Introduction
Although the health of most Americans has improved significantly over time, not all racial and ethnic groups have benefited equally. African-Americans and Hispanics, for example, are more likely than whites to suffer from poor health and to die prematurely. Minority and low-income families are more likely to live in substandard housing and polluted communities, increasing their risk of childhood lead poisoning, asthma, cancer, and other environmentally related diseases. In addition to being disproportionately affected by disease, minorities often lack adequate insurance and access to health care due to financial and cultural barriers.
To a large extent, disparities in health and access to care among minorities reflect disparities in socioeconomic status. In fact, according to the Health Resources and Services Administration, the connection between socioeconomic status and health disparities is so strong that income and education levels often serve as proxies for health status. The fact that minority populations on average are poorer than whites underlies many health disparities.
Insurance Coverage and Access to Health Care
Health insurance coverage and access to preventive care play a major role in determining health outcomes. Uninsured persons are less likely to seek routine care and may postpone or decline to seek treatment for health problems. According to a report by the Henry J. Kaiser Family Foundation, minority Americans are at least twice as likely to be uninsured than whites, due to disparities in private insurance coverage. At the same time, minorities are more likely than whites to be insured under Medicaid, which provides health coverage for low-income Americans.
Although insurance coverage improves access to health care, minority children have less access to primary medical care than white children, even after accounting for differences in insurance coverage, according to the Kaiser Family Foundation Report. Minority children are less likely to have a usual source of medical care or a specific doctor and are less likely than white children to seek care for symptoms warranting medical attention. Inadequate routine and preventive care increases a child’s incidence and burden of disease.
Over the past 20 years, childhood lead poisoning has declined dramatically in the United States due to bans on lead in gasoline, paint, food cans, and other consumer products. However, lead poisoning is still an important health problem, affecting an estimated 310,000 (1.6 percent) children ages 1-5, according to analysis of data from the National Health and Nutrition Examination Surveys (NHANES), released by the Centers for Disease Control and Prevention. As the numbers of lead-poisoned children have declined, the disparities of the disease have become more pronounced.
While lead poisoning crosses all socioeconomic, geographic, and racial boundaries, the burden of this disease falls disproportionately on low-income families and families of color living in older, poorly maintained housing. For example, in the U.S., African-American children are at two times greater risk than whites, according to the most recent data available on the disparities of the disease.
For a fact sheet explaining this prevalence and disparity data, click here.
The prevalence of asthma in the United States has increased dramatically over recent decades, affecting all racial, ethnic, and age groups. The risk for asthma appears to be more closely correlated with socioeconomic status than race. However, even after accounting for socioeconomic differences, African-American children are twice as likely to have asthma and six times more likely to die from it than white children, according to a Kaiser Family Foundation Report.
In a continuing study, researchers at the Harlem Hospital Center, Harlem Children’s Zone, and the Mailman School of Public Health have found that 25 percent of Harlem children tested have asthma, the highest rate ever documented in this country. For Hispanics, prevalence rates are mixed. For example, the Institute of Medicine reports that Mexican-American children living in the Southwest have some of the lowest rates of asthma in the country, while Puerto Rican children living on the East Coast have some of the highest asthma rates.
Hospitalization for asthma generally is avoidable if the disease is well managed. In urban, low-income, and minority areas, increases in asthma hospitalization and mortality rates are especially pronounced. Poverty, substandard housing, inadequate access to health care, lack of education, and failure to adequately control asthma with medication all contribute to asthma episodes and deaths.
In an inner-city asthma study supported by the National Institute of Allergy and Infectious Diseases (NIAID), researchers found that asthma was more severe in children who experienced significant barriers to accessing medical care. The NIAID study also found that when a nurse practitioner assisted high-risk children and their families in managing the child’s condition and instituting environmental controls, such as the removal of cockroach allergen from their homes, children experienced a 30 percent decrease in asthma-related hospitalizations and unscheduled doctor and emergency room visits. This study indicates that by addressing asthma triggers in the home and taking aggressive action to ensure that inner-city children adequately manage the disease, the disparities in hospitalizations and deaths caused by asthma can be reduced.
Minority populations are both more likely to develop cancer and more likely to die from the disease than whites. African-American men, for example, are 20 percent more likely to get cancer than white men, according to the American Cancer Society. Some specific forms of cancer affect minorities at rates several times higher than the national average.
Ethnic minorities also experience poorer cancer survival rates than whites. Like most diseases, cancer treatment is more effective if begun early in the course of the disease. If preventive medical care is inadequate, cancer is more likely to be diagnosed at a later stage, when options for treatment are more limited and the odds for survival reduced. According to the American Cancer Society, cancer mortality rates are 40 percent higher for African-American men than white men.
Many of the differences in cancer incidence and mortality rates likely are due to socioeconomic factors rather than race or ethnicity. Socioeconomic status bears upon education, occupation, health insurance, income level, and living conditions to a greater extent than race. Each of these factors in turn impacts a person’s risk of developing and surviving cancer.
Eliminating Health Disparities
Efforts to eliminate health disparities are underway both nationally and locally. The nation’s Healthy People 2010 agenda seeks to identify the most significant preventable threats to health and establish national goals to reduce them. The second of the program’s two overarching goals is to eliminate health disparities that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.
The National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, has developed a number of grant programs to document health disparities and arm policy makers with the information needed to reduce them. NIEHS and the National Institute of Allergy and Infectious Diseases have supported several urban asthma studies.
The U.S. Department of Health and Human Services created an Office of Minority Health in 1985, and the Centers for Disease Control and Prevention created a similar office in 1988. Many states also have created offices addressing minority health. The HHS OMH funds health projects conducted by minority community and national organizations, maintains minority health consultants in HHS Regional Offices, and operates a Resource Center on minority health issues. This Office also overseas the Healthy Community Innovation Initiative, a program designed to prevent asthma and other diseases through community services, with special attention to eliminating health disparities. The National Institutes of Health also has a National Center on Minority Health and Health Disparities to coordinate research, training, and outreach programs surrounding health disparities. Due to the strong link between socioeconomic status and health disparities, programs designed to improve the socioeconomic status of minorities also could help to reduce health disparities.
Addressing health disparities related to hazards in housing requires directing attention and resources to the communities at highest risk. Focusing on properties that pose the greatest health risks, which are overwhelmingly older, low-income, and in substandard condition, will yield the greatest improvement in health outcomes and address the striking health disparities borne by low-income and minority families.
Sources and Additional Information:
Agency for Healthcare Research and Quality – www.ahrq.gov
American Cancer Society, Cancer Facts & Figures for African Americans, 2003-2004 – www.cancer.org/downloads/STT/861403.pdf
National Cancer Institute, Center to Reduce Cancer Health Disparities – http://crchd.nci.nih.gov/
Centers for Disease Control and Prevention, Office of Minority Health – www.cdc.gov/omh/default.htm
Centers for Disease Control and Prevention, Third National Report on Human Exposure to Environmental Chemicals (July 2005)
Health Resources and Services Administration – www.hrsa.gov
Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care (1999)
Institute of Medicine, Clearing the Air: Asthma and Indoor Exposures (2000)
National Institute of Allergy and Infectious Diseases – www.niaid.nih.gov/default.htm
Office of Minority Health, U.S. Department of Health and Human Services – www.omhrc.gov
