Several groups and organizations throughout the country promote health and well-being in year-round campaigns that seek to educate the public on various health concerns, on healthcare management, and on life and longevity. The widely celebrated event, “Making Strides Against Breast Cancer” is sponsored by the American Cancer Society in October of every year. Breast cancer is the most common cancer diagnosed in women in the United States, and is the
second leading cause of cancer death in women. During the month of October stories of hope are shared and major fund-raising is done to advance science leading to eradicating this life-altering disease.
This month CARIB NEWS promotes our health and wellness agenda by highlighting the disproportionate burden of poor health among minority groups, and by joining efforts to bring the need for improved opportunities and l
ifestyles to the forefront for those who are affected most.
There are a multitude of ailments, diseases and viruses that warrant discussion because of the impact they have had on our population in general. What is strikingly apparent though is the greater impact of diseases and other life-threatening health concerns on minority groups.
Health disparities is explained by Yvonne Graham, Associate Commissioner, New York State Department of Health and Director, Office of Minority Health and Health Disparities Prevention in simple terms: Differences in health among groups of people. These differences can include how frequently a disease affects a group, how many people within that group get sick, or how often the disease causes death.
Health disparities were first documented thirty years ago in the Report of the Secretary’s Task Force on Black and Minority Health, otherwise known as the Heckler Report. Margaret Heckler was the then Health and Human Services Secretary under President Ronald Reagan. The Heckler Report brought about discussion on the issue and revealed critical data on health disparities among racial and ethnic groups that would be echoed in similar and subsequent reports – Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (2003), and the Kelly Report – Health Disparities in America (2015). The data can be described as riveting, but what is equally compelling is its origins. According to the 2015 Kelly Report, “[M]any of the gaps that exist in public health are shaped by generations of cultural bias, injustice, and inequality.” There currently exist higher rates of infant mortality, HIV/AIDS and cardiovascular disease among minority groups than whites, “and substantial differences in disease incidence, severity, progression and response to treatment” among those groups.
The Kelly Report, similar to the Heckler Report lists glaring disparities for certain diseases among racial and ethnic groups on a national level that cause more deaths, illnesses, disabilities and years of productive lives lost. These diseases include cancer, heart disease, stroke, chemical dependency, diabetes, homicides, and asthma.
A similar pattern is found on the state level. September 2016 US Census data reveal that the poorest communities in New York have corresponding higher rates of health issues. There are excess premature deaths - death from all causes before a person reaches 75 – among Blacks, Hispanics/Latinos, Asian and Pacific Islanders, and Native Americans when compared to their White counterparts. These same groups are also more likely to live in poverty, have lower levels of educational attainment, and be without health insurance coverage - a direct correlation between poor health outcomes and socio economic factors, immigration status and cultural influences, termed social determinants of health (factors that influence poor health outcomes.)
All is not lost. There is still a chance of success and recovery and to effect a shift in health disparities among the groups most impacted. The Kelly Report shows that tremendous progress has been made with diagnosis, treatment and management of diseases with the aid of technology. The New York State Department of Health has analyzed data made available by the US Census and the American Community Survey. The data identifies demographic distribution – race and ethnicity - within the State. Blacks, Hispanics and other minority groups account for 44% of the population - nearly 19.7M. The State agency has identified the groups impacted, where they live, and the other factors that affect them. This data has facilitated the creation of a map to identify high impact areas across the state. In 2014, forty-four (44) specific areas throughout the State of New York were identified, with a high volume in New York City. The data confirmed the direct co-relation between socio economic conditions and health outcomes. With this data, communities, governments and other agencies can better target resources to support health outcomes.
The New York State Prevention Agenda 2013-2018: Priorities, Focus Areas, Goals and Objectives is an ambitious undertaking by the Department of Health to make New York State the healthiest state by 2018. Associate Commissioner Graham said that her agency has set certain goals to reduce the level of poor health outcomes with the use of a dashboard that is free to the public where the progress of each goal is recorded. Goals include: improve the health status of all New Yorkers; reduce fall risks among the most vulnerable populations; increase the percentage of State residents that receive optimally fluoridated drinking water; create community environments that promote and support healthy food and beverage choices and physical activity; expand the role of health care and health service providers and insurers in obesity prevention; promote culturally relevant chronic disease self-management education; increase early access to and retention in HIV care; reduce premature births in New York State; increase the proportion of NYS children who receive comprehensive well child care in accordance with AAP guidelines; increase utilization of preventive health services among women of reproductive age to improve wellness, pregnancy outcomes and reduce recurrence of adverse birth outcomes; prevent and reduce occurrences of mental, emotional and behavioral disorders among youth and adults.
Additional programs directly impact outcomes of health disparities. The New York State of Health – the health benefit exchange – has enrolled 2M people for health insurance coverage in New York and is faring better than any other state in the country where enrollments are concerned.
Associate Commissioner Graham advocates for residents in high-impact communities to be the change that they need to see – a mantra long promoted by social and political activists. She believes that we should change the mindset that government will take care of everything. Communities are not victims but are catalysts for change. She remarked: “The problem is that health outcomes are a product of a complex array of variables at the individual level, neighborhood level and institutional level.” She believes that managing individual life style factors are critical, and that we ought to be accountable for our own health outcomes. The health executive also believes that the general political environment is another consideration in addressing the problem of health disparities: “There has to be the political will to address disparities and change the paradigm since improved health outcomes are incremental with ongoing effort” she noted.
Another big part of change will come through collective impact – mobilizing, engaging and empowering communities to take charge of their health and to identify their needs. “You have to be the neighborhood watchdog. You have to be your brother’s keeper with support from government and other stakeholders to move from poor health to optimal health.”
The work of agencies like the Office of Minority Health and Health Disparities Prevention reaffirms that much has been accomplished and that strides against health disparities must continue.
By Caroline Bruno, Associate Editor