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Health Care Disparities

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Health Care Disparities U.S. Commission on Civil Rights The U.S. Commission on Civil Rights is an independent, bipartisan agency established by Congress in 1957. It is directed to Investigate complaints alleging that citizens are being deprived of their right to vote by reason of their race, color, religion, sex, age, disability, or national origin, or by reason of fraudulent practices. Study and collect information relating to discrimination or a denial of equal protection of the laws under the Constitution because of race, color, religion, sex, age, disability, or national origin, or in the administration of justice. Appraise federal laws and policies with respect to discrimination or denial of equal protection of the laws because of race, color, religion, sex, age, disability, or national origin, or in the administration of justice. Serve as a national clearinghouse for information in respect to discrimination or denial of equal protection of the laws because of race, color, religion, sex, age, disability, or national origin. Submit reports, findings, and recommendations to the President and Congress. Issue public service announcements to discourage discrimination or denial of equal protection of the laws. Members of the Commission Gerald A. Reynolds, Chairman Abigail Thernstrom, Vice Chair Todd Gaziano Gail Heriot Peter N. Kirsanow Arlan D. Melendez Ashley L. Taylor, Jr. Michael Yaki Martin Dannenfelser, Staff Director U.S. Commission on Civil Rights 624 Ninth Street, NW Washington, DC 20425 (202) 376-8128 (202) 376-8116 TTY www.usccr.gov This report is available on disk in ASCII Text and Microsoft Word 2003 for persons with visual impairments. Please call (202) 376-8110. Health Care Disparities A Briefing Before The United States Commission on Civil Rights Held in Washington, DC Briefing Report Table of Contents v Table of Contents Executive Summary .................................................................................................................. 1 Panelist Statements: First Panel ................................................................................................ 3 Louis W. Sullivan ................................................................................................................. 3 Causes of Health Disparities ..................................................................................................... 8 Current Research and Actions to Eliminate Health Care Disparities ....................................... 9 Rubens J. Pamies ................................................................................................................ 12 Amitabh Chandra ................................................................................................................ 21 Peter Bach ........................................................................................................................... 35 Statements: Second Panel ....................................................................................................... 39 William R. Lewis ................................................................................................................ 39 Herman A. Taylor ............................................................................................................... 48 Strong Heart Study (SHS) 1989-2000 .................................................................................... 58 Stop Atherosclerosis in Native Diabetics (SANDS Trial) 2002-2007.................................... 58 Strong Heart Family Study (SHFS) 2000-2010 ...................................................................... 59 The Message ........................................................................................................................... 60 Bruce Siegel ........................................................................................................................ 61 Public Comments .................................................................................................................... 73 Peter Bach ........................................................................................................................... 75 Amitabh Chandra ................................................................................................................ 75 Garth N. Graham ................................................................................................................. 75 Barbara V. Howard ............................................................................................................. 76 William R. Lewis ................................................................................................................ 77 Rubens J. Pamies ................................................................................................................ 77 Sally L. Satel ....................................................................................................................... 78 Bruce Siegel ........................................................................................................................ 78 Louis W. Sullivan ............................................................................................................... 79 Herman A. Taylor ............................................................................................................... 79 Commissioner Statements ....................................................................................................... 81 Statement of Abigail Thernstrom, Vice Chair .................................................................... 81 Statement of Commissioner Todd Gaziano ........................................................................ 83 vi Health Care Disparities Statement and Rebuttal of Commissioner Gail Heriot ....................................................... 87 Executive Summary 1 Executive Summary The federal government defines health care disparities as the persistent gaps between the health status of minorities and non-minorities in the United States. According to the National Partnership for Action to End Health Disparities (a division of the Department of Health and Human Services), despite continued advances in health care and technology, racial and ethnic minorities continue to have more disease, disability, and premature death than non- minorities. In a briefing held on June 12, 2009, the Commissioners chose to examine health disparities through the microcosm of cardiovascular disease and the related condition of hypertension. Conditions arising from cardiovascular disease are the leading cause of death in America, cutting across all racial and ethnic groups, socioeconomic levels, and affecting both men and women. Within this context, the Commissioners heard experts discuss relevant data and their conclusions as to why disparities persist, possibly flawed conclusions resulting from omission of important variables in earlier studies such as the 2002 Institute of Medicine report, health care delivery system differences, recent and ongoing research, access to care and quality of care, patient behavior, and other aspects of differences between population groups in terms of cardiac/hypertension health and cardiac/hypertension care. Panelists did not agree on the causes of disparities in both health status and health care. Factors included receiving care from health care providers who were not Board-certified; bias resulting from insufficient numbers of minorities in the health care workforce; inadequate health insurance coverage and the high cost of healthcare; lack of data available for specific populations; differences in provider expertise and use of diagnostic and treatment resources; and geographic and demographic distributions. The American Heart Association testified that its prepared guidelines help doctors improve diagnosis and treatment for coronary artery disease, heart failure and stroke. The Jackson Heart Study, a single-site longitudinal study of African-American cardiovascular health, examines psychosocial, nutritional, metabolic, and genetic effects on cardiovascular disease. The Strong Heart Study, a population-based survey and the first to highlight the higher rates of cardiovascular disease among American Indians and other populations with high rates of diabetes, focuses on American Indian communities and has trained non-physician providers to offer certain medical services. Expecting Success, the first collaborative undertaking by a group of hospitals to eliminate disparities, concentrates on improving cardiac care for African-Americans and Latinos. At the completion of their testimony, the panelists fielded questions from the Commissioners on such issues as how problems with data collection in the 1990 and 2000 census skewed results for Native Americans; the percentage of the health care disparities caused by factors outside the health care delivery system; the portion of health care disparities related to possible bias; the extent to which linguistic and cultural competency affect access to and the quality of treatment in health care; research that attempts to explain disparities existing between rural, suburban and urban areas; the lack of public awareness as to the differences in 2 Health Care Disparities quality among various medical facilities with respect to high-quality health care; the quality of health care received in inner-city hospitals; success in developing procedures and training for non-physicians who can work in underserved communities; and why the gap in disparities
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