Finding Solutions to Health Disparities: At A Glance 2010
Racial and Ethnic Disparities in Health: The Facts
Despite great improvements in the overall health of the U.S. population, health disparities remain widespread among members of racial and ethnic minority populations. Members of these groups are more likely than whites to have poor health and to die prematurely, as the following examples illustrate:
African Americans. Although breast cancer is diagnosed 10% less frequently in African American women than in white women, African American women are 34% more likely to die of the disease. African American adults are 1.9 times more likely than non-Hispanic white adults to have a diagnosis of diabetes.
Although African American children aged 19–35 months had comparable rates of immunization for hepatitis, flu, measles-mumps-rubella (MMR), and polio, they were slightly less likely to be fully immunized compared with non-Hispanic white children.
In 2004, African Americans had asthma-related emergency room visits 4.5 times more often than whites. In 2006, non-Hispanic blacks were 70% more likely to die of viral hepatitis than whites.
American Indians and Alaska Natives. American Indian and Alaska Native adults are 2.3 times more likely than white adults to receive a diagnosis of diabetes. American Indian women are 1.7 times more likely to die of cervical cancer than white women.
American Indian/Alaska Native adults are 1.6 times as likely as white adults to be obese. In addition, infant mortality rates are 1.4 higher among American Indians/Alaska Natives than among non-Hispanic whites.
Asian Americans. Rates of cervical cancer are higher among Vietnamese American women than among any other racial or ethnic group in the United States. In fact, the rates are five times higher than the rates among non-Hispanic white women. Although rates of asthma are generally lower among Asian Americans than among whites, asthma-related deaths were 50% higher among Asian Americans in 2003.
Hispanics/Latinos. In 2005, Hispanics were 1.6 times more likely to die of diabetes than non-Hispanic whites. In addition, Hispanic women were twice as likely as non-Hispanic white women to have a diagnosis of cervical cancer. Although Hispanic children aged 19–35 months had comparable rates of immunization for hepatitis, flu, MMR, and polio, they were slightly less likely to be fully immunized when compared with non-Hispanic white children.
- Native Hawaiians/Pacific Islanders. In Hawaii, the rate of diabetes among Native Hawaiians is more than twice the rate among whites. Native Hawaiians are 5.7 times more likely to die of diabetes than whites living in Hawaii.
CDC’s Leadership Role
For years, public health officials, program managers, and policy makers have been frustrated by the seemingly intractable problem of health disparities, and they have been at a loss for solutions. In response, CDC created Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.), a program that continues to demonstrate that health disparities can be reduced and the health status of groups most affected by health inequities can be improved.
REACH U.S. supports CDC’s strategic goals by addressing health disparities throughout infancy, childhood, adolescence, adulthood, and older adulthood. This program has developed innovative approaches that focus on racial and ethnic groups and is improving people’s health in communities, health care settings, schools, and work sites.
CDC currently funds 40 communities to implement changes that address health disparities in key health areas (see map, page 4). In addition, about half of the 40 funded communities work with other selected communities to share lessons learned and to mentor these communities on how to effectively use best practices to reduce health disparities.
In fiscal year (FY) 2010, Congress allocated $39.6 million to support the REACH U.S. program. CDC provides training, technical assistance, and support to REACH communities to help them understand how social determinants of health—the economic and social conditions in the places where people live—can affect their health and longevity.
As a result, REACH communities empower residents to (1) seek better health; (2) help change local health care practices; and (3) mobilize communities to implement evidence-based public health programs that address their unique social, historical, economic, and cultural circumstances.
Data Show REACH U.S. Is Working
Data from the REACH Risk Factor Survey show that the REACH U.S. program is helping people to significantly reduce their health risks and manage their chronic diseases. This survey, which focuses on breast and cervical cancer prevention, cardiovascular health, and diabetes management, assesses how much people in REACH communities have changed their health behaviors and improved their health in these areas, which, in turn, reduces health disparities in REACH communities.
Survey results include the following:
Over a 4-year period, the cholesterol screening rates for Hispanics living in REACH communities increased steadily, from 56.3% in 2002 to 68.6% in 2006 (see figure). In 2002, the cholesterol screening rate for African Americans living in REACH communities (74.2%) was below the national average (76.2%). By 2006, the rate had risen to 78.8%, which was above the national average of 75.2% for that year.
In REACH communities that focused on breast and cervical cancer prevention, the percentage of women who reported having a pap smear in the previous year increased from 81% in 2002 to 86% in 2006.
The rate of cigarette smoking among Asian American men in REACH communities decreased from 42% in 2002 to 20% in 2006.
The Keys to Success
REACH U.S. has identified the following key principles and supporting activities for effective community-level work to reduce health disparities in racial and ethnic minority communities across the United States:
Trust. Build a culture of collaboration with communities that is based on trust.
Empowerment. Give individuals and communities the knowledge and tools needed to create change by seeking and demanding better health and building on local resources.
Culture and History. Design health initiatives that are grounded in the unique historical and cultural context of racial and ethnic minority communities in the United States.
Focus on Causes. Assess and focus on the underlying causes of poor community health and implement solutions that will stay embedded in the community infrastructure.
Community Investment and Expertise. Recognize and invest in local community expertise and motivate communities to mobilize and organize existing resources.
Trusted Organizations. Enlist organizations within the community that are valued by community members, including groups with a primary mission unrelated to health.
Community Leaders. Help community leaders and key organizations forge unique partnerships and act as catalysts for change in the community.
Ownership. Develop a collective outlook to promote shared interest in a healthy future through widespread community engagement and leadership.
Sustainability. Make changes to organizations, community environments, and policies to help ensure that health improvements are long-lasting and community activities and programs are self-sustaining.
Hope. Foster optimism, pride, and a promising vision for a healthier future.
REACH U.S. has used innovations in community engagement and environmental change to sharply reduce disparities among U.S. populations that are disproportionately affected by health inequities. CDC will continue to use the strategies proven to work in REACH communities to improve and change health care practices and polices across the public health system. In addition, CDC will continue to fund more communities to enhance their ability to make policy, systems, and environmental changes in order to reduce and eliminate health disparities. CDC and REACH communities also will continue to work together to analyze local data and evaluate program strategies.
Massachusetts: Targeted Strategies Help Latinos Improve Diabetes Outcomes
In Massachusetts, the prevalence of diabetes is higher among Latinos (7.4%) than among whites (6.4%). Overall, Latino residents are 15% more likely than white residents to have the disease. For people of Puerto Rican or Dominican descent, the prevalence of diabetes is 11.8%, which is nearly twice as high as the prevalence for whites.
To address these health disparities, the REACH Latino Health Project in Lawrence, Massachusetts, is working to raise awareness of diabetes and its complications and teach community members to eat a healthy diet and be more physically active. The project is based in the Greater Lawrence Family Health Center, which provides administrative support and access to other community programs and services.
To reach its target audience, the project distributes information on how to prevent and manage diabetes that is culturally sensitive and linguistically appropriate for local Latino residents. In addition, the project has partnered with local health care providers to promote appropriate health messages for this population. The goal is to improve health outcomes for Latinos living in Massachusetts.
As a result of these efforts, Latinos with diabetes who are clients of the Greater Lawrence Family Health Center have reported dramatic improvements in their ability to control their blood sugar and blood cholesterol levels. For example, the percentage who had reached their blood sugar goal (hemoglobin A1c level less than 7) increased from about 15% in 2001 to 42% in 2007. The percentage who had received an annual flu shot increased from 39% in 2001 to 50% in 2007, and the percentage who had received an annual foot examination increased from 12% in 2001 to 43% in 2007. In addition, the percentage whose blood sugar levels had been measured within 6 months (which is recommended for adults with diabetes) increased from about 56% in 2001 to 70% in 2007.
Michigan: Genesee County Health Department Works to Reduce Infant Deaths
Racial disparities related to infant deaths persist in the United States despite the efforts of clinicians, public health practitioners, and policy makers at every level of government for more than two decades. In Genesee County, Michigan, African American infants die before their first birthday at a rate more than twice that of white infants.
The Genesee County Health Department coordinated a multifaceted community effort to reduce the high death rates among African American infants born in and around Flint, Michigan. This effort, which was supported by funding from CDC’s REACH U.S. program, included
- Case-management services designed to reach pregnant women and new mothers in high-risk areas of the county.
- Community dialogue sessions designed to educate residents about infant death rates and available resources.
- Workshops that help participants understand the connections between racism and health care.
- Social marketing efforts designed to convey key health messages about how to reduce infant deaths.
- A medical services committee to identify and promote best clinical practices.
As a result of these efforts, the death rate for African American infants in Genesee County has dropped from a high of 23.5 deaths per 1,000 live births in 1999 to a low of 15.2 in 2005. By comparison, the rate among white infants in 2005 was 6.3 deaths per 1,000 live births. The disparity ratio between African Americans and whites also has dropped in recent years—from a high of 3.6 African American infant deaths for every 1 white infant death in 2001 to 2.4 in 2005.
The Genesee County Health Department is a CDC Centers of Excellence in the Elimination of Health Disparities (CEED) grantee. It is actively engaged in helping other communities benefit from its experience by sharing information about its activities with public health officials working in other areas of the country.
Alabama: Partners Join Forces to Improve Access to Breast and Cervical Cancer Treatment
For most cancers, African Americans have the highest death rates of any racial or ethnic group in the United States. In particular, breast cancer is the second most common cause of death among African American women. During 2001–2006, the death rate for breast cancer was 37% higher among African American women than among white women.
In addition, the 5-year relative survival rate for African American women with breast cancer diagnosed during 1995–2005 was 77%; for white women, the rate was 90%. One reason for this lower survival rate is that African Americans usually receive a diagnosis of cancer at a later stage of the disease.
With support from CDC, the Alabama REACH Breast and Cervical Cancer Coalition at the University of Alabama at Birmingham is working to eliminate these disparities. The coalition has engaged a wide variety of stakeholders, policy makers, and concerned citizens to promote awareness and use of breast and cervical cancer screening services in selected counties throughout the state.
The coalition’s efforts have been successful in the eight-county focus area, decreasing the gap in mammography screening rates between African American and white women by 76%.
The coalition also helped to mobilize local volunteers and engage policy makers to work for changes in state law to increase access to affordable cancer treatment for Alabama residents. The Breast and Cervical Cancer Prevention and Treatment Act passed the Alabama Legislature in 2009 and
took effect on July 1 of that year.
The legislation closed a loophole in state law and made more women—not just those whose disease was diagnosed at county clinical care centers—eligible for cancer treatment through Medicaid. As a result, coverage for breast and cervical cancer treatment has increased for uninsured and underinsured women in Alabama, regardless of where they receive a diagnosis.
For more information please contact the
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
4770 Buford Highway NE, Mail Stop F-76, Atlanta, GA 30341-3717
Telephone: 800-CDC-INFO (232-4636) • TTY: 888-232-6348