Disparities

We get really tired of hearing foes of health reform go on and on about waiting lists in Canada and how it's rationing... And how nobody in the United States lacks care because they can always go to the emergency room. We know that yes, people in other wealthy industrialized countries sometimes wait for elective procedures, but here in the United States people -- particularly the poor and the underserved or the uninsured -- do plenty of waiting and postponing even when lives are at stake. (And how many people do you know who get cancer diagnosis, surgery, chemo, radiation and follow up care in their local ER?) 

The American Cancer Society has made the point during the health care debate that uninsured and underinsured people get diagnosed later and die sooner. A new study in the Journal of Thoracic Oncology (which we read about on Health News Daily) found that the length of time a newly diagnosed lung cancer patient has to wait for treatment depends in part on whether they are treated at a public (safety net) or private hospital, whether they are insured, their age, and their race. 

With so much  ruckus over what's in the House health reform bill, what's not actually in the bill and what imaginary horrors it will bring about , we'd like to highlight a feature not getting much attention -- namely a push to reduce or eliminate health disparities.

Here are some of the highlights from the House Tri-Committee bill, HR 3200:

• Medicare will reimburse for "culturally and linguistically appropriate services" to promote access for Medicare beneficiaries with limited English proficiency. (NOTE: This is not a codeword for covering illegal immigrants, as some  foes of reform have contended).
• Reducing health disparities would be an explicit goal in the HHS Secretary's national priorities for quality improvement in health care.
• The Secretary of HHS and the Institute of Medicine would look at how providers utilize cultural and linguistic support services, design a demonstration program to pay for these services, and study the impact on reducing health disparities.
• Establish a CDC grant program for community-based prevention and wellness. Significantly, "At least 50% of these funds must be spent on implementing services whose primary purpose is to reduce health disparities."

Everyone has a stake in the health care reform debate. As the National Partnership for Women & Families pointed out in a recent issue brief, the stakes are particularly high for women.

Women face difficulties accessing and affording care. Recently, reports by both the White House and the Kaiser Family Foundation shed light on women's health disparities. Women are often the primary health care decision makers for their families, so they experience first-hand the strain brought on by problems in the current system. According to a recent poll by Consumer Reports, 76 percent of women support or strongly support health reform that would give all uninsured Americans access to affordable, quality health care.

The National Partnership has a number of policy suggestions to relieve the strain the health care system places on women and families. Here are some highlights:

Previously, we've discussed health disparities and barriers to care American women face. We've  looked at health disparities facing racial and ethnic minorities. At an event this week, the Kaiser Family Foundation put these issues, literally, on the map. The report, Putting Women's Health Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level, examines the relationship between gender, race, ethnicity, and health on a state-by-state and national basis.

The report looked at three dimensions of indicators:

• Health Status, such as overall wellness, and chronic or mental illness.
• Access and Utilization, such as coverage and regular check-ups.
• Social Determinants, such as income and education.

Though all women experience some level of difficulty with health disparities, the report found women of color were worse off than white women on almost all health indicators.

More evidence about the health care crisis facing poor people and minorities. Health and Human Services Secretary Kathleen Sebelius this week released a report, Health Disparities: A Case for Closing the Gap, examining widespread and worrisome disparities. Low-income Americans and racial and ethnic minorities experience higher rates of disease, face more barriers to accessing care, and often lack access to routine or preventative care.

Chronic disease is a particularly big problem. In general, minority populations are more likely than white populations to experience obesity, cancer, diabetes, or HIV. While about 39 percent of the general population suffers from chronic disease, the rate for African Americans is 48 percent. Seven out of 10 African Americans between the ages of 18 and 64 are overweight or obese. They are also more likely than other racial or ethnic groups develop cancer or be HIV infected.

We've noted the disparities in cost and coverage that women face in the health insurance marketplace before. The Department of Health and Human Services and the White House are taking notice too. Their report Roadblocks to Health Care: Why the Current Health Insurance System does not Work for Women highlights some worrisome statistics about women and health care.

Women often have a more difficult time finding health care coverage through an employer. Only 52 percent of women, as opposed to 73 percent of men, are employed full-time. Of those women, only 48 percent are able to get employer-sponsored health coverage, versus 57 percent of men. Women are twice as likely to be on a spouse's plan, and single women are two times more likely to be uninsured than married women.

Our nation's health care crisis affects all Americans in different ways. A new report from the Department of Health and Human Services details the health care challenges faced by the some 50 million people living in rural America.

Hard Times in the Heartlands is an excellent collection of resources for understanding what hits home for rural Americans. The report makes several key points.

First, the report notes that the economic downturn has struck rural America especially hard. Rural areas are losing jobs at faster rates than the rest of the economy. Now, nearly one in five (8.5 million) of our nation's uninsured live in rural areas.

So how's your health? And have you earned any good degrees lately?

American adults just aren't as healthy as they could be, a recent study by the Robert Wood Johnson Foundation Commission for a Healthier America found. Between 2005 and 2007, a little more than 45 percent of adults ages 25 to 74 reported being in less than very good health. And education levels seems to be a factor.

The study, Reaching America's Health Potential Among Adults: A State-by-State Look at Adult Health, found that the greatest indicator of health was education level. Nationally and on a state-by-state basis, people with higher levels of education were more likely to be healthy. Adults with a high school education were more likely to be unhealthy than college graduates. Adults who had not graduated from high school were more than three times more likely to be unhealthy than college graduates. The disparity between education level and health varied from state to state. Delaware was the best (only nine percent difference between overall adult health and overall health of adult college graduates) and California (with a nearly 20 percent difference) was the worst.

Earlier this week, the Robert Wood Johnson Foundation's Commission to Build a Healthier America released a new report titled: "Beyond Health Care: New Directions to a Healthier America."

The first post we ever wrote for this blog was for the launch of the Commission to Build a Healthier America, which was created to "raise awareness of the factors beyond medical care that affect a person's health and recommend viable short- and long-term strategies to help improve the health of all Americans." They made their point brilliantly with a chart that looked like the D.C. metro-map showing the large variations in average lifespan in just a few miles between metro stops. Those disparities reflected differences in wealth, education and environment—in short, the social determinants of health beyond medical care. Over at RWJF's health reform blog, Jim Marks, a pediatrician and director of the RWJF's health group, elaborates:

The rising rates of unemployment and the growing numbers of uninsured people are exacerbating health disparities in low income and minority communities that already suffer from barriers to care and high rates of chronic disease. The Kaiser Family Foundation recently a hosted a webcast moderated by Cara James, Ph.D, the Foundation's Senior Policy Analyst on Race, Ethnicity, and Healthcare, to look at these all-too familiar patterns.

Howard University economist Dr. William Spriggs sketched out the economic backdrop. Nationally, the unemployment rate in February was 8.1 percent. For blacks, it's above 13 percent, and in Latino communities it ranges from 8 to 14 percent. Joblessness is a double-whammy, because it often means people also lose employer-sponsored health insurance.