Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Satcher: Cuts Show Lack of Seriousness About Ending Racial Disparities

By John Reichard, CQ HealthBeat Editor

December 21, 2007 -- Despite progress at the federal level toward ending racial and ethnic disparities in health care, federal efforts are underfunded and show a lack of seriousness about getting the job done, former U.S. Surgeon General David Satcher said during a recent panel on minority health issues.

"If we are serious about eliminating disparities in health, if we are serious about improving health of minorities, then we would adequately fund these programs. And we're nowhere close to adequate," Satcher said during a Dec. 14 panel discussion on health care disparities webcast by the Henry J. Kaiser Family Foundation.

Satcher served as director of the Centers for Disease Control and Prevention and as Surgeon General during the Clinton administration and has conducted research on disparities since then. He now heads the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, which conducts workshops, training, and research programs aimed at increasing the number of minorities in the health professions and at ending racial disparities in health.

Garth N. Graham, who heads the Health and Human Services Office of Minority Health, said Friday that HHS "continues to be committed to the issue of eliminating health disparities through a number of programmatic activities and campaigns." He noted in particular that the Bush administration has accomplished its goal of expanding or opening 1,200 community health centers around the U.S.

"In 2006, 23 percent of health center patients were African American and 36 percent were Hispanic/Latino—almost twice the proportion of African Americans and over two-and-a-half times the proportion of Hispanics/Latinos reported in the overall U.S. population," he said. Graham added that "in April we launched a national infant mortality campaign aimed at addressing the serious problem of infant mortality in the African American community and just recently awarded $11 million to community based organizations to tackle health disparities."

During the panel discussion, Satcher said recent examples of federal progress toward ending racial and ethnic health care disparities include the creation of the National Center for Minority Health and Health Disparities at the National Institutes of Health and establishment of the Racial and Ethnic Approaches to Community Health (REACH) program at the CDC.

The National Center funds research aimed at improving minority health and ultimately ending racial health disparities. The REACH program funds community programs targeting disparities for a variety of conditions including asthma, breast and cervical cancer, diabetes, and cardiovascular disease.

Groups addressed by REACH include African Americans, Latinos, Asian and Pacific Islanders, and Native Americans. Through REACH, "there are at least 40 to 50 communities throughout this country that are really focused on what we can do to eliminate disparities in health," he said. REACH is different because it grants money directly to communities, Satcher observed. "It's amazing what's happened with the leadership of communities, and I think we ought to take a real close look at REACH and what it teaches us about empowering communities."

Satcher also pointed to helpful "processes," including a 2002 Institute of Medicine report on disparities and an annual report by the Agency for Healthcare Research and Quality documenting disparities. Another recent effort includes the setting of dozens of public health goals relating to race and ethnicity in the federal "Healthy People 2010" document.

"It's also perhaps good news that when I came into government, seven years separated African Americans from whites in terms of life expectancy. In 2004, it was five years." But "the bad news ... is that five years still separate African Americans and whites," he said. Satcher added that there is a "29 percent greater risk of mortality among African Americans—that's down from 37 percent back in 1990."

One way of viewing recent efforts is against a backdrop of research published by Satcher and other researchers in 2005 in the health policy journal Health Affairs. The study concluded that if disparities had been eliminated in the 20th century, in the year 2000 there would have been 83,500 fewer deaths among African Americans, including almost 5,000 fewer deaths among African American babies.

Satcher said that if the same percentage of African Americans as of whites were insured there would be three million more African Americans with health coverage today. But access to care, while important, is only part of the reason for disparities in health status, he said.

"We've got to deal with health behavior, and that accounts for 40 to 50 percent of the variation," he said. "So, obesity and the increase in diabetes as a result of that" constitute "a very critical issue." Legislation requiring schools to adopt physical education and good nutrition is "just as critical as access to health care," Satcher said.

The social and physical environment also contributes to disparities, he said. "We talk about human behavior, health behavior, but you know that there are people who live in communities where there is no safe place to get out and walk or jog. You know that there are people who live in communities where they can't find a grocery store with fresh fruits and vegetables. So social determinants of health are sort of basic to this whole discussion and certainly underlie a lot of the disparities that we are talking about."

"We're making progress, but at the same time there are major disparities in health," Satcher said.

Panel moderator Marsha Lillie-Blanton of the Kaiser Family Foundation asked Satcher why progress had been made on only 24 of the 195 objectives in the Healthy People 2010 document. "We've not put the funding behind it," Satcher replied. "NIH's budget is $28 billion, and if the National Center for Minority Health and Health Disparities received less than $250 million for its budget, that tells you we have not made a serious effort."

"CDC's budget is being cut, so the REACH program struggles, and data systems struggle because of cuts in funding. So we've not made greater progress because we have not made this the priority that it's supposed to be as a goal of Healthy People 2010," he said.

Funding is an issue with other programs relating to disparities, including the HHS Office of Minority Health, Satcher said. "I don't think it's ever been adequately funded," he said. And the Bush administration has tried to scale back or zero out the "Health Professions" programs at the Health Resources and Services Administration (HRSA), which aim to increase the number of minority health professionals as a way to increase the availability of health care services in medically underserved areas of the U.S., he said.

Other members of the panel said legislation in 2008 or 2009 could aid efforts to reduce disparities. Goals of the legislation include funding more vigorous efforts to collect data to pinpoint and further delineate the nature of disparities. That in turn could focus lawmakers on specific problems and mobilize them to take concrete action. Research, for example, might show that considerably fewer African Americans get regular dental care, a finding that could focus efforts in that area.

"We hope to be successful in moving some type of minority health bill in the spring of 2008, at the latest," said Dora Hughes, health and education policy adviser to Sen. Barack Obama, D-Ill. For example, the Senate Health Education Labor and Pensions Committee may mark up a measure (S 1576) in February that would reauthorize the HRSA programs to foster diversity among health professionals, codify the REACH program, and strengthen data-collection efforts. The legislation, introduced by Sen. Edward M. Kennedy, D-Mass, has 14 co-sponsors including Thad Cochran, R-Miss. The bill also requires the creation of a national plan to improve minority health and eliminate health disparities.

Another focus of disparity proposals is lowering language barriers to care. Sean McCluskie, legislative director for Rep. Xavier Becerra, D-Calif., said his boss has pushed to have Medicare conduct a pilot project to determine whether offering language services for non-English speakers in Medicare would improve their health by avoiding improper use of medications, for example.

Hughes said the Senate may not move on the language issue in the next few months, however. She said "language access is an extremely important issue, but ... has been unfortunately tied up with the fights over immigration."

During the webcast, HHS' Graham said his office has focused on getting providers to adopt standards to help eliminate disparities. Examples include providing interpreter services and training doctors to understand the cultures of their various patients and how cultural differences might affect their care and response to treatment. Graham said hospital accreditation officials and state groups have been working with his office on the use of those standards.

Publication Details