NBNA BRIEFING PAPER ON
ELIMINATING HEALTH CARE DISPARITIES

The 2003 “National Healthcare Disparities Report” developed by the Agency for Healthcare Research and Quality (AHRQ) offered a comprehensive tool to measure access and use of health care services by various populations.

In its 2005 National Healthcare Quality and Disparities report released on January 9, 2006, AHRQ reported that access to care for African Americans was narrowing.  Improvements were observed among non-Hispanic Whites and Non-Hispanic Blacks relative to blood pressure control.  Yet, cardiovascular disease is the number one killer of African Americans.  Only 40 percent of those diagnosed with diabetes have their HbA1c under optimal control (<7 percent).  Blacks with diabetes are more likely than Whites to have their total cholesterol under control.  Only 70 percent of those diagnosed with diabetes had their blood pressure under control.  Rates of late-stage breast cancer decreased more rapidly from 1992 to 2002 among black women (169 to 161 per 100,000 women) than among white women (152 to 151 per 100,000), resulting in a narrowing disparity.   Yet, Black women had higher rates of advanced state breast cancer than White women in 1992, 1993, 2002. 

The Behavioral Risk Factor Surveillance System (BRFSS), a random telephone survey conducted by state health department and the CDC; and the National Health and Nutrition Examination Survey (NHANES) 1999-2002 found that Blacks had the highest prevalence of hypertension, the highest self-report prevalence of diagnosed diabetes and the highest rate of hospitalizations for stroke.

Over 40 million Americans are uninsured and millions lack adequate care.  Communities of color have a higher incidence of chronic diseases, cardiovascular disease, diabetes, cancer, violence and HIV/AIDS, leading to high rates of morbidity and mortality.   20 million Americans have diabetes; it is estimated that 20 million Americans have undiagnosed diabetes. 2.7 million African Americans aged 20 and older have diabetes.  African Americans develop diabetes at 1.6 times the rate of whites.  Diabetes is the leading cause of kidney failure and African Americans are more likely to suffer from kidney disease.  According to the Centers for Disease Control and Prevention, the incidence of diabetes is expected to double by the year 2050 and healthcare costs associated with diabetes exceeded $132 billion in 2002.   African Americans account for 50 percent of new AIDS cases in 2002.

The staggering statistics related to these disease states are only a snapshot of the continuing pain and suffering, let alone the economic impact that continues to plague our communities.  While advances in prevention, diagnosis and treatment, particularly through biomedical research and technology, offer incredible promise for improved health and delivery of care, for a good number of this Nation’s citizens, this dire state of health continues.

The questions that must be addressed are:

• What is being done to expand health insurance coverage for the uninsured?
• How is the latest biomedical research and technology being used to help close the disparities gap?
• Can more appropriate dispensing of first tier drugs for certain chronic conditions improve the health disparities gap?
• Why are African Americans less likely to get the expensive, newer treatments?
• How can more vigorous intervention research, occurring in clinical and community based settings, be funded to produce critical findings that underpin evidenced based practice?
• Can research funds be granted to discover and evaluate practical and replicable solutions to reduce and eliminate racial and ethnic health care disparities?
• How will the education and training at health professions institutions help to improve the access, and quality of health care services to communities of color?
• What are the strategies to recruit and retain nurses and other health professionals to help reduce and eliminate health care disparities?  
• Can a comprehensive health disparities bill like that introduced by Representative Elijah Cummings (D-MD) and other Members of Congress change our Nation’s health care infrastructure to eliminate racial and ethnic health care disparities?  Elements of such legislation seek to ensure quality health care; expand access; strengthen accountability; implement the IOM study recommendations; enhance the Office of Minority Health, Office for Civil Rights and the National Center on Minority Health and Health Disparities; support and empower communities in their efforts to eliminate health disparities; improves workforce diversity; reduce diseases and related complications from HIV/AIDS to asthma; and improve racial, ethnic and primary language data collection, use and monitoring.    
• What can be done to better communicate to communities of color about the warning signs of diseases and consequences of diseases like strokes?

The NBNA mission is provide a forum for collective action by African American nurses to “investigate, define and determine what the health care needs of African Americans are and to implement change to make available to African Americans and other minorities health care commensurate with that of the larger society”.

National Black Nurses Association, 8630 Fenton Street, Suite 330, Silver Spring, MD 20910

Visit NBNA at www.nbna.org; 2/3/07