Resolution for Eliminating Racial and Ethinic Health Disparities

Whereas SOPHE recognizes that the health and well-being of communities and the individuals within them is dependent not only on biological but also social and environmental factors and that under-represented communities of people in which health disparities are most evident have been historically silenced, ignored and their trust violated with regard to economic opportunity, environmental safety, health care access, health care service delivery and education and,

Whereas Healthy People 2010 Objectives for the Nation recognize that the systematic silencing, disregard, and violation of trust has a negative effect on the health and well-being of under-represented communities by continuing to perpetuate institutionalized oppressions and health disparities (1,2) and,

Whereas, mortality from stroke is 80% higher in African Americans than Whites and the mortality rate for hypertension is three times higher for African Americans than Whites (1,2) and,

Whereas, the mortality rate for all cancers is higher among African Americans than all other racial or ethnic groups; and the incidence of cervical and liver cancers in Asian Americans is as much as 5 times higher than other ethnic and racial groups (2,3,4) and,

Whereas, African Americans and Hispanics make up 25% of the U.S. population, yet 55% of all AIDS cases; and African American and Hispanic women account for 77% of all female AIDS cases; and 57% and 24% of all pediatric AIDS cases occur in African Americans and Hispanics, respectively (2,5,6) and,

Whereas, the infant mortality rates in African American and American Indian/Alaska Native infants are 1.5-2 times higher than the rate of Whites; and mortality for African American women during childbirth is 3.5 times higher than White women (7,8,9,10) and,

Whereas, African Americans and Native Americans are two times more likely to die from diabetes than Whites; and Hispanics are 2.5 times more likely to experience diabetes-associated renal failure than Whites (2,11) and,

Whereas Native Americans are almost 2 times more likely to die from unintentional injury than whites,, followed by African Americans (2,12-17) and,

Whereas, immunization rates are lowest among minorities, children from lower income families, and children with less educated parents (18-24) and,

Whereas, the rate of non-elderly Hispanics who lack health insurance is two times the national average; and only 20% of Native Americans have access to the Indian Health Service (2,25-31) and,

Whereas, African Americans, Hispanics, Native Americans, and people with low socioeconomic status are less likely to own or have access, knowledge and skills to use computers (2,32) thereby decreasing their access to the latest health information and access to medical records and,

Whereas, underrepresented minorities represent over 25% of the U.S. population, but account for only 10% of all health professionals; and affirmative action programs in higher education have been under attack or dismantled; and barriers to the recruitment and retention of qualified persons from under-represented groups into the health professions and schools of public health, medicine, nursing etc. are considerable; and that these groups can play an indispensable role in helping to reduce health disparities by working in underserved communities (29,33-44),

Now therefore be it resolved that SOPHE:

INTERNAL ACTIVITIES:

(1) Assess possible means by which SOPHE contributes to exclusion, discrimination or oppression of under represented groups in its operations, policies, and actions.

(2) Initiate an organizational wide educational campaign to eliminate operations, policies, and processes that exclude and discriminate against under represented populations.

(3) Through the Open Society Commission examine ways in which SOPHE can more vigorously participate in efforts toward an open and just society both within our own organization and in collaboration with others.

(4) Support professional training opportunities to increase cultural competency of public health education and health care professionals.

(5) Initiate scholarship opportunities for African Americans, Hispanics, and Native Americans, Asian and Pacific Islanders, and Alaska Natives SOPHE members to promote their public health education professional development, education and training.

(6) Commit resources and efforts to developing and implementing effective methods of recruiting students of color, and other underrepresented groups into SOPHE.

EXTERNAL ACTIVITIES:

(1) Support advocacy efforts for:

• Increased funding opportunities for the identification of data for under represented racial and ethnic groups as well as the provision and evaluation of programs to address the underlying determinants of health disparities.
• Increased funding opportunities for recruitment and training public health educators and other health care professionals representing under represented groups.

(2) Improve professional education and development opportunities by:

• Seeking funds from Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA) or other potential parties to examine the proportion of students in professional preparation programs in health education that represent minorities according to either race or ethnicity.
• Advocating for the hiring and promotion of racial and ethnic minority faculty in professional preparation programs in health education

(3) Collaborate with national initiatives to eliminate racial and ethnic health disparities such as the President’s Initiative on Race, the NIH National Center on Minority Health and Health Disparities, HRSA’s Office on Minority Health and, the DHHS Office on Minority Health.

Authors: Brandie Adams, BS, Victoria Anwuri, BS, Eleanor Dixon-Terry, MPH, CHES, Lorna Houghton, MPH, Sue Lachenmayr, MPH, CHES, Sharyn Parks, BS, Roland Richard, BS, Darcell P. Scharff, PhD, Cherylee Sherry, MPH, CHES, Charles E. Williams, III, MA.

References

(1) American Heart Association, High Blood Pressure Fact Sheet, http://www.americanheart.org/hbp/phys_stats.html, 2000.

(2) US Department of Health and Human Services, (2000) Healthy People 2010. Washington, DC: US Government Printing Office.

(3) National Cancer Institute, SEER Cancer Statistics Review, 1973-1996, 1999.

(4) Haynes MA. And Smedley BD. (Eds.) The burden of cancer among ethnic minorities and medically underserved populations. In: The Unequal Burden of Cancer. An Assessment of NIH Research and programs for Ethnic Minorities and the Medically Underserved. 199. Washington DC: National Academy Press.

(5) Murrain M. Differential survival in Blacks and Hispanics with AIDS. Ethnicity & Health. 1996;1(4):373-382.

(6) Centers for Disease Control and Prevention. HIV Surveillance Report. www.cdc.gov/hiv/stats/hasrlink.htm. 2000.

(7) Office of Minority Health, Race and Health. Infant Mortality: How to Reach the Goals (underlined) http://www.raceandhealth.omhrc.gov.

(8) Monthly vital statistics, 46(12)(s), August 27, 1998.

(9) Hill, W.C. (1999). Jumping the broom toward eliminating health disparities: Presidential address. American Journal of Obstetrics and Gynecology, 180(60),1315-1321.

(10) Singh, G.K.& Yu, S.M. (1995). Infant Mortality in the United States: Trends, Differentials, and Projections, 1950 through 2010. American Journal of Public Health, 85(7), 957-964.

(11) Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, http://www.cdc.gov/diabetes/statistics/surv199/chap5/chapter5Intro.htm, 2000.

(12) Christoffel T., Gallagher SS. Injury Prevention and Public Health. Practical Knowledge, Skills, and Strategies. 1999. Gaithersburg: Athens Publications.

(13) National Safe Kids Campaign. Children at Risk. 1999. http://www.safekids.org

(14) Sadowski LS. Munoz SR. Nonfatal and fatal firearm injuries in a rural county. JAMA. 1996;275(22):1762-64.

(15) Kellerman AL, Rivara FP. Lee RK. Banton JG, Cummings P, Hackman B, Somes G. Injuries due to firearms in three cities. The New England Journal of Medicine. 1996;336(19):1438-44.

(16) Overpeck MD, Jones DH, Trumble AC, Scheidt PC, Bijur PE. Socioeconomic and racial/ethnic factors affecting non-fatal medically attended injury rates in US children. Injury Prevention. 1997;3:272-76.

(17) Johnson SJ, Sullivan M, Grossman DC. Injury hospitalization among American Indian youth. Injury Prevention. 1999;5:119-23.

(18) Carter/Bumpers Campaign for Early Immunization. Every Child by Two. http://www.ecbt.org.

(19) Kenyon TA, Matuck MA, Stroh, G. Persistent low immunization coverage among inner-city preschool children despite access to free vaccine. Pediatrics. 1998;101(4):612-616.

(20) CDC. Reported vaccine-preventable diseases -- United States, 1993, and the Childhood Immunization Initiative. MMWR 1994; 43:57-60.

(21) National Center for Health Statistics. Health, United States, 1998, with socioeconomic status and health chart book. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 1998.

(22) CDC. Recommendations of the Advisory committee on Immunization Practices: programmatic strategies to increase vaccination rates -- assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219-20.

(23) CDC. Status report on the Childhood Immunization Initiative: national, state, and urban area vaccination coverage levels among children aged 19-35 months -- United States, 1996. MMWR 1997;46:657-64.

(24) CDC. Immunization schedule -- United States, 1998. MMWR 1998;47:8-12.

(25) Wright RA. Community-oriented primary care: The cornerstone of health care reform. J Am Medical Association 269(19):2544-2547, 1993.

(26) Carrasquillo O, Carrasquillo AI, Shea SS: Health insurance coverage if Immigrants living in the United States: Differences by citizenship status and country of origin. Am J Public Health 90(6):917-923, 2000.

(27) Friedrich MJ: Medically underserved children need more than insurance card. J Am Medical Association 283(23):3056-3057, 2000.

(28) Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. The role of Black and Hispanic physicians in providing health care for the underserved populations. New England Journal of Medicine. 1996;334(2): 1305-1310.

(29) Xu G, Fields SK, Laine M, Veloski JJ, Barzansky B, Martini CJM. The relationship between the race/ethnicity of generalist physicians in providing their care for the underserved populations. Am J Public Health 1997;87(5):817-822.

(30) House JS, Kessler RC, Herzog AR. Age, socioeconomic status, and health. The Milbank Quarterly. 1990;68(3):383-411.

U.S. Department of Health and Human Services. Health, United States, 1998 with Socioeconomic Status and Health Chartbook. Hyattsville, MD: National Center for Health Statistics, 1998.

(31) Hall AG, Collins KS, Glied S. Employer sponsored health insurance: Implications for minority workers. New York: New York. The Commonwealth Fund, February 1999.

(32) Eng TR, Maxfield A, Patrick K, Deering M, Ratzan SC, Gustafson, DH: Access to health information and support: A public highway or a private road?. J Am Medical Association 280(15):1371-1375, 1998.

(33) Zimmerman MK: Status Report on Women’s Health in Medical Education and Training. [Online] http://www.hcsc.gc.ca/canusa/papers/usa/english/training.htm.

(34) Health Care Fairness Act (H.R.3250 and S.1880) [Online]. Available: http://www.amsa.org/lad/fairness.html.

(35) Bureau of Health Professions Health Resources and Services Administration. United States Health Workforce Personnel Factbook. [Online]. Available: http://bhpr.hrsa.gov.healthworkforce.factbook.htm. 2000.

(36) Minorities in Medicine. Rockville, MD: Council on Graduate Medical Education, Twelfth Report, 1998.

(37) Chavkin W. Topic for out times: Affirmative Action and Women’s Health. Am J of Public Health 1997;87(5):732-734.

(38) Libby DL, Ahou Z, Kindig DA. Will minority physician supply meet U.S. needs? Health Affairs. 1997;16(4):205-214.

(39) Nickens HW, Cohen J. On Affirmative action. JAMA. 1996;275(7):572-574.

(40) Trevino FM. The representation of Hispanics in the health professions. Journal of Allied Health. 1994;23(2):65-77.

(41) Keith SM, Bell RM, Swanson AG, and Willliams AP. Effects of affirmative action in medical schools: A study of the class of 1975. New England Journal of Medicine. 1985;313(24):1519-1525.

(42) Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273(19):1515-1521.

(43) Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. The role of Black and Hispanic physicians in providing health care for the underserved populations. New England Journal of Medicine. 1996;334(2): 1305-1310.

(44) Fang D; Moy E, Colburn, Hurley, J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284(9):1085-1092