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Reflections on Coalitions and Health Disparities

In reflecting on the meaning and spirit of Martin Luther King Day last week and the 50th anniversary of Lyndon Johnson’s Civil Right Act, I decided to share some information and resources on health disparities and what some coalitions and communities are doing to achieve health equity. It illustrates the continuing need to remind ourselves of why the courageous, groundbreaking work of Dr. King and others is very relevant for us today.

In a recent issue of the Center for Disease Control and Prevention’s (CDC) Health Equity Matters newsletter, Leandris Liburd, Associate Director for CDC’s Office of Minority Health and Health Equity, wrote (2013):

 “In 2013, our nation celebrated the 50th anniversary of the March on Washington; we remembered the life and legacy of President John F. Kennedy on the occasion of the 50th anniversary of his assassination; and the whole world paused to honor the life, love, and revolutionary contributions of Nelson Mandela in his passing at the age of 95. Mr. Mandela wrote in Long Walk to Freedom (1995), “I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one’s head pointed toward the sun, one’s feet moving forward.” We salute these great men of courage, integrity, and sacrifice, and are inspired by their embodiment of leadership, hope, and perseverance. The same characteristics are needed if we are to win the battle to reduce preventable health disparities and premature mortality in the U.S. and globally.“

What is a Health Disparity? A health disparity is best defined as the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the U.S.  The causes of racial and ethnic health disparities are complex and include individual, community, societal, cultural, and environmental factors. The World Health Organization’s  Commission on Social Determinants of Health states that to achieve health equity, we must “improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age” (2008, p. 1). Income, education level, sex, race, ethnicity, employment status, and sexual orientation are all related to health and health outcomes for a number of Americans, according to the 2nd Health Disparities and Inequalities Report — United States, 2013 released last November (CDC, 2013).

Why is eliminating health disparities important? Every person should have the opportunity to attain his or her full health potential. The goal should be to eliminate barriers to achieving this potential because of social position or other socially determined circumstances. According to the CDC, health disparities remain widespread among members of racial and ethnic minority populations.

  • Heart disease is the leading cause of death for people of most ethnicities in the U.S.
  • Non-Hispanic blacks have the highest rates of obesity (44.1%) followed by Mexican Americans (39.3%)
  • Compared to non-Hispanic whites, the risk of diagnosed diabetes is 18% higher among Asian Americans, 66% higher among Hispanics/Latinos, and 77% higher among non-Hispanic blacks

What is CDC’s Racial and Ethnic Approaches to Community Health (REACH). The best community-based interventions are community-centered, racially and ethnically appropriate, and practice/evidence based to advance policy, systems and environmental change at local, state and national levels. REACH is the strongest national initiative to eliminate racial and ethnic disparities in health. CDC supports  partners, many of which are coalitions, to establish community-based programs and culturally-tailored interventions to eliminate health disparities among African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders. Coalitions and partners use community-based approaches to identify, develop, and disseminate effective strategies to address health disparities across health priority areas, such as heart disease, diabetes, infant mortality, asthma, and obesity. The initiatives focus on changes in weight, proper nutrition, physical activity, tobacco use, and emotional well-being and overall mental health. For more information about REACH, see: http://www.cdc.gov/nccdphp/dch/programs/reach/about.htm

Does REACH work? REACH Risk Factor Surveys indicate that from 2001-2011:

  • Cholesterol screening increased among African Americans, Hispanics, and Asians in REACH communities, while it decreased or remained constant among the same population groups nationwide.
  • The proportion of Hispanics who reported having hypertension and were taking medication for it increased.
  • Pneumonia vaccination rates increased in black, Hispanic, Alaskan/Pacific Islander, and Native American communities.

Again, I hope this blog serves as food for thought as you engage communities in the work to end disparities in health. I’d like to end, as I began, with wisdom from Lenore Liburd from the Office of Minority Health:

 “As we begin the New Year, it is worth reiterating that health disparities are a societal issue and not just the burden of selected populations. In the years ahead, we must identify ways to quantify and communicate to all of our society the benefits to everyone in eliminating preventable health disparities and achieving health equity” (2014).

References

CDC. CDC Health Disparities & Inequalities Report – United States, 2013. MMWR Supplement, November 22, 2013, 62(3):1-187. (The full report and other information is available at: http://www.cdc.gov/DisparitiesAnalytics

Liburd, L.C. Health Equity Matters Newsletter, 2(4), 2013.  http://www.cdc.gov/minorityhealth/newsletter/current.html

Liburd, L.C. Reflections, Revisions, Renewals. Conversations in Equity blog. January 15, 2014. http://blogs.cdc.gov/healthequity/2013/01/15/reflections-revisions-renewals/

WHO Commission on Social Determinants of Health. (2008).Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization. http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf?ua=1

Other Resources & Information 

Federal Agencies and Offices

 Other Health Equity Coalitions

 News Sources on Minority Health