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Posted: June 15, 2009

Health disparities: A growing community threat


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Franklin Roosevelt once said, "The success or failure of any government ... must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health: The state's paramount concern should be the health of its people."

Since FDR's time, overall health and life expectancy have improved greatly for most Americans. However, the former president's words still ring true in communities throughout America, where too many citizens are not receiving the full benefits of better health. The term for this imbalance is called "health disparities," defined by the American Public Health Association as "differences in health status between people that are related to social or demographic factors such as race, gender, income or geographic region."

Numerous studies, too detailed to explore in this forum, convincingly demonstrate solid evidence that race and ethnicity correlate with persistent and increasing health disparities, mainly due to availability and quality of care as associated with an individual's economic status, race and gender. According to a research article in the June 2004 issue of the Journal of the American Medical Association, "Substantial evidence indicates that disparities in health status in the U.S. result largely from longstanding, pervasive racial and ethnic discrimination." In fact, according to APHA, people of diverse racial and ethnic backgrounds experience higher rates of a variety of diseases and health conditions than Caucasian Americans. For example, twice as many African-American, American Indians and Alaskan Native infants die before one year of age than their white counterparts.

According to Dr. Kathryn Cardarelli, director of the Center for Community Health at the UNT Health Science Center, infant mortality is one of the most significant measurements of health disparities, as well as a powerful marker of a community's overall health. Unfortunately, the North Texas region has some of the highest infant mortality rates among all large Texas cities.  In 2005 (the most recent data year), Fort Worth's infant mortality rate was 8.1 per 1,000 live births, the highest for all large Texas cities. And in mid-size to large cities, Arlington took the No. 1 slot in Texas. I think we can all agree that these rankings are nothing short of dismal.

When companies and businesses look to establish themselves or relocate, one of their first parameters for desirability is community health. Similarly, the cost of health disparities is transferred throughout the health system and ultimately increases the cost of insurance and health care services to business.  All said, health disparities are directly and indirectly a major issue for business.  With our rankings, we are hurting ourselves both in terms of a happier, healthier community and in a very real business development sense. The situation is deplorable, given our depth of world-class medical capabilities and institutions.

There's no silver bullet to resolve this situation. But given that health disparity issues are not predominately genetic but socioeconomic, we can take measures to change policies that affect socioeconomic issues and can, therefore, improve domestic health outcomes.

On a national level, since most Americans are unaware that there is a health disparity issue, we can educate and build awareness. The people of this country are willing to help their fellow citizens, as long as they understand the issue. A long-term strategic approach to research and intervention, integrating industry, academics and local community groups, will yield positive benefits. And current programs that successfully combat health disparities, like the CDC's REACH 2010 (Racial and Ethnic Approaches to Community Health 2010) can and should be replicated and implemented in target populations.

Again, there are no simple solutions. But it's abundantly clear that where there's a will, there's a way. FDR recognized the problems more than five decades ago, and significant strides were made to address the challenges of his era. That same commitment of will can have an equally salutary effect on our nation's health now, as well as build a foundation for a healthier

future.

Scott Ransom is president and professor in obstetrics,

gynecology, health management and policy at the University of North Texas Health Science Center at Fort Worth.

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