[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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