[Congressional Record Volume 146, Number 136 (Thursday, October 26, 2000)]
[Senate]
[Pages S11188-S11190]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH AND EDUCATION ACT OF
2000
Mr. BROWNBACK. Mr. President, I ask unanimous consent that the Health
Committee be discharged from further consideration of S. 1880, and the
Senate proceed to its immediate consideration.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 1880) to amend the Public Health Service Act to
improve the health of minority individuals.
There being no objection, the Senate proceeded to consider the bill.
Amendment No. 4349
Mr. BROWNBACK. Mr. President, Senator Frist has a substitute
amendment at the desk for himself and others.
The PRESIDING OFFICER. The clerk will report.
The clerk read as follows:
The Senator from Kansas (Mr. Brownback) for Mr. Frist, for
himself, Mr. Kennedy, Mr. Jeffords, Mr. Dodd, Mr. DeWine, Ms.
Mikulski, Mr. Enzi, Mr. Wellstone, Mr. Hutchinson, Mrs.
Murray, Ms. Collins, Mr. Akaka, Mr. Bond, Mr. Lautenberg, Mr.
[[Page S11189]]
Hatch, Mr. Cleland, and Mr. Sessions, proposes an amendment
numbered 4349.
The PRESIDING OFFICER. Without objection, reading of the amendment is
dispensed with.
(The text of the amendment is printed in today's Record under
``Amendments Submitted.'')
Mr. FRIST. Mr. President. Every day, through personal experience or
the news, we are reminded of the tremendous scientific advances that
have been made in medicine; but unfortunately, millions of Americans
still experience serious disparities in health outcomes as a result of
ethnicity, race, gender, or a lack of access to health care services.
Recent studies have demonstrated that minority populations, in
addition to having lower rates of health care access, exhibit poorer
health outcomes and may have higher rates of HIV/AIDS, diabetes, infant
mortality, death from cancer and heart disease, and other health
problems. For example, when compared to whites, the mortality rate for
prostate cancer is nearly twice that for black men; and while African
Americans make up only 13 percent of our nations's population, they
represented 49 percent of AIDS deaths in 1998. Further, compared to
whites, the prevalence of diabetes in Hispanic individuals is nearly
double. In my home state of Tennessee, African Americans have an infant
mortality rate nearly three times that of white Tennesseans, and
Tennessee's African Americans suffer from heart disease at one and a
half times that rate of whites and are twice as likely to suffer a
stroke.
The Jackson Sun recently published an investigative report, ``What's
Killing Us?: The Color of Death 10 Years Later,'' which analyzes health
data specific to West Tennessee. The report highlighted that,
``[African Americans] in West Tennessee die at a much higher rate--370
percent higher for hypertension for example--than whites with the same
diseases,'' and made it clear that we have failed to close the gap
between death rates for black and white citizens over the last ten
years. West Tennessee is a snapshot of what is happening around the
country, and the lessons apply broadly. The report provides key lessons
to improve health that are applicable to all Americans including the
need for targeted research, improved education and public awareness,
increased prevention measures, and better access to care.
However, health disparities are not limited to minority communities.
Medically underserved populations located in rural Appalachia, which
include significant portions of my home state of Tennessee, exhibit
health disparities consistent with minority populations. In rural
Appalachia, where only one doctor exists for every 1,025 patients,
white males between 35 and 64 are 19 percent more likely to die of
heart disease than their counterparts elsewhere in the country, and
white Appalachian women are 21 percent more likely to die of heart
disease. Moreover, barriers to care are undermining thee health of many
communities, including rural areas where poverty and the lack of a
health care infrastructure often inhibit the ability to prevent or
treat health care conditions.
In order to address the issue of health disparities, in June of this
year the National Institutes of Health (NIH) announced that it began
the administrative process to elevate the current NIH Office of
Research on Minority Health to a center. In July, I held a Public
Health Subcommittee hearing, ``Health Disparities: Bridging the Gap,''
to focus on how to address minority health disparities and what
measures we should take to improve minority health.
During this hearing, the Subcommittee examined health care
disparities among minorities, rural and underserved populations, and
women. Witnesses ranging from the Administration to experts
representing the minority and underserved communities testified that a
Center on Minority Health and Health Disparities is needed to focus
national attention on this unrelenting problem. My friend and fellow
Tennessean, Dr. John Maupin, President of Meharry Medical College of
Nashville, said it best when he testified that ``ethnic minority and
medically underserved populations continue to suffer disproportionately
from virtually every disease and we can no longer sit idly by without
addressing this national crisis.''
Today, I am pleased to introduce the Minority Health and Health
Disparities Research and Education Act of 2000, with Senators Kennedy
and Jeffords. The Minority Health and Health Disparities Research and
Education Act will expand research and education for the biomedical,
behavioral, economic, institutional, and environmental factors
contributing to health disparities in minority and medically
underserved populations.
This legislation establishes a National Center on Minority Health and
Health Disparities at NIH; a grant program through the new Center to
further biomedical and behavioral research, education, and training; an
endowment program to facilitate minority and other health disparities
research at centers of excellence; and an extramural loan repayment
program to train members of minority or other health disparities
populations as biomedical research professionals.
This bill also directs the Agency for Healthcare Research and Quality
(AHRQ) to conduct and support research to identify populations for
which there is a significant disparity in the quality, outcomes, cost,
or use of health care services or access, as well as the causes and
barriers to reducing health disparities. Additionally, AHRQ is able to
identify, test, and evaluate strategies for reducing or eliminating
health disparities; develop measures and tools for the assessment and
improvement of the outcomes, quality, and appropriateness of health
care services; and increase the number of researchers who are members
of health disparity populations, or the health services research
capacity of institutions that train such researchers.
Furthermore, this Act provides resources under the Health Resources
and Services Administration for research and demonstration projects for
the training and education of health professionals in reducing
disparities in health care outcomes. A national campaign to inform the
public and a plan for the dissemination of information and findings
under all Titles of the Act is also established under the bill.
Health disparities may be the result of many factors, including
limited access to prevention and treatment services, poverty and
socioeconomic factors, exposure to environmental toxins, and even
cultural factors. Turning our back on these disparities would be a
national failure. Every Tennessean and every American deserves the best
quality of health regardless of their race, ethnicity, sex, or where
they live. With the concerted efforts of those supporting this bill,
I'm certain that we can take the necessary steps to reverse our
nation's health disparities.
I am pleased that the Minority Health and Health Disparities Research
and Education Act is supported by Meharry Medical College in Nashville,
Tennessee; East Tennessee State University (ETSU) in Johnson City,
Tennessee; Morehouse School of Medicine in Atlanta, Georgia; and the
Association of Minority Health Professions Schools. Dr. Ronald Franks
of ETSU wrote of his support for this legislation because it identifies
``health populations as a priority in the nation's health agenda and
the recognition of the health disparities in the Appalachian region.''
Mr. President, I would like to express my gratitude to Dr. John
Maupin of Meharry Medical College, and Dr. Ronald Franks and Dr. Bruce
Behringer of East Tennessee State University for their dedication to
helping the minority and medically underserved populations in Tennessee
and for their counsel and assistance on this legislation. I would also
like to thank my colleagues for their work and dedication to this
issue, and I look forward to the enactment of the bill this year.
Mr. KENNEDY. Mr. President, I strongly support passage of the
Minority Health and Health Disparities Research and Education Act of
2000. I commend Senator Frist for his leadership on the issue of health
disparities in our minority and underserved communities. I also commend
the many Senators on both sides of the aisle who worked hard to ensure
that the principles of equal justice and opportunity apply to health
care. Health care
[[Page S11190]]
should be a basic right. With our current economic prosperity and the
extraordinary recent advances in medicine, we should be able to
guarantee that right to all Americans.
The extraordinary advances in health care in recent decades have not
been shared by all our citizens. Minority communities suffer
disproportionately from higher rates of death from cancer, stroke, and
heart disease, as well as from higher rates of HIV/AIDS, diabetes, and
other severe health problems. Africa American men who contract prostate
cancer are more than twice as likely to die from it as white men.
Vietnamese American women are five times more likely than white women
to contract cervical cancer. Hispanic women are twice as likely to
contract cervical cancer. Native Hawaiian men are 13 percent more
likely to contract lung cancer. Alaskan Native women are 72 percent
more likely to contract colon cancer and rectal cancer. In addition,
African Americans and Hispanic Americans are more likely to be
diagnosed with cancer after the disease has reached an advanced stage.
For African Americans, the result is a 35 percent higher death rate.
The reality of poverty clearly affects the nation's health. Nearly 20
million white Americans live below the poverty line and many live in
rural areas such as Appalachia, where 46 percent of counties are
designated as health professions shortage areas and high rates of
poverty contribute to health disparity outcomes. The lack of a health
care facilities or benefits often means poor health care and often a
poor prognosis for what might have been a preventable or curable
condition. In the Appalachia regions of Kentucky, Tennessee, and West
Virginia, the rates of the five top causes of death in the U.S. all
exceeded the national, average in 1997. Lack of availability and access
to health care for poor and underserved regions often goes hand in hand
with higher morbidity and mortality rates. Higher rates of heart
disease in white males between the ages of 35 and 64 and cervical
cancer in white females are also found in Appalachia. We must find
better answers to identify and overcome the barriers to care that lead
to dire outcomes in underserved communities.
While we have continued to make progress in the reduction of child
poverty, child mortality, teenage pregnancy, and juvenile violence, we
continue to see wide disparities by race and income, with communities
of color and those in poverty lagging behind others. Infant mortality
rate has declined nationally from 10.9 infant deaths for every 1,000
live births in 1983 to 7.2 in 1998. But among African Americans, the
rate is 13.7--more than twice the rate of any other group. In addition,
far too many people across this nation lack the health insurance that
is necessary for access to basic health care. Over one-third of
Hispanic Americans are uninsured, the highest rate among all ethnic
groups and two and a half time the rate of 14% for whites. Nearly one-
fourth of African Americans, and about one-fifth of Asian Americans are
also uninsured.
In Massachusetts, significant progress has been made in improving the
overall health status and access to health care. We are one of a
handful of states in the country to devote the tobacco settlement money
entirely to health care. Yet our significant commitment to health care
is not translating into equal access or improved health status for all
of our citizens. Health status differs by racial/ethnic group and by
income group and the differences are reflected in the alarming
discrepancy in mortality rates. The infant mortality rate for African-
Americans is 11.7--over twice as high as the overall statewide rate of
5.3.
The same pattern exists for the HIV/AIDS-related mortality rate,
which is more than six times greater for African-Americans and more
than four times greater for Hispanics. African American women are more
likely to lose their lives to breast cancer, and nearly six times a
many Asian-American women and nearly two times as many Hispanic women
have never taken a Pap test, which is essential in detection cervical
cancer. Clearly, too many citizens are not benefitting from the
advances made in science, medicine, and the economy.
The Minority Health and Health Disparities Research and Education Act
addresses the biomedical, behavioral, economic, institutional, and
environmental factors that have caused health disparities in
communities of color and in undeserved communities around our nation.
It provides needed resources for research, data collection, medical
education, and public awareness, in order to understand the root causes
of diseases and poor health outcomes and to develop strategies to meet
the health needs of these vulnerable communities. Each of these aspects
has an important role to play in the reduction and eventual elimination
of the unacceptable disparities that now exist.
Title I of the bill establishes a Center for Research on Minority
Health and Health Disparities at the National Institutes of Health. It
also provides resources to educational institutions to train minority
individuals as biomedical research professionals.
Title II focuses on identifying, evaluating, and disseminating
information on the factors that contribute to health disparities.
Title III addresses the critical need for trained and culturally
competent health care professionals by providing resources to develop
effective educational support.
Title IV enhances the collection of data on race and ethnicity to
determine what steps the federal government should take to ensure that
all necessary information is collected.
Title V provides funding for a public awareness and information
campaign to inform minority communities of the health conditions that
are affecting them disproportionately and of the programs and services
available to them.
Passage of the Minority Health and Health Disparities Research and
Education Act demonstrates our strong commitment a healthier future for
all our citizens. America has the resources to accomplish this goal and
I urge the Senate to achieve it.
Mr. BROWNBACK. Mr. President, I ask unanimous consent that the
amendment be agreed to, the bill be read a third time and passed, the
motion to reconsider be laid upon the table, and that any statements
relating to the bill be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 4349) was agreed to.
The bill (S. 1880), as amended, was passed.
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