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“In the last two decades, we have made very little progress in addressing health disparities” – Lovell Jones, PhD

A few weeks ago, as I sat in LAX waiting for my red eye to wing my way back to Houston for a morning meeting, I wondered if our nation truly wants to eliminate health disparities, or have we created just another industry that relies on health disparities to continue in order to become another employment opportunity?

A few years ago I asked, “How can we expect solutions from those who benefit from the problem?”  It is in the vested interest of the beneficiary to continue the situation. Unfortunately, they live for the moment and not the future. In the end, we all suffer. Such was apparent with the passage of the recent Health Reform Bill in the US House of Representatives. Why do I say that? Just think about the following and the continued discussions that are taking place.

As the March 2008 article produced by the American Medical Association stated, “we have not made any significant gains in reducing health disparities over the past two decades.”  In a recent report by researchers at John Hopkins University and the University of Maryland indicated, the impact of health disparities in one four year period has cost this nation a total of  $1.24 TRILLION. YES, $1.24 TRILLION.  So if one assumed a steady state, which is not true in reality, but lets assume so, the cost of the impact of health disparities over the next 10 year period will approach $3.1 TRILLION if nothing is accomplished to address the disparities.

Now, how much is the projected cost of health reform over the next 10 years? $1 TRILLION.  Assume that we are unable to completely eliminate health disparities over the next 10 years, but over that same period of time we can reduce it by an average of 33%? Lets see, 33% of $3 TRILLION is approximately $1.023 TRILLION.  So if we subtract $1.033 TRILLION from the TRILLION proposed in the recent Health Reform Bill, we have a surplus of $23 BILLION.

So my question is why are we not talking about working to eliminate health disparities as a means of paying for health care reform? I have a few ideas why, but what do you think?

Let’s set some reasonable milestones and work toward elimination of disparities. Why not truly set a Presidential goal of reducing health disparities by the end of the next decade like Kennedy did for space exploration?  In spite of the lack of anything that could support a man in space, in less than ten years, it was accomplished.  Why not seek the reduction and ultimate elimination of health disparities before 2020 with Healthy People having ONE GOAL that would benefit ALL?

I believe that this nation should commit itself to achieving a milestone of reducing health disparities by at least 33% before 2020. No single health initiative in this period will be more impressive to mankind, or more important for the long-range survival of this nation. I propose to move toward eliminating the gap by delivering what we already know today – but to all Americans; to eliminate the gap between discovery and delivery and accelerate the development of programs to address the math and science gaps that exist in our schools.  We need more people, especially persons of color to achieve this goal.  We propose to develop alternatives to what we have always done, and to supply additional funds for other programs to address the need for more health care personnel.

An unhealthy nation is not an economically viable nation. In a very real sense, eliminating health disparities will not just address the health of the underserved and/or minorities, but the health of all. All of us must work together to make this happen.  For as Franklin Roosevelt would have stated in his last, but undelivered speech, “Today, we are faced with the preeminent fact that, if civilization is to survive, we must cultivate the science of human relationships – the ability of all peoples, of all kinds, to live together and work together in the same world, at peace.”

If reducing health disparities is a true national priority, then we need to find the money to make this happen. From what I have seen of the Health Care (Finance) Reform debate it is not, at least at the level of the Congressional leadership on both sides of the aisle. If it were, it would truly give the promise to someday eliminate health disparities, not only in this country, but the world at large.

Let it be clear that I am asking the Congress and the country to accept a firm commitment to a new course of action – a course which will last for many years and carry very heavy costs, but the ultimate financial gain will far exceed the initial investment. The White House and Members of the Congress must make this judgment, but at this moment, I am not so confident. Just going half way and giving lip service is not going to solve the problem. This decision demands a major national commitment to scientific and technical manpower, material and facilities, and the possibility of their diversion from other important activities where they are already thinly spread.   It means a degree of dedication, organization and discipline that have not always characterized our research and development efforts in this area.  It means we cannot afford undue work stoppages, inflated costs of materials or talent, wasteful inter-agency rivalries, a high turnover of key personnel, or the impact of institutional racialism on our decisions. We all have biases; the problem is what we have done with those biases. The results so far have not been pretty for the health of our nation.

New objectives and new money alone cannot solve these problems. They could, in fact, aggravate the problems further as we have seen with new discoveries and a lack of delivery to the people who need the discoveries the most.  Unless every scientist, every physician, every health care professional, every politician, businessperson, and civil servant gives his/her personal pledge that this nation will move forward with the full speed of freedom to address the issue of health disparities, we will not be successful. This kind of change will require dedication and a genuine willingness to address health disparities despite biases and perceptions. We must also learn to speak with one voice on this subject.

Suggested reading from LikeTheDew editors:

• Estimating the Cost of Racial and Ethnic Health Disparities – The Urban Institute (PDF)
• The Economic Burden of Health Inequalities in the United States – Joint Center for Political and Economic Studies (PDF)
• Addressing Racial and Ethnic Health Care Disparities – Joint Center for Political and Economic Studies (PDF)
• Institute for Partnerships to Eliminate Health Disparities – University of SC Arnold School of Public Health (PDF)
• The National Council for Research on Women
• Eliminating Health Disparities – American Medical Association
• Commission to Build a Healthier America – Robert Wood Johnson Foundation

1. Hala Moddelmog says:

   November 15, 2009 at 3:58 pm

   So glad to see Lovell back on the “Dew” — his message is so important but is often not heard.

   Reply
2. Lovell Jones says:

   November 15, 2009 at 6:47 pm

   Thanks Hal!!! I have written a few more editorial, but this one struck me as something that especially needed to be heard. Hopefully not only by those who are intend on doing nothing while benefiting from the problem (my career reflect that more often than not), but from those who truly are in power to do something. It is not just to improve the health of the underserved, but for the survival of this nation. For those who know history, Roman was not destroyed from the outside, it started from the inside and centered on the health, or lack of, by the populus. We are headed down that same road. Yet our leaders, and the population at large, seem to fail to understand this. And we allow those who have so much to gain in the short run lead to the end. The question is will be jump. Right now the end is to jumping.

   Reply
3. La Shonda Ellis says:

   February 7, 2010 at 2:22 pm

   This is a very enriching article, I always enjoy reading or hearing about your work!

   Reply