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Health Disparities Among Races Narrow, but Remain

Many minority groups made gains in 1990s, U.S. report says

SATURDAY, Feb. 2, 2002 (HealthDayNews) -- A new government report finds that while there have been overall improvements in the health status of most racial and ethnic groups, gaps remain.

While the health of the various races has improved, "not all groups have benefited equally, and substantial differences among racial/ethnic groups persist," says the report from the U.S. Department of Health and Human Services (HHS).

"It's encouraging, but it's also a source of discouragement," says Stephen Thomas, director of the Center for Minority Health at the University of Pittsburgh's Graduate School of Public Health. "The most important thing is that we're finally acknowledging that these disparities exist and focusing on them in a way that success is measured by closing the gap. Our scientific challenge, political challenge and moral challenge is to close the gap, and to understand why this gap exists."

"The new HHS report shows improvements in national health, and in the health of racial and ethnic minorities over the past decade, but persistent and troubling disparities remain," adds Barbara Krimgold, director of the Scholars and Health Disparities Program at the Center for the Advancement for Health.

The HHS report looked at 17 indicators across five ethnic/racial groups between 1990 and 1998. The ethnic/racial groups were white non-Hispanic, black non-Hispanic, Hispanic, American Indian or Alaska Native, and Asian or Pacific Islander.

The indicators were: overall death rate; death rate from heart disease; death rate from stroke; death rate from lung cancer; death rate from breast cancer; death rate from motor vehicle crashes; death rate from suicide; death rate from homicide; death rate from work-related injury; tuberculosis case rate; syphilis case rate; percent of children under 18 living in poverty; percent of persons living in counties exceeding federal air quality standards; percent of low birth weight; women with no prenatal care in first trimester; infant morality; and live birth rates in females aged 15 to 17.

Most of the information was gleaned from birth and death records, as well as from records of recorded diseases such as tuberculosis and syphilis.

The good news is all racial and ethnic groups improved in 10 of the 17 categories: prenatal care, infant mortality, teen births, death rates for heart disease, homicide, motor vehicle crashes, work-related injuries, tuberculosis case rate, syphilis case rate, and poor air quality.

The infant mortality rate, for instance, fell 29 percent among American Indians, 23 percent among Hispanics, and 18 percent among blacks. That may be in part because the rate of women in all racial groups with no prenatal care in the first trimester fell from 35 percent to 26 percent. The birth rate to girls between 15 and 17 fell in all groups -- especially among blacks, where it fell 31 percent.

No group performed better than Asians and Pacific Islanders, who scored the best on eight of the indicators, says Kenneth G. Keppel, a statistician in the Division of Health Promotion Statistics at the National Center for Health Statistics. However, even this group suffered in some measures: The tuberculosis rate among them declined only 15 percent during the study years, when it fell between 36 percent and 45 percent for the other racial groups.

American Indians and Alaska Natives fared the worst, and were the only group not to experience improvements in total death rate, stroke death rate, lung cancer death rate, female breast cancer death rate and suicide.

"It's clear that those populations are not getting the same message and participating in the same improvement that other groups have," says Keppel.

"Much remains to be done to improve the opportunity of minority children to achieve their full educational and health potential," Krimgold adds. "Policies of vigorous support for early childhood development hold the potential for a big payoff in improved national health."

Reasons for the improvements and remaining disparities vary.

"Given that there are a variety of indicators, there are a variety of reasons," says Keppel. "[Reductions in] childhood poverty are a reflection of the improving economy over the last decade. Changes in syphilis rates are probably a result of targeted programs."

The report is part of Healthy People 2000, the HHS program that sets health-related goals and monitors progress towards them. One of the goals is to eliminate racial/ethnic disparities in health care.

"There's an overall improvement in the health status of America, but then we start looking at the details and we find that all Americans are not benefiting," says Thomas. "Therein lies the challenge."

What To Do

The HHS report can be found at the Centers for Disease Control and Prevention.

A related study is also available at the CDC.

The Center for Minority Health at the University of Pittsburgh's Graduate School of Public Health has a wealth of information on discrimination in the health-care system and efforts to eliminate disparities.

SOURCES: Interviews with Kenneth G. Keppel, Ph.D., statistician, division, health promotion statistics, National Center for Health Statistics, Hyattsville, Md.; Stephen Thomas, Ph.D., director, Center for Minority Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh; Barbara Krimgold, senior project director and director, Scholars and Health Disparities Program, Center for the Advancement for Health, Washington, D.C.; U.S. Department of Health and Human Services report
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