April was National Minority Health Month, a time to raise awareness about health disparities that continue to affect racial and ethnic minorities in the United States. The Centers for Disease Control and Prevention (CDC) defines health disparities as “…preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
Health disparities can be caused by socioeconomic status, little or no access to medical care, geographic region, language barriers, social structures, environmental threats, education status, and many other factors. As we celebrate National Minority Health Month, it is important to note how minority health influences the health of this nation. One key example is the health disparity that exists among African Americans and Hispanics/Latinos. According to a study that was published in 2010 by CDC, 1 in 52 Hispanics/Latinos and 1 in 22 African Americans will receive an HIV diagnosis during their lifetimes, compared to an estimated 1 in 170 whites.
During the 2nd Annual Morehouse College Health Disparity Symposium on April 17, 2013, four public health professionals representing different departments within CDC discussed how high-impact prevention programs can promote health equity. High-impact prevention programs are interventions focused on the places and populations where needs are most urgent and where programs will have the most impact. The speakers also focused on the 21st century challenges that organizations like CDC face in offering solutions to public health problems, such as violence, sexually transmitted infections (STIs), pandemics, and access to healthcare.
Are Inequities Inevitable?
Dr. Alex Crosby, a medical epidemiologist in the Surveillance Branch of the Division of Violence Prevention at CDC, opened the discussion with a presentation titled “Are Inequities Inevitable?” and focused on violence in communities of color like Chicago, New Orleans, and Miami. One of the most striking visuals Dr. Crosby showed was a bar graph that compared educational attainment with homicide rates; communities where educational attainment was above high school levels were less likely to see homicides in their neighborhoods versus communities where education attainment was less than high school. Dr. Crosby emphasized that health disparities, like violence, cannot be viewed as independent incidences. Instead, determinants of health like high-quality education and safe housing influence health outcomes, and our prevention efforts should address the symptoms, not just the disease.
Promoting Health Equity
Dr. Hazel Dean, deputy director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), followed Dr. Crosby and discussed promoting health equity for the prevention of STIs among young people. Along with Dr. Crosby, Dr. Dean discussed the impact of STIs on young people of color and how determinants of health influence health outcomes. Dr. Dean explained that young people of color are affected by STIs and HIV/AIDS more than their white counterparts, and this outcome is tied to their education level, access to health insurance, and the cultural sensitivity of their health care providers. Dr. Dean said that interventions like CDC’s national HIV/AIDS campaign, Act Against AIDS, are models for reaching high-risk populations like African Americans, Hispanic Americans, and men who have sex with men (MSM) about HIV prevention. Dr. Dean explained that, “When we improve our strategies, we improve our health outcomes.”
Maleeka Glover, senior research scientist and lead for CDC’s Vulnerable Populations Planning for Pandemic Influenza with the Influenza Coordination Unit (ICU), discussed the importance of risk communication and pandemic preparedness for populations who are most at risk. One example Ms. Glover used was pandemic preparedness for H1N1. According to Ms. Glover, vulnerable populations for H1N1 include: the elderly, pregnant women, those with developmental disabilities, minorities, individuals with limited English proficiency, public housing residents, and those living in low-income residences. Often, there is a care gap among these populations when it comes to seeking vaccination and understanding risk. Ms. Glover explained that risk communication must be culturally competent and tailored to these groups.
Collectively, the panelists at the Health Disparity Symposium proved that while race and ethnicity are not directly linked to higher rates of diseases, it is important to note that social determinants of health shape the context of vulnerability, and this leads to an increased risk of exposure to disease. For example, insufficient screening, confidentiality concerns, lack of access to health care, and multiple sex partners can lead to an increased risk of acquiring and transmitting diseases. The World Health Organization (WHO) report on Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health represents a global framework on how to eliminate health disparities. The WHO’s overarching recommendations to eliminate health disparities involve:
- Improving daily living conditions, including living and working conditions that will create better lifestyles.
- Tackling the inequitable distribution of power, money, and resources addresses the inequitable pay between men and women so that society is organized at the global, national, and local levels. The public sector will play a vital role in this agenda.
- Measuring and understanding the problem and assessing the impact of action, the first step to addressing a problem is to acknowledge that a problem exists. Global health equity surveillance systems should monitor health inequities and the social determinants of health to evaluate the health equity impact of policy and action. This will involve strong public health research and evaluation.
It is clear that individual risk behaviors do not occur in a vacuum. When it comes to high-impact prevention efforts, it is important to take into account these social determinants of health, and how these factors contribute to risk factors for acquiring and transmitting diseases.
Achieving Health Equity in the 21st Century
There are efforts and programs in place in this country to address the ongoing concern of health disparities. Dr. Leandris Liburd, director of the Office of Minority Health and Health Equity (OMHHE) at CDC, highlighted the National Partnership for Action to End Health Disparities (NPA) as one. This national movement aims to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. What began as a collection of views and recommendations from community leaders and other public and private partners to achieve health equity resulted in the National Stakeholder Strategy for Achieving Health Equity. This strategy provides an overarching roadmap for eliminating health disparities through cooperative and strategic actions and outlines 20 specific goals and objectives for public and private partnerships to help racial and ethnic minorities reach their full health potential. The roadmap also serves as a guide for local organizations to use to identify which strategies are most effective in reaching their communities.
Released along with the National Stakeholder Strategy for Achieving Health Equity was the HHS Action Plan to Reduce Racial and Ethnic Health Disparities. This plan outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. Some of these goals include: increasing the availability, quality, and use of data to improve the health of minority populations; assessing the impact of all HHS policies, programs, and decisions to reduce health disparities; and measuring and providing incentives for better health care quality for minority populations.
In our opinion, reducing and eliminating health disparities, especially among minority populations, is an ethical issue. We cannot accept a health care infrastructure where individuals and populations are subject to premature death and disease due to race, ethnicity, socioeconomic status, sexual orientation, disability status, age, or gender. Eliminating health disparities means that health care is equitable and easily accessible for all. As health communication practitioners, the Health Disparity Symposium at Morehouse College reinforced to us that health prevention messages must be targeted, and appropriate communication channels must be used to reach audiences in each community that is affected by health disparities and health inequities.