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"Our goal is to eliminate disparities in health among all population groups by 2010," Secretary Thompson said. "While we are making progress, this report shows how far we still have to go."

The report, "Trends in Racial and Ethnic-Specific Rates for the Health Status Indicators: United States, 1990-1998," presents national trends for 17 health status indicators during the 1990s.

Related, this week's MMWR includes "Recent Trends in Mortality Rates for Four Major Cancers, by Sex and Race/Ethnicity -United States, 1990 - 1998."

CDC Telebriefing Transcript
Health Improves for Most Racial, Ethnic Groups But Disparities Remain in Some Areas

January 24, 2002

CDC MODERATOR: Good afternoon, and thank you for joining the CDC Teleconference.

CDC is planning to hold a teleconference every Thursday at noon, so hopefully you can count on those. There may be some exceptions during the year when we don't hold one, but we will notify you either way with a media advisory.

Today, CDC is releasing two new reports which present trends in racial and ethnic disparities and key measures of health.

First, Dr. Ken Keppel and Jeffrey Pearcy of CDC's National Center for Health Statistics will summarize the results of an analysis of the trends during the 1990s in the 17 health status indicators established under Healthy People 2000. These indicators take a broad view of health and include not only the major causes of death, such as heart disease, cancer and stroke, but also encompass cases of infectious disease, low birth weight, prenatal care and other key health measures.

Second, Dr. Phyllis Wingo of CDC's Cancer Prevention and Control Program addresses an article today's MMWR, taking a more in-depth look at trends and differences by race, ethnicity, and sex for four cancer sites. Those are lung, colon and rectum, prostate and female breasts, which together account for more than half of cancer deaths each year.

We'll start with opening remarks from our speakers and then take questions.

Dr. Keppel?

DR. KEPPEL: Thank you.

One of the goals of Healthy People 2000, a decade-long national effort to improve health and prevent disease was the reduction of disparities and health by race, origin, and other characteristics.

Healthy People established hundreds of specific objectives, but identified 17 health status indicators that could be tracked at the national, state and local levels for comparison purposes. This report tracks the success on those key indicators over the past decade and measures the progress in reducing disparities.

The study examines data for white non-Hispanic, black non-Hispanic, American Indian or Alaskan Natives, Asian or Pacific Islander, and Hispanic groups. The report shows significant improvements in the health of ethnic and racial minorities, but also shows that substantial disparities persist among these groups.

First, we found that between 1990 and 1998 all but one of the 17 indicators improved for the U.S. as a whole. The percent of low-birth-weight infants did not improve.

Second, we found that all five race and origin groups improved on 10 of the indicators, including death rates for heart disease, motor vehicle crashes, work-related injuries, TB, syphilis, infant mortality rates, prenatal care, birth rates for teens, and air quality and also the homicide rate.

There was improvement on five additional indicators for every group except native Americans. Native Americans failed to improve for all causes of death combined, for stroke death rates, lung cancer death rates, and female breast cancer death rates and suicide.

And then there was the percent of low-birth-weight infants for which there was only one group that improved at all, and that was black non-Hispanics, and the other four groups moved in the wrong direction.

Third, we developed an index of disparity to measure differences among all five racial and ethnic groups. We did this so that we could determine whether the differences among groups were changing over time. Based on this index, the differences among groups declined for 12 of the 17 indicators between 1990 and '98. That's good. It's good that the differences declined, but the differences declined by 19 percent for only one indicator and by about 10 percent for five other indicators.

In light of these modest reductions in disparity during the last 8 or 10 years, a great deal more effort will be required to eliminate disparities.

The differences among groups increased for five indicators, with substantial increases for motor vehicle crash deaths, suicide death rates, and work-related injury death rates.

Clearly, targeted efforts will be required to achieve the goal of eliminating disparities between now and the Year 2010.

Thank you.

CDC MODERATOR: Okay. Now we will hear opening remarks from Dr. Phyllis Wingo.

DR. WINGO: Good afternoon.

The report from the Cancer Division at CDC provides information about trends in cancer mortality during the same time period as the NCHS report and, as Lisa already mentioned, for the top four cancers: lung and bronchus, colon-rectum, prostate and female breast.

We examined the trends for each of these cancers over this time period by sex and by the same racial and ethnic populations as used in the NCHS report. I would like to highlight several key findings in the report, and those are other death rates from the major cancers were generally decreasing for blacks in the 1990s. Blacks continued to have the highest of all racial and ethnic group--highest cancer mortality rates of all of the racial and ethnic groups that we studied.

Second, in the 1990s, the death rates for the top four cancers were generally increasing for American Indians and Alaskan Natives.

Third, lung cancer death rates during this time period were increasing among black and white women, on average, of about 1 percent year and among American Indian and Alaskan Native women at an even greater rate--on average, 2 to 3 percent per year.

Finally, throughout the 1990s, breast cancer death rates decreased for white women on average 2.5 percent per year, and for Hispanic women, on average, 1.1 percent year. Breast cancer death rates were relatively unchanged for black, American Indian, Alaskan Native and Asian and Pacific Islander women.

So, for three of the four cancers studied, we can point to prevention. The declines in death rates for cancers of the lung and bronchus, colon-rectum, and female breasts are due, in part, to decreases in tobacco smoking, early detection and more effective treatment.

Although death rates from prostate cancer are also decreasing, the reasons for this are less clear and point toward a need for more research to better understand the reasons for these declines.

Success in reducing cancer death rates has not been shared equally by all racial and ethnic groups, and has not been shared equally between men and women. Differences in cancer death rates that cross the racial and ethnic populations, probably result from a combination of factors, including health, behavior such as smoking, exercise and nutrition, access to preventive screenings, diagnostic and therapeutic services, and the aggressiveness of the treatment prescribed.

If these factors were modified, more than half of cancer deaths could be prevented, and most racial and ethnic disparities in cancer death rates could be eliminated.

Thank you very much.

CDC MODERATOR: Okay. Now we will take questions, and I just ask that you state who you are directing your question to. First question, please.

AT&T MODERATOR: And once again, ladies and gentlemen, if you do have a question, please press the 1 at this time. And we have a question from the line of Kim Dixon with [inaudible] News. Please go ahead.

QUESTION: Hi. I just wanted to clarify the rate increase of lung cancer among women. You said it's 1 percent, about 1 percent per year. Is that right?

DR. WINGO: Yes, that 1.1 percent per year. Between 1990 and 1998.

QUESTION: So could I say it's 10 percent over the 8-year period because it is a jump of 3 percentage points out of 31.6? Is that accurate?

DR. WINGO: Mathematically that usually doesn't quite work out that way.


DR. WINGO: I would stick to the 1--on average 1.1 percent per year.

QUESTION: Per year, okay. Okay, great. Thanks.

DR. WINGO: You're welcome.

AT&T MODERATOR: And we have a question from the line of Emma Hitts with Reuters Health. Please go ahead.

QUESTION: Yes. Hi. This is directed to Dr. Wingo or Keppel. I was wondering, was there any one health society that seemed to have the greatest effect on the differences in rates, you know, such as screening or other preventive methods, and what plans does the CDC have to eliminate these disparities at this time?

CDC MODERATOR: Do you want to start, Dr. Keppel?

DR. KEPPEL: Well, perhaps the biggest success during this period was in syphilis, that case rate. Black non-Hispanics had a rate of 41.9 per 100,000 in 1990, and this was reduced by 88 percent between 1990 and '98. So there is a very, very substantial reduction in rates of syphilis for black non-Hispanics, and also for the other groups. So that nationally Healthy People 2000 target for syphilis were reached for both the total population and for the black population.

CDC MODERATOR: And, Emma, CDC does have a National Syphilis Elimination program that started several years ago, and we'd be happy to give you more information about that if you wanted to call after the conference call.

QUESTION: Okay, thanks.

CDC MODERATOR: Next question?

AT&T MODERATOR: And that's from the line of Aaron McClaren with the Associated Press. Please go ahead.

QUESTION: Hi, thanks. This question is for either of you. I'm wondering about some of the specific things we could to eliminate the disparities in some of these other diseases, some of these other factors. Some of the gaps are pretty glaring, and it seems to me a pretty lofty goal to eliminate these disparities by 2010. What are some of the specific things we can do beyond syphilis?

CDC MODERATOR: Want to start, Dr. Keppel?

DR. KEPPEL: Well, we've got a tremendous range of factors that are associated with these differences. Certainly some of the differences are due to social and economic factors. Others are due to behavioral factors. I can't point to specific--in most of these instances I can't point to specific programs that would address some of these differences. However, there certainly are substantial plans associated with Healthy People 2000, strategic plans within CDC and within NIH and so forth, that are targeted to the reduction of specific disparities. So we could refer you to some other sources on this I think.

CDC MODERATOR: Yeah. Aaron, we do have the Reach program here at CDC that's been in the works for about two years now, and I'd be happy to hook you up with somebody to talk about that, what's going on in the field.

QUESTION: Thank you.

CDC MODERATOR: Did you want to add anything, Dr. Wingo?

DR. WINGO: Sure. And of course my comments are strictly about cancer as opposed to the 17 indicators that Dr. Keppel has been commenting on.

I think from a cancer perspective the health disparities that should be addressed, we should think about the health behaviors such as tobacco use, overweight and obesity, physical activity. I think they're also--these are all leading health indicators for Healthy People 2010.

I also think that from a cancer perspective, we have to talk about equal access to care for all populations, equal access to preventive services to effective screening and diagnostic tools and effective treatments as well.

CDC MODERATOR: Okay. Next question.

AT&T MODERATOR: And once again, ladies and gentlemen, if you do have a question, please press the 1 at this time.

And Ms. Swenarski, there are no further questions on queue.

CDC MODERATOR: Okay. Would either of the spokespeople like to add anything, Dr. Keppel? Any other remarks you have about the study?

DR. KEPPEL: Well, the one thing that I might reiterate is that American Indian Alaska natives fared less well than the other groups that we considered. There were six indicators that they failed to improve on, and it really represents a population that is in need of additional preventive health services, curative health services, and social services.

CDC MODERATOR: And, Dr. Wingo, anything you'd like to add about your article in the MMWR today on cancer?

DR. WINGO: Sure. I would just like to add to Dr. Keppel's comments that American Indian Alaskan native populations in cancer do not fare as well as the other populations that we studied, that their rates--their cancer death rates for the cancers that we studied, were generally increasing, whereas the cancer death rates in the other populations that we studied, such as the whites, blacks, Asian and Pacific Islanders and Hispanics were generally decreasing for these sites.

So they are the only population that we studied whose cancer death rates were going in the opposite direction.

CDC MODERATOR: Any questions in the queue?

AT&T MODERATOR: No questions.

CDC MODERATOR: Okay. Well then, that concludes our telebriefing today. If there are any other questions later, reporters can call the CDC Press Office at 404-639-3286. Thank you.

AT&T MODERATOR: And, ladies and gentlemen, that does conclude your conference for today. Thank you for your participation and you may now disconnect.

Listen to the telebriefing

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