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An urgent task: reducing health disparities

For the first time in history, slightly more than half of newborn Americans are people of color. It is projected that by 2050, the majority of Americans will be from minority populations. This demographic shift has serious implications on a myriad of fronts, especially for the nation's overall health. The unfortunate truth is that nonwhite populations as a whole live sicker and die younger than their white counterparts. And black populations tend to be among the sickest.

But the racial health divide doesn't end at our shores. Across the Western Hemisphere, black populations suffer from lower birthweights, higher infant mortality rates, higher incidences of chronic disease and earlier mortality among adults.

The descendants of enslaved Africans living in Baltimore and those living in Salvador da Bahia, Brazil, experience poorer health. In most countries, this trend cuts across indicators of health: access to care, quality of care, health status and health outcomes.

The links between Baltimore and Bahia — a region of Brazil with more African descendants than any place outside of the African continent — are fused by two historic gatherings. In 2007, scholars, activists and health experts from throughout the Western Hemisphere gathered in Brazil to grapple with questions of race, history, culture and health. That vision has grown into a multidisciplinary meeting in Baltimore this weekend that will take up the health challenges that confront people of the United States, Canada, Central and South America and the Caribbean. This region of the world is home to nearly 160 million descendants of the transatlantic slave trade.

While people of African descent throughout the Americas tend to be concentrated in poor living conditions, health inequities can't be attributed solely to poverty. Social status can also contribute to or detract from health and well-being. And some inequities persist across income and educational strata.

For example, in the United States, a college-educated African-American woman is more likely to deliver a low-birthweight baby than a white woman without a high school diploma. So, while economic status is clearly part of the equation, race has a great deal of influence on health, even after accounting for income.

Solving the global health divide requires global understanding and cooperation. We need to survey the health of African descendants in the context of the history of slavery and the social experience of race as it unfolds in our world today. What do people of African descent in the Americas have in common, and how do they differ, in matters of health? What underlying conditions are leading to poorer health outcomes? What must we do to reverse persistent disparities?

Achieving health equity demands a multidisciplinary response that merges medicine with public health and health policy. The medical model treats one patient at a time. Today's public health and policy strategies demand solutions that emerge from the complex interrelationship among poverty, the lack of health care, family history and inadequate health education that are contributing to people becoming sick in the first place.

Expanded access to quality care can produce better health outcomes. Policies and remedies are within our grasp that can address socioeconomic conditions, social and physical environments; expand access to quality care; heighten cultural competency; improve health literacy; and empower health care consumers.

As a nation, we need to commit ourselves to ending health disparities in our lifetimes. The same national resolve and resources we once summoned for space exploration, conservation of our national parks and forests and the eradication of diseases like polio and smallpox should be summoned in pursuit of solutions.

The Rev. Martin Luther King once called health care a basic civil right saying, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Those words still ring true.

Let America's racial tipping point spur us to finally bridge the racial health divide here in the U.S. and across the region.

Thomas LaVeist, Ph.D. (tlaveist@jhsph.edu), is director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health and chairman of the International Conference on Health in the African Diaspora 2012 (ICHAD 2012). Daniel L. Howard, Ph.D. (dhoward@mmc.edu), is executive director of the RWJF Center for Health Policy at Meharry Medical College and is a sponsor of ICHAD 2012.

Copyright © 2014, The Baltimore Sun
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