thebullet
Rebel without applause
- Joined
- Feb 25, 2003
- Posts
- 1,247
Amicus will love this one:
Dying for Basic Care
For Blacks, Poor Health Care Access Cost 900,000
Lives
By January W. Payne
The Washington Post
Tuesday 21 December 2004
More than 886,000 deaths could have been prevented
from 1991 to 2000 if African Americans had received
the same care as whites, according to an analysis in
the December issue of the American Journal of Public
Health. The study estimates that technological
improvements in medicine - including better drugs,
devices and procedures - averted only 176,633 deaths
during the same period.
That means "five times as many lives can be saved
by correcting the disparities [in care between whites
and blacks] than in developing new treatments," Steven
H. Woolf, lead author and director of research at
Virginia Commonwealth University's Department of
Family Medicine, said in a telephone interview.
Woolf and four co-authors compiled and examined
the data, which they drew from the National Center for
Health Statistics.
"We were trying to say that there was something
you could do in medical research to improve health
outcomes," said co-author David Satcher, former U.S.
Surgeon General and current director of the National
Center for Primary Care at the Morehouse School of
Medicine. "But if you didn't focus more on the
translation of that into especially the populations
that tended to be left behind . . .you were not going
to get as much out of the research as you would
otherwise."
Otis Brawley, medical director of the Georgia
Cancer Center for Excellence and professor of
hematology, oncology and epidemiology at Emory
University in Atlanta, said: "It's important [to note]
that this is not an argument against science. . . .
This is an argument that there are therapies out there
that are not new that people just don't get."
Reduced access to health care doesn't account for
all the racial disparity in preventable deaths. Blacks
have greater incidence of some diseases; some of this
greater morbidity results from education, income level
and environment as well as access to health care. The challenge, the authors said, is to deliver the same quality health care to everyone, despite these factors.
One of the Healthy People 2010 goals - the
nation's health priorities for the decade - is to
eliminate such inequities in health care. Satcher said
some steps, such as the creation of the National
Center on Minority Health and Health Disparities at
the National Institutes of Health, have already been
taken, but more needs to be done.
"Access to care is a big factor. African Americans
and Hispanics are much more likely to be uninsured and underinsured and underserved" and may not seek care as often as whites, Satcher said. "So a great part of it is really focusing on how do we get prevention programs, intervention programs [and] treatment programs to people in underserved communities?"
Shiraz I. Mishra, of the University of Maryland
School of Medicine's Comprehensive Center for Health Disparities, Research, Training and Outreach, agreed that more attention should be paid to addressing the causes of disparities. "Unless those issues are addressed, we will not be able to reduce disparities [between racial groups] in morbidity [illness] or mortality in the United States," he said. "Technological advances do have their place in our society; however, there are some things that are a little bit more basic."
The researchers used mortality rates, which
decreased by an average of about 0.7 percent per year
during the studied period, to estimate the number of
deaths that were prevented by improvements in the
"technology of care." For the purpose of the analysis,
they gave full credit for the decline in mortality to
these advances.
During that decade, age-adjusted mortality rates
for white men and women averaged 29 percent and 24
percent lower than those of African Americans. The
authors calculated how many deaths could have been
averted if the two groups' mortality rates were equal.
Woolf said that while the study is based on many
debatable assumptions - such as the possibility of
equalizing the death rates of whites and African
Americans - policymakers should not wait for further
research before taking steps to eliminate these
disparities. Even if further studies with more precise calculations find a different estimate of lives saved, they would be "unlikely to change the direction of our findings," the authors say in the analysis.
Winston Price, president of the Washington-based
National Medical Association (NMA), called the
findings "staggering" and said the study sheds new
light on a concern that has existed for decades. The
NMA, which calls itself "the collective voice of
physicians of African descent," recently launched the
W. Montague Cobb/NMA Health Policy Institute,
dedicated to eliminating racial disparities in health
care.
Policymakers, doctors, community activists and
other leaders need to "create an environment where the
data and the best practices are communicated to the
areas of need in a real-time sense, so communities
where health disparities are most rampant will not
need to wait . . . before interventions are brought"
to them, Price said.
That means developing outreach programs to educate residents about their options for health care, he said. Community leaders and doctors should go to beauty parlors, barber shops, faith-based organizations and community centers in underserved areas to tell people about best practices - such as taking medication to lower cholesterol and blood pressure, taking insulin to control diabetes and having testing done to detect heart disease, Price said.
But for this to happen, experts said, more funding
is needed for programs that seek to deliver
appropriate care to underserved groups. The study's
authors also noted this need. "The prudence of
investing billions [of dollars] in the development of
new drugs and technologies while investing only a
fraction of that amount in the correction of
disparities deserves reconsideration," the study says.
The authors write that their analysis has several limitations. It assumes that racial disparities could be eliminated quickly. "In real life, it would be a gradual approach" that would require a number of years," Woolf said. The research also looks at deaths averted by improving technology and eliminating disparities as mutually exclusive - but the two could be done simultaneously, the authors state.
Another limitation, according to the report, is
that the study focused only on mortality, but "racial disparities encompass morbidity [illness] and other domains." Mortality rates are also influenced by factors in addition to medical care, such as lifestyle and environment.
Other types of disparities - affecting other
racial groups and people disadvantaged because of
their social and economic backgrounds - are important
to investigate, too, the authors write.
"Socioeconomic conditions represent a more
pertinent cause of disparities than race," the study
states. "An intriguing question is whether more lives
are saved by medical advances or by resolving social
inequities in education and income."
Dying for Basic Care
For Blacks, Poor Health Care Access Cost 900,000
Lives
By January W. Payne
The Washington Post
Tuesday 21 December 2004
More than 886,000 deaths could have been prevented
from 1991 to 2000 if African Americans had received
the same care as whites, according to an analysis in
the December issue of the American Journal of Public
Health. The study estimates that technological
improvements in medicine - including better drugs,
devices and procedures - averted only 176,633 deaths
during the same period.
That means "five times as many lives can be saved
by correcting the disparities [in care between whites
and blacks] than in developing new treatments," Steven
H. Woolf, lead author and director of research at
Virginia Commonwealth University's Department of
Family Medicine, said in a telephone interview.
Woolf and four co-authors compiled and examined
the data, which they drew from the National Center for
Health Statistics.
"We were trying to say that there was something
you could do in medical research to improve health
outcomes," said co-author David Satcher, former U.S.
Surgeon General and current director of the National
Center for Primary Care at the Morehouse School of
Medicine. "But if you didn't focus more on the
translation of that into especially the populations
that tended to be left behind . . .you were not going
to get as much out of the research as you would
otherwise."
Otis Brawley, medical director of the Georgia
Cancer Center for Excellence and professor of
hematology, oncology and epidemiology at Emory
University in Atlanta, said: "It's important [to note]
that this is not an argument against science. . . .
This is an argument that there are therapies out there
that are not new that people just don't get."
Reduced access to health care doesn't account for
all the racial disparity in preventable deaths. Blacks
have greater incidence of some diseases; some of this
greater morbidity results from education, income level
and environment as well as access to health care. The challenge, the authors said, is to deliver the same quality health care to everyone, despite these factors.
One of the Healthy People 2010 goals - the
nation's health priorities for the decade - is to
eliminate such inequities in health care. Satcher said
some steps, such as the creation of the National
Center on Minority Health and Health Disparities at
the National Institutes of Health, have already been
taken, but more needs to be done.
"Access to care is a big factor. African Americans
and Hispanics are much more likely to be uninsured and underinsured and underserved" and may not seek care as often as whites, Satcher said. "So a great part of it is really focusing on how do we get prevention programs, intervention programs [and] treatment programs to people in underserved communities?"
Shiraz I. Mishra, of the University of Maryland
School of Medicine's Comprehensive Center for Health Disparities, Research, Training and Outreach, agreed that more attention should be paid to addressing the causes of disparities. "Unless those issues are addressed, we will not be able to reduce disparities [between racial groups] in morbidity [illness] or mortality in the United States," he said. "Technological advances do have their place in our society; however, there are some things that are a little bit more basic."
The researchers used mortality rates, which
decreased by an average of about 0.7 percent per year
during the studied period, to estimate the number of
deaths that were prevented by improvements in the
"technology of care." For the purpose of the analysis,
they gave full credit for the decline in mortality to
these advances.
During that decade, age-adjusted mortality rates
for white men and women averaged 29 percent and 24
percent lower than those of African Americans. The
authors calculated how many deaths could have been
averted if the two groups' mortality rates were equal.
Woolf said that while the study is based on many
debatable assumptions - such as the possibility of
equalizing the death rates of whites and African
Americans - policymakers should not wait for further
research before taking steps to eliminate these
disparities. Even if further studies with more precise calculations find a different estimate of lives saved, they would be "unlikely to change the direction of our findings," the authors say in the analysis.
Winston Price, president of the Washington-based
National Medical Association (NMA), called the
findings "staggering" and said the study sheds new
light on a concern that has existed for decades. The
NMA, which calls itself "the collective voice of
physicians of African descent," recently launched the
W. Montague Cobb/NMA Health Policy Institute,
dedicated to eliminating racial disparities in health
care.
Policymakers, doctors, community activists and
other leaders need to "create an environment where the
data and the best practices are communicated to the
areas of need in a real-time sense, so communities
where health disparities are most rampant will not
need to wait . . . before interventions are brought"
to them, Price said.
That means developing outreach programs to educate residents about their options for health care, he said. Community leaders and doctors should go to beauty parlors, barber shops, faith-based organizations and community centers in underserved areas to tell people about best practices - such as taking medication to lower cholesterol and blood pressure, taking insulin to control diabetes and having testing done to detect heart disease, Price said.
But for this to happen, experts said, more funding
is needed for programs that seek to deliver
appropriate care to underserved groups. The study's
authors also noted this need. "The prudence of
investing billions [of dollars] in the development of
new drugs and technologies while investing only a
fraction of that amount in the correction of
disparities deserves reconsideration," the study says.
The authors write that their analysis has several limitations. It assumes that racial disparities could be eliminated quickly. "In real life, it would be a gradual approach" that would require a number of years," Woolf said. The research also looks at deaths averted by improving technology and eliminating disparities as mutually exclusive - but the two could be done simultaneously, the authors state.
Another limitation, according to the report, is
that the study focused only on mortality, but "racial disparities encompass morbidity [illness] and other domains." Mortality rates are also influenced by factors in addition to medical care, such as lifestyle and environment.
Other types of disparities - affecting other
racial groups and people disadvantaged because of
their social and economic backgrounds - are important
to investigate, too, the authors write.
"Socioeconomic conditions represent a more
pertinent cause of disparities than race," the study
states. "An intriguing question is whether more lives
are saved by medical advances or by resolving social
inequities in education and income."
