This Blog and Website will deal with and provide you with information regarding one of the most important problems facing an ever increasing percentage of this nations population, that of health disparities in racial minority populations. We will feature articles and information on the topics of health disparities and including the causes and potential solutions to eliminating health disparities. Health disparities in prostate cancer, diabetes, hypertension, heart disease, chronic kidney disease and kidney transplantation, lupus and other conditions, health & wellness, and minority men’s health, health literacy, cultural competency and health provider-patient communications will be covered.
Our goal also is to give other health providers practical information that will help them improve the patient experience and clinical outcomes of their minority patients. We believe that improved outcomes in racial minorities will result as physicians, other health providers, health systems, health insurers and policy makers become more aware of the health disparities confronting racial minorities and when they embrace, adopt and innovate unique and novel more efficacious ways in which to deliver personalized culturally competent health care to racial and ethnic minorities.
Background on Health Disparities
The percentage population of those considered as minorities in the United States is rapidly increasing. In 1970, all minorities (African American, Hispanic, Asian, and Native American) comprised 12.3% of the US population; now they account for 25%. These demographic changes
are predicted to continue. By 2050, minorities will become the majority with one in every two Americans being African American, Hispanic, Asian American, Pacific Islander, or Native American (1).
Despite the fact that innovations in medicine have resulted in reductions in death rates from cancer and coronary artery disease and have contributed to improving overall life-spans of Americans, not all segments of society have seen equal reductions in the incidence of disease and improvement in life spans, particularly minorities (2).
With the growing rates of minorities in the U.S. and the fact that minorities, in particular African Americans and Hispanics, suffer disproportionately from health disparities, the disproportionate incidence, burden of disease and poorer health outcomes contributing to lower life spans commonly seen in African Americans and Hispanics, denotes the urgency for physicians, other healthcare providers, health systems, and medical researchers, to increase their awareness of the existence and overall impact of health disparities in racial and ethnic minorities (as well as the overall impact of health disparities on the entire health system and U.S. economy) and to become better equipped to more effectively engage minorities and to deliver culturally competent medical care to improve outcomes in minority patients.
Increasingly, clinical observations and research into the various causes of health disparities reveal that more than poverty and lack of access to quality healthcare accounts for the striking health disparities observed in racial and ethnic minorities. Other social determinants of health and other factors contribute substantially to the health disparities observed in racial and ethnic minorities, such as culture (1), dietary preferences, health seeking behaviors often influenced by historical distrust of the doctors, researchers and the healthcare system, deficiencies in health literacy, poor communication between physicians and minority patients resulting from health provider deficiencies in cultural sensitivity and cultural competency, lack of minority participation in clinical research trials, along with genetic/hereditary and biological factors (3).
In recognition of the various contributing causes of health disparities in racial and ethnic minorities, the U.S. Department of Health & Human Services recently released Healthy People 2020, which is an extension of Healthy People 2000 and 2010, calling for health providers and health systems to design and devise more effective ways in which to eliminate health disparities afflicting racial and ethnic minorities (4). Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives along with high priority health issues and actions for improving the health of all Americans and includes high-priority health issues and actions that can be taken to address health disparities (4). The National Institutes of Health in 2010 formally established its National Institute of Health & Health Disparities which provides funding for researchers to study the pathogenesis of health disparities in racial and ethnic minorities (5).
Clinicians are increasingly becoming aware that a “one-size-fits-all-approach” to delivery of healthcare to all patients does not result in equal outcomes in minority populations, in many cases due to differential responses to and metabolism of medications. For example, research has shown that African Americans with hypertension are often times more effectively treated with calcium channel blockers as opposed to ACE inhibitors in Caucasian Americans (6). In the field of renal transplantation, to reduce the incidence of rejection, African Americans commonly require higher dosages of immunosuppression with Mycophenolate Mofatil and Tacrolimus than others. The recent approval by the FDA of BiDil to be used in self-identified African Americans for the treatment of congestive heart failure as a result of remarkably observed improved clinical outcomes in African Americans versus Caucasians, though controversial, is an example of the evolving area of medicine called Race-Based Medicine (7).
Despite the fact that there is no one clear definition as to what constitutes race, race in medicine, when used responsibly by clinicians who are culturally competent, and in the absence of wide-spread genetic testing, still has important implications in helping health providers select the most appropriate treatments for their patients, provides health systems and policy makers with the resolve to dedicate resources to engage, select and make available the most important preventive health screenings for individuals and mass populations most susceptible to developing certain diseases, and provides medical investigators with the charge to dedicate themselves to research into the discovery of novel innovative medications and therapies to improve health outcomes in minorities, which are an every growing percentage of the U.S. population.
Two such examples of our efforts at Cleveland Clinic to address unique health concerns and eliminate health disparities in African Americans and other minorities are our Minority Men’s Health Center, housed within the Cleveland Clinic Glickman Urological & Kidney Institute (8), which was established in 2003 and our newly established Multicultural Skin of Color Center of Excellence housed in the Cleveland Clinic Department of Dermatology.
1. Modlin, C. S. Culture, race, and disparities in health care. Cleveland Clinic Journal of Medicine: 70 (4), APRIL 2003: 283,287-288.
2. Centers for Disease Control and Prevention life expectancy data. http:// http://www.cdc.gov/nchs/fastats/lifexpec.htm. Access November 27, 2011.
3. Klein JB, Nguyen CT, Saffore L, Modlin C 3rd, Modlin CS Jr. Racial disparities in urologic health care. J Natl Med Assoc. 2010 Feb;102(2):108-17.
4. Healthy People 2020. HealthyPeople.Gov. http://www.healthypeople.gov/2020/LHI/Default.aspx. Accessed November 27, 2011.
5. NIH News. NIH announces Institute on Minority Health and Health Disparities. http://www.nih.gov/news/health/sep2010/nimhd-27.htm. Accessed November 27, 2011.
6. Rao, S, Cherukuri, M, Mayo, H. What is the best treatment for hypertension in African Americans? February 2007. The Journal of Family Practice:56, (2): 149-151.
7. Temple, R and Stockbridge, NL. BiDil for Heart Failure in Black Patients: The U.S. Food and Drug Administration Perspective. Annals of Internal Medicine. Annals of Internal Medicine January 2007: 146 (1): 56-62.
8. Cleveland Clinic Minority Men’s Health Center. http://www.ClevelandClinic.org/mmhc.