First Seminar: Stage Set

First Seminar: Background session on health disparities - First Seminar - Stage Set (posted on 6 June, 2010(R J Bulger)

As a prelude to this first seminar on health disparities policy, I hope all participants and readers will envision our primary audience as those people who are already working in the field of disparities reduction, either through research or clinical work or community public health efforts. These are people who are not primarily policy wonks but rather find it important for them to gain some degree of policy sophistication so that they have a more realistic platform for appraisal of our situation and for advocacy for important changes or improvements. This our goal is to enlighten those who are listening or reading our posts either through our insights or the questions we have raised. Participants can also be helpful if we can pass along through our posts, the best references or sources we have found most useful.

As an example at the outset here, I would offer my own impression that the journal Health Affairs is the monthly journal I would recommend to persons interested in following developments at the interface of health/health disparities policy, and health care. In the April 2010 issue, the focus was on Health IT, while the May 2010 issue concentrates on the reinvention of primary care with work force manipulations and innovative new team models for providing care for the expected expanding patient base. At the same time, professional medical and nursing journals (especially those with wide public exposure like the New England Journal of Medicine and the Journal of the American Medical Association) are providing fewer, but nonetheless excellent health policy articles which sometimes shape or reflect important movement.

I am old enough to remember quietly celebrating when Dr. Julius Richmond, President Carter’s choice for US Surgeon General, initiated the Healthy People Program, through which specific goals for improvement of our population’s health status were established and data was collected and made available for all to see concerning our progress toward our national health goals Through the years, this data-driven instrument has become more and more useful, refined and precise. We, in 2010 are able to look back at the third decade of these public records and will have a fresh look at our nation’s progress towards the elimination of health disparities.

In the May 6, 2010 issue of the NEJM, the lead article is by MH Koh, Assistant Secretary for Health, US Department of Health and Human Services. Dr. Koh concisely presents the history of the Healthy People Program, summarizes the results of the last decade and prefigures the official plan or vision for the year 2020. Dr. Koh says, As part of Healthy People 2010, ten leading health indicators were selected with input from the Institute of Medicine as high-priority areas for motivating societal action. These indicators provide both a concise summary of major, preventable health threats and a gateway into the broader framework; preliminary data show progress for about half of the indicator objectives.”

Dr. Koh gives as an example of a significant gain in the fight against health disparities is the progress in immunization rates for infants 19 to 35 months of age, up from 72.8% in 1998 to 80.6% in 2006, with great progress in shrinking racial and ethnic differences. On the down-side, we have lost ground in weight control and diabetes both in the population as a whole and within virtually all racial groups.

The ten leading health indicators Healthy People 2010, are: Physical activity; Tobacco use; Responsible sexual behavior; Injury and Violence; Immunization; Overweight and obesity; Substance abuse; Mental health; Environmental quality; Access to health care. (As an aside, it gave me great pleasure, having served as the chair of that IOM committee which recommended the list of Leading Indicators, to realize that the effort did not go in vain and that it is possible for people to come together to produce work that in turn influences public policy and seems to still be of some continuing value.)

The two overarching goals of the 2010 program were to increase the quality and years of life and to reduce disparities: the first was achieved; the second wasn’t. Of interest in Dr. Koh’s paper was his presenting some hints about the 2020 plan which will be presented in six months or so. Dr. Koh says, “It reaffirms the two overarching goals from the past decade but adds two more: promoting quality of life, healthy development, and healthy behaviors across life stages; and creating social and physical environments that promote good health.” This means that there will need to be a stretch beyond traditional health sectors to achieve these broader social goals for health, issues sure to spark important debate.

At this initial seminar, I am pleased to identify three very important books exploring the breadth and depth of health disparities, whose authors have been invited to comment early if they would in this seminar and of course as they are moved to in subsequent seminars. They are as follows: David Satcher MD, PhD and Rubens Pamies MD, Multicultural Medicine and Health Disparities, McGraw Hill, 2006; Brian Smedley, Adreinne Stith and Alan R. Nelson, Unequal Treatment – Confronting racial and ethnic disparities in healthcare, Institute of Medicine national Academies Press, 2003; Richard Allen Williams, MD, Eliminating Healthcare Disparities –beyond the IOM Report, Humana Press, 2007.

For the next seven days, the seminar is open for anyone who has registered to add their comments, references and insights, all of which will be archived (saved) at the end of the week.