April. A time for spring, a time for new growth. The start of a new season, and National Minority Health Month, which is a time to learn more about the health status of racial and ethnic minority populations in the U.S. It’s also a time to raise awareness about health disparities that minority populations are affected by. The theme for 2018 is Partnering for Health Equity, which highlights partnerships at federal, state, local, tribal and territorial levels that help reduce disparities in health and healthcare (National Minority Health Month).
Let’s start with a bit of history to understand how National Minority Health Month began…
In 1985, the Secretary’s Task Force Report on Black and Minority Health was released by the United States Department of Health and Human Services (HHS). This report detailed the existence of health disparities among racial and ethnic minorities in the U.S. and labeled such disparities “an affront both to our ideals and to the ongoing genius of American medicine” (History of the Office of Minority Health). Due to this report, referred to as the Heckler Report, the Office of Minority Health was established in 1986 and was reauthorized by the Affordable Care Act (ACA) in 2010. The Office of Minority Health’s mission is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities (History of the Office of Minority Health).
Later on, the National Minority Health Month Foundation launched the initial Minority Health Month in April 2001, in response to the HHS Healthy People 2010 initiative (National Minority Health Month). Healthy People 2010 focuses on health promotion and disease prevention and has since been succeeded by Healthy People 2020. National Minority Health Month then received Congressional support in 2002.
On the state level, Minority Health Month was created in April of 1989, and was meant to be a 30-day inclusive wellness campaign where an event would be held each day. In Ohio, five goals were also developed to provide a focus (Ohio Minority Health Month Promotion Activity):
Provide crucial information to allow individuals to practice disease prevention;
Promote healthy lifestyles;
Showcase the providers of grassroots healthcare resources and information;
Highlight the disparate health conditions between Ohio’s minority and non-minority populations; and
To gain additional support for on-going efforts to improve minority health throughout the year.
National Minority Health Month
Locally in Summit County, the Office of Minority Health provides minority health data and assistance to agencies in the area that work to improve the health status of minority populations. They are funded through the Ohio Commission on Minority Health and serve as a central location for the coordination of community health efforts targeting health improvement in Summit County’s African-American/Black, Asian, Hispanic/Latino and Native American populations (Summit County Office of Minority Health). The OMH is also involved in a national initiative to localize the concept of racial and ethnic health equity.
So, with the different governmental organizations mentioned above, what is it exactly that National Minority Health Month is raising awareness for? To fully understand, let’s revisit a topic we’ve discussed in another one of our blogs: equality and equity. Both terms are frequently used when discussing health inequities and attempting to create a fair and level playing field. These terms are often used interchangeably, but there is a major difference between the two. Equality means everyone is treated the same while equity means treatment is based on what they need to thrive.
For example, two people visit the same doctor’s office when they are sick. Let’s assume both individuals are women in their mid-30’s and both have the same symptoms and illness. The first woman, who lives in an affluent neighborhood and has a mid-management level job, is seen by the doctor and is prescribed medication. The second woman, who lives in a low-income neighborhood and has been out of work for six months, is seen by the same doctor and is prescribed the same medication as the first woman. Excellent, they both were treated the same and both have equality. The first woman goes to the nearest pharmacy, purchases the medication, takes it as directed and gets better. The second woman received the prescription from the doctor, but she cannot afford it. Therefore, she does not take any medication and she does not get better. Here we have an example of social determinants, or barriers, creating health inequity. The second woman clearly has a variety of socioeconomic issues that influenced her health outcome, even though the physician provided the appropriate level of medical care. However, if she was given the prescribed medication, regardless of ability to pay, she would experience equity and would be at a level playing field as the first woman. Makes sense, right?
Health equity is a key focus of what National Minority Health Month brings awareness to. Everyone should have the opportunity to be as healthy as possible, regardless of race or socioeconomic background. While it has a less focus on social determinants, or barriers, to health, it shines a heavy light on the health inequities experienced by minority populations. Research shows that disparities between different population groups serve as a barrier to health equity across a wide range of diseases and health behaviors. Here are a few examples from the profiles by the Office of Minority Health:
The death rate for African Americans was generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide.
According to the Centers for Disease Control and Prevention (CDC) the leading causes of illness and death among Hispanics, include heart disease, cancer, unintentional injuries (accidents), stroke and diabetes. Some other health conditions and risk factors that significantly affect Hispanics are: asthma, chronic obstructive pulmonary disease, HIV/AIDS, obesity, suicide and liver disease.
Some of the leading diseases and causes of death among American Indians and Alaska Natives are heart disease, cancer, unintentional injuries (accidents), diabetes and stroke. This population also has a high prevalence and risk factors for mental health and suicide, obesity, substance abuse, sudden infant death syndrome (SIDS), teenage pregnancy, liver disease and hepatitis. They also have an infant death rate 60 percent higher than the rate for Caucasians.
Asian Americans are most at risk for the following health conditions: cancer, heart disease, stroke, unintentional injuries (accidents) and diabetes. Asian Americans also have a high risk and prevalence of: chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, tuberculosis and liver disease. Tuberculosis was 30 times more common among Asians, with a case rate of 18.2 as compared to 0.6 for the non-Hispanic white population.
Native Hawaiians/ Pacific Islanders have higher rates of smoking, alcohol consumption and obesity. This group also has little access to cancer prevention and control programs. Some leading causes of death among Native Hawaiians/Pacific Islanders include: cancer, heart disease, unintentional injuries (accidents), stroke and diabetes. Some other health conditions and risk factors that are prevalent among Native Hawaiians/Pacific Islanders are hepatitis B, HIV/AIDS and tuberculosis.
Now you may be asking yourself, what causes these differences in diseases amongst different populations? The answer, however, is not a simple one. There are numerous factors and barriers that affect access to quality healthcare. For example, the Hispanic population deals with language/cultural barriers, lack of health insurance and a lack of access to preventive care. Asian Americans also have a lack of health insurance and language barriers, but also face a fear of deportation, which causes infrequent medical visits. American Indians and Alaska Natives not only deal with cultural barriers, but also geographic isolation, low income and poor sewage disposal.
There are some common factors that all minority populations seem to share that impact their healthcare. These include: education level, insurance coverage, language fluency and poverty level. Typically, amongst all groups as compared to non-Hispanic whites (with the exception of Asian Americans), they experience a lower education level and a lower household income. For example, according to a 2015 Census Bureau report, the average non-Hispanic black household median income was $36,515 in comparison to $61,394 for non-Hispanic white households (Profile: Black/African Americans). In 2015, the Census Bureau reported that 47 percent of Hispanics have private insurance coverage, making them the highest uninsured rate of any racial or ethnic group in the U.S. (Profile: Hispanic/Latino Americans).
And THIS, this is what National Minority Health Month is shedding light on. The inequities experienced by minority populations that have a direct impact on their health. It’s brining awareness to the fact that something needs to be done to ensure that everyone can have access to a healthy life. As J. Nadine Gracia, MD, MSCE, the former Deputy Assistant Secretary for Minority Health stated, “We must bolster collaborations that reach across sectors such as education, justice, housing, and labor and confront the structural forces and social, economic and political influences on the health of our communities. Let us join together in April, and throughout the year, in a renewed commitment to end health disparities and achieve health equity in America.”