An article published in MedPage Today discusses the need for Congress to better address minority health issues, especially for African Americans. On Friday, Chairman of the Congressional Black Caucus, Rep. G.K. Butterfield (D-NC) called out House Republicans for not attending an Energy and Commerce Committee forum on minority health and health disparities. "There are no Republicans in this room," Rep. G.K. Butterfield said. "That isn't because they weren't invited; they were invited, but they did not show up. That speaks volumes." The article goes on to describe several ways that Congress can reduce health disparities for African Americans including: finding more ways to encourage diversity in the healthcare workforce; reducing the number of health professional shortage areas, and including more African Americans in clinical trials.
Minority Health Issues Need Bigger Play, House Dems Say
Minority health issues are being ignored by Congress and are often misunderstood, panelists said at a forum on Capitol Hill on Friday.
"There are no Republicans in this room," Rep. G.K. Butterfield (D-N.C.) noted at the forum, which was held Friday and was sponsored by Democrats on the House Energy & Commerce Committee. "That isn't because they weren't invited; they were invited, but they did not show up. That speaks volumes."
The current Congress has been in session for 477 days, "and the Republican majority is unwilling to hold a hearing on health disparities like [the meeting] we've having today," Butterfield said.
Butterfield, who is chair of the Congressional Black Caucus, listed several keys for reducing health disparities among blacks: finding more ways to encourage diversity in the healthcare workforce; reducing the number of health professional shortage areas, and including more blacks in clinical trials. "We must think creatively to establish policies to reduce disparities in communities we represent."
Lack of Insurance a Problem
Improving insurance rates among minorities also is part of the solution, according to Rep. Linda Sanchez (D-Calif.), chair of the Congressional Hispanic Caucus "At 26.5%, Hispanics have the highest uninsured rate of all ethnic groups," she said.
And, while Hispanics are 60% more likely to be diabetic and 45% more likely to die from diabetes, "unfortunately, these disparities aren't limited to suffering from illness," Sanchez said.
"There are also inequalities in medical research ... Just 7.5% of enrollees in NIH [National Institutes of Health] clinical trials are Hispanic," she noted, adding that in California, the Hispanic community is particularly desperate for more Hispanic people to participate in studies on Alzheimer's.
Rep. Judy Chu (D-Calif.), chair of the House Asian-Pacific American Caucus, said that there are myths about some minority health issues that continue to persist.
For example, "Before, we thought that diabetes was not a big problem in the Asian community, but now we believe simply being Asian is a risk factor. There is evidence to show that Asian Americans and Pacific Islanders get diabetes at younger ages and lower weights than the rest of the community," she said. As a result, a campaign -- Screen at 23 -- has been started to screen members of this ethnic group for diabetes when their body mass index reaches 23, instead of at 25 as is done for other groups.
Focusing on Hypertension
Rhonda Moore Johnson, MD, MPH, senior medical director of health equity and quality services at Highmark, a Blue Cross/Blue Shield Plan headquartered in Pittsburgh, said that although it's commonly known that blacks have a higher rate of hypertension than other ethnic groups, there are still many opportunities to improve treatment in this population.
"We recently had 500 [black] individuals screened [at area churches] ... these people had poorly controlled blood pressure," she said. In many cases, "they've been going to the doctor regularly but they're not on the right medication."
Rep. Bobby Rush (D-Ill.), who is African American, suggested another way he thinks blacks are different in terms of their health issues. "I have a theory that there is a lot of unspoken rage among African Americans, even among highest levels, that's different from others," he said. "It's more pronounced if you have inadequate support systems, or if support systems are less present in your life. Even among working middle-class blacks, there is still certain stress they face on the job, driving in cars, and with promotion policies at work. "
Brenda Battle, BSN, chief diversity and inclusion officer at University of Chicago Medicine and Biological Sciences, said that while some groups may suffer more stress than others, "It's your response to the stress you can modify ... You can't compare one stress to the other."
Government's Role
Kim Allan Williams Sr., MD, immediate past president of the American College of Cardiology, said that the government could do a better job helping healthcare providers respond to stress-related and other health issues. He said the college was concerned about Medicare's current system of hospital readmission penalties, which he said "disproportionately applied" to areas with socioeconomic disparities. "Let's actually put together programs that can help people who are under these kind of stresses."
He also noted that while many people have heard of "white coat hypertension," there is another issue with hypertension that's less well-known: masked hypertension. "You come to my office and your blood pressure is good, but do it at home and it's extremely high. [Some patients] are more comfortable in my office than they are in their own neighborhood."
Rep. Frank Pallone (R-N.J.) told MedPage Today that the readmission penalties were not working the way he and others who helped write the legislation intended. They thought that there would be a particular threshold set for readmission rates, and that as long as a hospital was above that bar -- meaning it had fewer readmissions -- it wouldn't be penalized. Instead, he said, even if 10 hospitals out of 10 are above the bar, the lowest two or three will get penalized just for being at the bottom of the list.
"That should be corrected," he told the audience. "We didn't expect that was going to be the way that was handled."
Abigail Echo-Hawk, MA, co-director of the partnerships for Native Health at Washington State University, said more funds are needed for Native American healthcare, noting that Indian health centers spent $3,100 per patient in 2013, versus a national average of $8,500 per patient. "America has a responsibility to provide care for American Indians that's unique to us, and those dollars are not being spent," she said.
Gary Puckrein, PhD, president and CEO of the National Minority Quality Forum, discussed the need to have more minorities participate in clinical trials. He noted that the "I'm In!" campaign that was recently launched is trying to do just that, but that "the initiative has to be done with trusted voices in the community. We need a national conversation to occur, but we have to make sure advocates and organizations within the local community can prolong the conversation."
In addition, just as the FDA grants longer patent exclusivity to drug companies that include children in some of their clinical trials, there should be a similar arrangement for companies that include minorities, he suggested.
Several panelists noted that some minorities are leery of participating in clinical trials because of incidents such as the one involving black men in clinical trials at the Tuskegee Institute in Alabama -- in which volunteers who contracted syphilis remained untreated even after penicillin became available as a cure -- and a clinical trial among the Havasupai Indian tribe in Arizona, in which volunteers in one trial had their lab samples used in other trials without their permission.
"Even though Tuskegee happened in the 1930s through the 1970s, one of the worst things we can do is ignore that it happened," said George Mensah, MD, of the National Heart, Lung, and Blood Institute. "This is the time to do everything possible so we can encourage full participation."
When asked how to tackle the problem of too little diversity in the healthcare workforce, Marc Nivet, EdD, chief diversity officer at the Association of American Medical Colleges, urged the members of Congress who were present to increase funding for the Health Careers Opportunity Program, which provides summer enrichment programs and and financial and emotional support for minority students interested in healthcare careers. "It's currently funded at about $14 million; if we could double the funding," more students could be helped, he said.
Johnson reminded everyone that reducing disparities will take time. "We should not give up hope when eradicating and closing these gaps because we have only been at this 10-12 years," she said. "These disparities are long in the making and they are not going to disappear overnight. There is a lot of progress being made, and we need to stay the course."
