of minorities (on average) compared to whites."

Controversy isn't confined to statewide studies. U.S. Health and Human Services Secretary Tommy Thompson came under fire recently because a report by his department on national health disparities was watered down to the point where critics said it amounted to censorship.

The Washington Post reported that the words "disparities" and "inequality" were removed from key findings in a draft report and were replaced by the phrase "inequalities in quality." And while the initial report stated clearly that "racial, ethnic and socioeconomic disparities are national problems that affect health care at all points in the process," the final draft said merely that "some socioeconomic, racial, ethnic and geographical differences exist."

After being questioned by a House Ways and Means committee about the two versions, Thompson said he would reissue the original report. It is now online at www.ahcpr.gov under Minority Health.

Community leaders in the Triangle say it's high time such disputes were put to rest.

"We're beyond discovering that there are health disparities around race or ethnicity," says Andrea Bazan-Manson, head of the Raleigh-based Latino advocacy group El Pueblo. "If you ask any of us in the community, we can easily come up with two or three solutions to these issues."

First and foremost for the state's Latino community is addressing the language barrier that keeps many Spanish-speaking residents from getting or even seeking health care, Bazan-Manson says. "If you ask people in the community about their top health concerns, they won't even talk about health," she says. "They'll talk about the language barrier." Health organizations should be hiring bilingual staff as a matter of course, Bazan-Manson adds, instead of relying on part-time translators or children who are all too often asked to interpret complex health messages for their parents.

Latino leaders aren't waiting for government officials to act. El Pueblo has just received a three-year grant to train volunteer health leaders in the Spanish-speaking community. They will distribute disease-prevention information and help friends and neighbors gain better access to care.

Information about the Lideres de Salud program is available at 835-1525.

More by Barbara Solow

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