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Health Disparities: A Looming Challenge

February 2005

The disparity between the health of white Americans and black Americans was the topic of W. E. B. DuBois's presentation in 1906 at Atlanta University. His paper, "The Health and Physique of the Negro American," focused on diseases that disproportionately affect black Americans. DuBois and others initiated action to address health disparities, and black schools and churches took the lead, reaching out to assist those in their communities.

In the 1950s, however, that responsibility was taken over by the U.S. Public Health Service. Some 30 years later, in 1985, then Health and Human Services Secretary Margaret Heckler officially identified a gap in healthcare that left blacks and other minorities with inferior healthcare.

In 1990, NIH established the Office of Research on Minority Health, and 10 years after that, it became the National Center on Minority Health and Health Disparities. The legislation that established and funded the NCMHD also added the element of socioeconomic disadvantage to the group of risk factors for health disparities.

But today, many of the same problems identified by DuBois and Heckler continue to plague minority populations. High blood pressure, high cholesterol and high triglycerides, stroke, diabetes and some forms of cancer are among the diseases that disproportionately affect black Americans. Obesity, which research has tied to many other health problems, too, is disproportionately higher among black Americans.

NIEHS Director Ken Olden said he believes health disparities are the result of a set of complex factors, including socio-economic factors, access to healthcare and bias by health-care providers, biological and environmental factors, cultural beliefs, public policies and individual behaviors. Those factors interact to afflict the poor - and large numbers of minorities - with disproportionate levels of disease.

Marian Johnson-Thompson, director of education and biomedical research at NIEHS said research on Hispanic, Asian, and African people shows some health disparities that do not exist in their native countries develop when they immigrate to the U. S.

Johnson-Thompson will make a presentation on the Niagara Movement, in which DuBois played a lead role, at the NIH African American History program Feb. 14. That movement started in 1905. It was the first significant black organized protest of the 20th century, and among the demands was equality in healthcare.

Johnson-Thompson said the factors that result in health disparities are very complex. They include access to jobs; housing; education and healthcare; the kind and quality of healthcare received; and the quality of housing and everyday environmental exposures, in addition to the unique pollutants in minority and poor neighborhoods.

Johnson-Thompson said it is vital to recruit minorities into the areas of health research, health policy, and education. By establishing influence in those areas, minorities will begin to make progress toward solving issues related to health disparities.

To fully understand human disease, researchers must also delve into those social factors that cause disproportionately negative outcomes in health among ethnic and medically underserved groups, Johnson-Thompson said.

In 1997, President Bill Clinton issued a national apology for the Tuskegee syphilis study. According to a National Public Radio account of the study, nearly 400 poor black men with syphilis in Macon County, Ala., were studied by the Public Health Service, working with the Tuskegee Institute, beginning in 1932. The men were never told they had syphilis, and they were never treated for it. Many died from the disease and related conditions. In his 1997 apology, Clinton said that 25 years after the Tuskegee study, there was very little participation by African Americans in clinical trials. The lack of participation seriously impedes efforts to conduct promising research and to provide adequate healthcare to all people, Clinton said.

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