In 1900, life expectancy in the United States was 47.6 years for whites and 33.0 years for non-whites (mainly blacks).1 By 1998, life expectancy had risen to 77.3 years for whites and 71.3 years for blacks.2 Clearly, advances in medical science, sanitation, nutrition, work place protections, clean air and water laws and ambitious, often innovative approaches to health care services have improved public health dramatically during the past century. Yet, despite decades of effort, successfully administered programs and advancements in civil rights, racial and ethnic health disparities persist.
The 1985 Report of the Secretary's Task Force on Black and Minority Health3 documented that, like blacks, other racial and ethnic populations in the United States experience poorer health status than whites. Statistics clearly show, and research documents, the greater burden of illness, disease and death experienced by racial and ethnic minorities in this country.4,5 Some of the disparities are as follows5
The infant mortality rate is 2.5 times higher in blacks than in whites. Blacks have a 40 percent higher heart disease rate and a nearly 30 percent higher cancer mortality rate. Blacks are also seven times more likely than whites to die of acquired immunodeficiency syndrome (AIDS).
The mortality rate for diabetes is twice as high in Hispanics as in whites. Rates of hypertension and obesity are also significantly higher. Although Hispanics constitute only 11 percent of the U.S. population, they account for 20 percent of reported tuberculosis cases.
American Indians and Alaskan Natives
The infant mortality rate in American Indians and Alaskan natives is almost double that in whites. Pima Indians living in Arizona have one of the highest rates of diabetes in the world. The average life expectancy for American Indians living in the Dakotas is 11 years lower than that for the rest of the U.S. population. Overall, the average life expectancy for American Indians and Alaskan natives is about six years lower than the life expectancy for white Americans.
Asians and Pacific Islanders
Vietnamese women develop cervical cancer at nearly five times the rate of white women. Compared with other groups, Asians have significantly higher rates of hepatitis B, hepatocellular carcinoma and stomach cancer.
The demographic changes that are anticipated in the United States over the next decade magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population, placing an undue burden on the health care system as a whole. Consequently, the future health of America will be influenced substantially by this country's success in improving the health status of its racial and ethnic minorities.
The U.S. Department of Health and Human Services (HHS) has made a commitment to eliminate disparities in health on the basis of race and ethnicity by the year 2010. Former President Bill Clinton announced this unprecedented initiative from the White House in February 1998. The HHS then began to focus on six key areas:
Breast and cervical cancer screening and management;
Cardiovascular disease risk factor reduction;
Adult and childhood immunizations; and
Human immunodeficiency virus (HIV) infection and AIDS.
These six health areas were selected because they reflect areas of disparity known to affect multiple racial and ethnic minority groups at all stages of life, and because they are areas in which the HHS could have a direct impact.
Family physicians are a critical component in the effort to eliminate racial and ethnic disparities in health. The specialty of family medicine exemplifies five principles that are paramount to this task: continuity of care; comprehensive care; coordinated care; care of the patient in the context of the family; and health care in the context of the community.
In 1996, 82 percent of Americans had a usual source of health care.6 Of those, 56 percent regarded an individual as that source, and of those, 62 percent identified a family physician, 16 percent an internist, 15 percent a pediatrician and 8 percent identified someone else. In 1997, there were 787 million visits to office-based physicians in the United States. Of these visits, 200 million were to family physicians or general practitioners, 121 million were to internists, 92 million were to pediatricians and 71 million were to obstetrician-gynecologists.
As of 1999, there were 476 family medicine residencies with 11,313 residents in training, and 55,000 family physicians who were board certified. Furthermore, the American Academy of Family Physicians (AAFP) had become the third largest professional organization for physicians.6
A national partnership is needed to develop a balanced community health system that promotes healthy lifestyles and behaviors. Private foundations and endowments, along with state governments, have realized that an unprecedented opportunity exists to influence and affect health in a way that is fundamentally fair and more inclusive of all Americans. Thus, they are engaging their colleagues to eliminate disparities in health by using leading health indicators to measure the progress of the nation's health promotion and disease prevention agenda, advocating for a balanced community health system and educating fellow physicians about racial and ethnic disparities in health care. Family physicians are in a position to advocate for positive change and to be an integral part of the solution.
One avenue of participation is implementation of Healthy People 2010, the nation's health promotion and disease prevention agenda for the first decade of the 21st century (http://www.health.gov/healthypeople).4,5 Healthy People 2010 is designed to achieve two overarching goals: (1) to increase the quality and years of healthy life and (2) to eliminate disparities in health.
In addition, leading health indicators have been chosen based on their ability to motivate action, the availability of data to measure their progress and their relevance as broad public health issues. These indicators illuminate individual behaviors, physical and social environmental factors, and health system issues that greatly affect the health of individuals and communities.
The vision of the AAFP is the creation of accessible and affordable health care dedicated to the health, dignity and well-being of all American people, founded on the principle that the family physician is the specialist of choice. The mission of the AAFP is to improve the health of patients, their families and the American people, to advance and represent the specialty of family physicians, and to serve the unique needs of members with professionalism and creativity. Thus, shouldn't the elimination of racial and ethnic disparities in health also be the AAFP's cause?