[Congressional Record Volume 148, Number 51 (Tuesday, April 30, 2002)]
[House]
[Pages H1716-H1722]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ESTABLISHING A NATIONAL MINORITY HEALTH AND HEALTH DISPARITIES MONTH
Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and agree to
the concurrent resolution (H. Con. Res. 388) expressing the sense of
the Congress that there should be established a National Minority
Health and Health Disparities Month, and for other purposes.
The Clerk read as follows:
H. Con. Res. 388
Whereas in 2000, the Surgeon General of the Public Health
Service announced as a goal the elimination by 2010 of health
disparities experienced by racial and ethnic minorities in
health access and outcome in 6 areas: infant mortality,
cancer screening, cardiovascular disease, diabetes, acquired
immunodeficiency syndrome and human immunodeficiency virus
infection, and immunizations;
Whereas despite notable progress in the overall health of
the Nation there are continuing health disparities in the
burden of illness and death experienced by African-Americans,
Hispanics, Native Americans, Alaska Natives, Asians, and
Pacific Islanders, compared to the United States population
as a whole;
Whereas minorities are more likely to die from cancer,
cardiovascular disease, stroke, chemical dependency,
diabetes, infant mortality, violence, and, in recent years,
acquired immunodeficiency syndrome;
Whereas there is a national need for scientists in the
fields of biomedical, clinical, behavioral, and health
services research to focus on how best to eliminate health
disparities;
Whereas individuals such as underrepresented minorities and
women in the workforce enable society to address its diverse
needs; and
Whereas behavioral and social sciences research has
increased awareness and understanding of factors associated
with health care utilization and access, patient attitudes
toward health services, and risk and protective behaviors
that affect health and illness, and these factors have the
potential to be modified to help close the health disparities
gap among ethnic minority populations: Now, therefore, be it
Resolved by the House of Representatives (the Senate
concurring), That it is the sense of the Congress that--
(1) a National Minority Health and Health Disparities Month
should be established to promote educational efforts on the
health problems currently facing minorities and other health
disparity populations;
(2) the Secretary of Health and Human services should, as
authorized by the Minority Health and Health Disparities
Research and Education Act of 2000, present public service
announcements on health promotion and disease prevention
among minorities and other health disparity populations in
the United States and educate the public and health care
professionals about health disparities;
(3) the President should issue a proclamation recognizing
the immediate need to reduce health disparities in the United
States and encouraging all health organizations and Americans
to conduct appropriate programs and activities to promote
healthfulness in minority and other health disparity
communities;
(4) Federal, State, and local governments should work in
concert with the private and nonprofit sector to emphasize
the recruitment and retention of qualified individuals from
racial, ethnic, and gender groups that are currently
underrepresented in health care professions;
(5) the Agency for Healthcare Research and Quality should
continue to collect and report data on health care access and
utilization on patients by race, ethnicity, socioeconomic
status, and where possible, primary language, as authorized
by the Minority Health and Health Disparities Research and
Education Act of 2000, to monitor the Nation's progress
toward the elimination of health care disparities; and
(6) the information gained from research about factors
associated with health care utilization and access, patient
attitudes toward health services, and risk and protective
behaviors that affect health and illness, should be
disseminated to all health care professionals so that they
may better communicate with all patients, regardless of race
or ethnicity, without bias or prejudice.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each
will control 20 minutes.
The Chair recognizes the gentleman from Florida (Mr. Bilirakis).
[[Page H1717]]
General Leave
Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks and include extraneous material on H. Con. Res. 388.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, today I rise in support of H. Con. Res. 388. Thanks to
numerous medical advances, Americans are healthier than they have ever
been before.
Unfortunately, not all Americans have equally shared in this
progress. During the 106th Congress, the Committee on Commerce,
Subcommittee on Health and Environment, which I chaired, reviewed the
health disparities that persist between minority groups and the non-
Hispanic white population. Hepatitis C, heart disease, diabetes, lupus,
lung cancer and cervical cancer are but a few of the diseases that
disproportionately affect minorities in this country.
Congress took an important step forward in addressing health
disparities when it passed the Minority Health and Health Disparities
Research and Education Act of 2000 late in the 106th Congress. This
important legislation created a new National Center on Minority Health
and Health Disparities which coordinates biomedical and behavioral
research on these issues at the National Institutes of Health. I was
pleased to move this legislation through my subcommittee and support it
on the House floor.
Among other things, the resolution we are considering today would
call for the establishment of a National Minority Health and Health
Disparities Month to focus educational efforts on the health problems
disproportionately affecting minorities. It also calls on the Secretary
of Health and Human Services to develop public service announcements on
health promotion and disease prevention. Finally, H. Con. Res. 388
calls for dissemination of information that would help health care
professionals communicate in a culturally sensitive manner with all of
their patients.
Raising awareness of existing health disparities is necessary to
improving the overall health and well-being of the American people. Mr.
Speaker, I urge my colleagues to support H. Con. Res. 388.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
I rise in support of the Christensen resolution. Our values and
success as a Nation are a function of multiple races, multiple
ethnicities and multiple cultures. The Nation's health care system, our
medical research, our medical education and our medical care, should
reflect that fact, but we have major work to do.
Minority populations have higher rates of cancer, higher rates of
heart disease, especially higher rates of diabetes, higher rates of
HIV/AIDS. Minorities have shorter life expectancies, higher infant
mortality rates and a high, much too high, incidence of premature
death. Minorities are less likely in this health care system to receive
cancer screening and monitoring. Minorities are less likely to receive
childhood and adult vaccinations.
Unless we initiate changes explicitly aimed at reducing disparities
in health and health care, those disparities will persist. This
resolution is a good start. Among other things, it would encourage the
establishment of the Minority Health and Health Disparities Month. It
asks the Secretary to deliver public service announcements on health
promotion and disease prevention among minorities. It encourages
governments to work with the private sector to recruit and to retain
qualified individuals from racial and ethnic and gender groups
underrepresented in health care professions.
Mr. Speaker, I want to thank the gentlewoman from the Virgin Islands
(Mrs. Christensen) for sponsoring this resolution. I urge my colleagues
to support it.
Mr. Speaker, I reserve the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I am pleased to yield such time as he may
consume to the gentleman from Oklahoma (Mr. Watts), one of our
Republican leaders who has been so very much involved in this
legislation but also the legislation we passed in the last Congress.
Mr. WATTS of Oklahoma. Mr. Speaker, I appreciate the gentleman from
Florida (Mr. Bilirakis) yielding me the time.
Mr. Speaker, I rise to support and increase the awareness of a very
serious problem in our Nation today. Despite so much progress in the
field of medicine, there is a significant discrepancy in the health of
ethnic minorities compared to the rest of our American population. The
silent reality should spur more than indignation. The facts and
statistics that make up this crisis must be a wake-up call to all of
us, regardless of the color of our skin.
The resolution before the House today aims to raise the level of
awareness to the disparity of health care concerning members of
minority communities. It calls for a dedicated month of minority health
care recognition, urges the Secretary of Health and Human Services to
develop public service announcements on health promotion and disease
prevention among minorities, requests the President to issue a
proclamation on minority health care, and encourages better use of data
and statistics in order to help eliminate health disparities.
Hispanics, black Americans, Indians and other members of racial
minorities have had higher levels of cancer, cardiovascular disease,
stroke, diabetes and infant mortality. This is more than a misfortune.
It is a systemic emergency that we must view as a call to action.
Hippocrates recognized the importance of quality health care over
2400 years ago when he said, ``A wise man should consider that health
is the greatest of human blessings.'' Let us make sure that all
Americans have access to the care they need to sustain a healthy life.
I thank the gentlewoman from the Virgin Islands (Mrs. Christensen)
for sponsoring this resolution with me, and I urge my colleagues to
support our legislation to increase the level of attention America pays
to minority health disparities. With a heightened level of awareness,
we can make our country a healthier Nation and better the lives of all
her citizens.
Mr. BROWN of Ohio. Mr. Speaker, I yield 5 minutes to the gentlewoman
from the Virgin Islands (Mrs. Christensen) who is the sponsor of this
resolution.
(Mrs. Christensen asked and was given permission to revise and extend
her remarks.)
Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman from Ohio (Mr.
Brown) for yielding me the time.
I am pleased to rise in support of H. Con. Res. 388, expressing the
sense of Congress that there should be established a National Minority
Health and Disparities Month, and I want to begin by expressing my
gratitude to my cosponsors of the resolution, my colleagues, Chairman
of the House Republican Conference, the gentleman from Oklahoma (Mr.
Watts), and chairman of the Subcommittee on Workforce Protections of
the Committee on Education and the Workforce, the gentleman from
Georgia (Mr. Norwood) for their willingness to join me in putting this
important resolution forward.
I also want to thank the gentleman from Florida (Mr. Bilirakis) and
the gentleman from Ohio (Mr. Brown) for their support in making it
possible to bring this resolution to the floor of the House today.
Mr. Speaker, pick any minority community across our great Nation or
any of our Nation's rural areas and the reports will be the same.
Minorities and people living in those rural areas, of all races and
ethnicities, are dying of preventable diseases in alarmingly excessive
numbers. Heart disease, hypertension, HIV/AIDS, cancer, diabetes,
stroke and kidney disease predominate as the leading causes of death in
these groups in far greater numbers than that of white suburban or
urban America.
In addition, substance abuse and diminished mental health continue to
take a staggering toll on many individuals in this group and undermine
the well-being of our communities.
This resolution in establishing a special month of focus on this
national
[[Page H1718]]
tragedy will hopefully forge a national resolve to close these gaps
through increasing the awareness that gross disparities in health care
continue to exist for people of color and those in our rural areas,
which disrupt families, damage community and threaten our national
security.
1645
While this resolution is only a beginning, I am pleased and honored
to have had a role in bringing it to the floor today, because the
existence and the impact of the centuries of disparities in health is a
dark blot on this country's legacy, and it must be erased.
Achieving this important goal will not only take a strong and
unwavering commitment, but also a significant investment, which would
yield immeasurable dividends in terms of the health of our constituents
and our Nation. To do otherwise would result in dire consequences of
monumental and far-reaching threats, not only to the financial
stability of this Nation, but also to our collective productivity,
global competitiveness, and our defense capacity. These are risks we
cannot afford and must not take.
While health is influenced by only three factors, genetics,
environment and behavior, it is my belief that there has been too much
focus on the behavior as individuals and not enough on the behavior of
institutions that are supposed to serve us and the system that is
supposed to provide us with health care. Just this past spring,
following on three other important reports, failure to collect needed
health data by race and ethnicity by Summit Health, a health care
quality survey by the Commonwealth Fund, and another on language
interpretation in health care settings by the National Health Law
Program, the Institutes of Medicine, following on those, released a
hard-hitting eye-opening report entitled Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care.
Mr. Speaker, I am grateful for the opportunity that H. Con. Res. 388
provides to highlight the disparities in health care experienced by
racial and ethnic minorities in our country and in our rural
communities. The importance of such a month cannot be overestimated.
Again, I want to thank my colleagues for their cosponsorship and
support, and I urge everyone to support its passage and hope in doing
so it will serve as a catalyst to recommit all of us to the creation of
a health care system in this country where there are disparities for
none and equity in access for all.
Mr. Speaker, I am pleased to rise in support of H. Con. Res. 388,
expressing the sense of Congress that there should be established a
national Minority Health and Health Disparities Month.
I want to begin by expressing my gratitude to my cosponsors of the
resolution, my colleagues, the Chairman of the House Republican
Conference, JC Watts and the Chairman of the Workforce Protections
Subcommittee of the Education and the Workforce Committee, Charlie
Norwood, for their willingness to join me in putting this important
resolution forward.
I also want to thank the Chairman and Ranking Member of the Energy
and Commerce Committee for their support in making it possible for the
resolution to be on the floor of the House today.
Mr. Speaker, pick any minority community across our great country,
whether it be California or Virginia, New York or Texas, the U.S.
Virgin Islands or Illinois or any of our nation's rural areas and the
reports will all be the same: Minorities and people living in our rural
areas, of all races and ethnicities, are dying of preventable diseases
in alarmingly excessive numbers. Heart disease, hypertension, HIV/AIDS,
cancer, diabetes, stroke and kidney disease predominate as the leading
causes on the death certificates these groups in far greater numbers
than that of white suburban or urban America.
In addition, substance abuse and diminished mental health continue to
take a staggering toll on many individuals in this group, and undermine
the well-being of our communities.
This resolution in establishing a special month of focus on this
national tragedy, will hopefully forge a national resolve to close
these gaps through increasing the awareness that gross disparities in
health care continue to exist for people of color and those in our
rural areas, which disrupt families damage communities and threaten our
national security.
While this resolution is only a beginning, I am pleased and honored
to have had a role in bringing it to the floor today, because the
existence and impact of the centuries of disparities in health is a
dark blot on this country's legacy, and must be erased.
Achieving this important goal will not only take strong, and
unwavering commitment, but also a significant investment, which would
yield immeasurable dividends, in terms of the health of our
constituents and of our nation. To do otherwise would result in dire
consequences of monumental and far reaching threats not only to the
financial stability of this nation, but also to our collective
productivity, global competitiveness, and our defense capacity--Risks
we cannot afford and must not take.
Let me share some statistics, but let us never forget that each
number represents a real person, who is a part of a real and living
family and a community that needs him to her to be a part;
Around 40 million Americans have no health insurance of which 50% are
minorities.
Rural populations which are disproportionately poor, uninsured and
underserved compared to urban populations, and whose residents are
often eligible but unenrolled in publicly sponsored programs are also
at particular risk.
This lack of coverage alone, results in 83,000 deaths every year.
HIV/AIDS has become primarily a disease and epidemic of communities
of color: In 2002 the rate of reported AIDS cases among African
Americans was 8 times the rate for whites and 2 times the rate for
Hispanics, which was about three times that of whites.
All minorities except Alaska Natives have a prevalence of type 2
diabetes that is 2 to 6 times greater than that of the white
population.
Native American elders are 173% more likely to experience diabetes
than the general population;
African Americans and other people of color are likely to seek care
later and die in greater numbers from cancer.
This is particularly true for African Americans, whose men, for
example, are 2 to 3 times as likely to die of prostate cancer as white
men.
According to the national Kidney Foundation, African Americans, Asian
and Pacific Islanders and Hispanics are three-times more likely to
suffer from end-stage renal disease--complete failure of the kidneys to
function--than whites.
In my own district, the U.S. Virgin Islands, we have the highest
adjusted mortality rate for circulatory disease (namely heart disease
and hypertension) in the Americas.
Our nation's poor, who are more likely to be rural or of color are
more likely to be living with mental illness, and be untreated.
These are just a few of many areas where disparities are rampant.
Why is this so? One leading health expert at the National Institutes
of Health has repeatedly pointed out that health or lack of it is
influenced by three factors, behavior, genetics and environment.
While there is much in the news today about the role of genetics in
the diseases that we all face, the evidence is that it plays only a
small part.
Today, we are learning more about the relationship between health and
the environment, which requires more attention as we can directly seek
redress of those issues. And while some point to the fact that many of
us in communities of color wait too long to seek treatment, eat the
wrong foods, don't exercise or that we continue to smoke or engage in
high risk behavior, there are other significant factors, which continue
to lead to early death in our families which until now have largely
been ignored.
It is my belief that there has been too much focus on our behavior as
individuals and as a community and not enough focus on the behavior of
the institutions that are supposed to help to serve us, and the system
that is supposed to provide us with healthcare.
Just this last spring, following on three other important reports, on
failure to collect needed health data by race and ethnicity by SHIRE,
and a Health Care quality survey by the Commonwealth Fund, and one on
the need for language interpretation in health care settings by the
National Health Law Program, the Institutes of Medicine at the National
Academy of Sciences released a hard hitting, eye opening report
entitled; Unequal Treatment: Confronting Racial and Ethnic Disparities
in Healthcare.
Mr. Speaker, I ask to submit testimony and summaries of these reports
and one from the Kaiser Family foundation, which expand on these issues
into my statement, into the record.
In this review of all current research and reports on health care
delivery in this country tells an ugly story of health care deferred
and denied simply because of race, ethnicity and language.
Mr. Speaker, I am greatful for the opportunity that H. Con. Res. 388
provides to highlight the disparities in health care experienced by
racial and ethnic minorities in our country.
[[Page H1719]]
The importance of such a month and the need to have one is
underscored by the reminder just today at a briefing on the hill from
Dr. Brian Smedley of the Institute of Medicine that the issue of
disparities is one of life and death, and testimony from Dr. Marsha
Lillie Blanton, Vice President for Health Policy of the Henry J. Kaiser
Family Foundation at our recent hearing, who stated in a representative
survey sample, that most Americans, including people of color did not
know that Blacks generally fare worse than whites in terms of infant
mortality or that Latinos are less likely than Whites to have health
insurance as well as other important facts about health disparities. To
further aggravate an already bad condition, some of the same
misperceptions are shared by health care providers.
Again I want to thank my colleagues for their cosponsorship and
support.
I urge my colleagues to support its passage and hope that in so doing
it will serve as the catalyst to recommit all of us to the creation of
a health care system where there are disparities for none and equity in
access for all.
Mr. Speaker, I submit the summary report I referred to earlier for
the Record.
Eliminating Racial/Ethnic Disparities in Medical Care: Progress and
Challenges
Marsha Lillie-Blanton, DrPh, Vice-President, Health Policy, The Henry
J. Kaiser Family foundation, for Hearing on the Status and Progress of
the Department of Health and Human Services Initiative to Eliminate
Racial and Ethnic Health disparities
The Congressional Black Caucus, The Congressional Hispanic Caucus, and
the Congressional Asian Pacific American Caucus
April 12, 2002
Good morning. First, I'd like to thank the members of the
Congressional Black Caucus (CBC), the Congressional Hispanic
Caucus (CHC), and the Congressional Asian Pacific American
Caucus (CAPAC) for holding today's hearing on the status and
progress of the Department of Health and Human Services'
initiative to eliminate racial and ethnic health disparities.
I am Marsha Lillie-Blanton, a vice-president of the Henry J.
Kaiser Family Foundation and director of the Foundation's
work on access to care for vulnerable populations.
The recently released IOM report, Unequal Treatment, has
helped to refocus the nation's attention on racial and ethnic
disparities in medical care. The problem is by no means new,
but seldom gets priority attention in public policy
discussions around the health care system. Few would disagree
that for most of this nation's history, race has been a major
factor in determining if and where medical care was obtained;
however, its influence today has become more subtle. Public
policy efforts, most notably the enactment of Medicaid and
Medicare and enforcement of the 1964 Civil Rights Act, have
made an enormous difference in reducing the health care
divides for some of this nation's most vulnerable
populations. So much progress has been achieved that many
tend to think that the problems that remain are
inconsequential.
The IOW report provides compelling evidence to the
contrary. After an extensive review of the research, IOM
concluded that there is a ``preponderance'' of evidence that
racial and ethnic disparities in medical care persist for a
number of health conditions and services, some of which may
contribute to the poorer health outcomes of people of color.
The findings are consistent with those of a comprehensive
review of the literature by Robert Mayberry and colleagues
from the Morehouse School of Medicine, undertaken about a
year ago with funding support from the Foundation.
While there are some who will question whether the racial/
ethnic differences in the studies cited by IOM are real or a
function of factors not well-measured, the IOM report should
help to shift the research focus from documenting disparities
to investigating their underlying causes and the impact of
interventions. Investigating the underlying causes will be a
challenge in large part because the influence of race on the
health care system is deeply intertwined with other forces--
especially economic and educational opportunities--that shape
life in America. Disentangling this web of interrelated
factors should be helpful in developing more targeted
interventions, but pursuing that research agenda need not
delay efforts to address those factors now known to create a
barrier in obtaining greater equity in access to quality
medical care.
As noted in the IOM report, many factors likely contribute
to racial/ethnic disparities in medical care, including
patient, provider, and health system related factors.
Differences in the extent of health insurance coverage (see
Figure 1) are perhaps the most widely recognized of factors,
other than health needs, that account for variations in the
medical care obtained. The uninsured are less likely than
those who are insured to get appropriate care. However,
evidence of racial/ethnic differences among individuals who
are similarly insured is particularly disturbing since health
coverage is considered the ``great equalizer'' in the health
system. In a recent study by Johns Hopkins University
researchers Daumit and Powe, the racial disparity in cardiac
procedures among men and women was sharply reduced when
patients with chronic renal disease qualified for Medicare.
However, this study also found that even after enrolling in
Medicare, black men with chronic renal disease were less
likely to undergo invasive cardiac procedures than white men
who were of similar age, clinical characteristics, and other
socio-demographic factors (see Figure 2). This study provides
strong evidence that race--independent of other factors--is
associated with the medical care obtained.
Why such a challenging problem to address
Efforts to address racial inequalities throughout varying
sectors of society are challenging for many different
reasons, including the troubling history of race relations in
America. However, misperceptions about the nature and extent
of the problem in the health care system adds a new level of
complexity to efforts to eliminate health and health care
disparities. The battle we are waging is with perceptions, as
well as the reality of life in America. Two issues, in
particular deserve note.
First, the public has a marginal, at best, awareness of
racial/ethnic disparities in our health system. In a 1999
national survey of a representative sample of about 4,000
adults, we learned that most Americans, including people of
color, didn't know that blacks generally fare worse than
whites in terms of infant mortality, or that Latinos are less
likely than whites to have health insurance--two indicators
that have received considerable attention in the media.
The survey also found that a significant majority of
whites perceive that African Americans and Latinos get the
same quality of care as they do; however, the majority of
African Americans and Latinos perceive that they get lower
quality care than whites (see Figure 3). These findings
make it clear that the public's knowledge about
disparities should not be assumed and the challenge we
face is one of public perceptions as well as reality. Not
surprisingly, some of the misperceptions of the public are
also found among providers of care.
Second, there is a common perception that disparities in
medical care are largely a result of patient characteristics
(their financial resources, education, help-seeking behavior,
preferences for care). This perception persists despite an
abundance of studies that control for patient level
characteristics (e.g., as measured by income, education,
severity of health condition). There are fewer studies that
have assessed patient preferences for care, but some offer
insight on this issue. In a study of the quality of medical
care provided for congestive heart failure and pneumonia--two
common health problems in which the care is fairly low-tech
and thus assumed to be influenced less by patient choice--
Harvard University researchers, Ayanian and colleagues, found
that elderly black patients with Medicare received lower
quality care than whites based on defined clinical criteria.
Similar findings were observed for women relative to men. The
analysis adjusted for age, income, and hospital teaching
status and used the Rand appropriateness criteria to assess
health need.
Perceptions of a problem often influence the actions taken
(or not taken) to change policy and practices. If the public
is unaware that a problem exists or misunderstands the nature
of the problem, it will be difficult to mount effective
efforts to address that problem. Societal change requires a
public understanding and willingness as well as the resources
to address the problem.
Strengthening the Federal response
In 1999, the U.S. Department of Health and Human Services
(DHHS), under the leadership of former Surgeon General, Dr.
David Satcher, took a bold step in announcing a national
initiative to eliminate health disparities in six health
areas by 2010. The Congress provided important leadership to
this effort by legislatively mandating the IOM study of
health care disparities, creating in statute a Center on
Minority Health and Health Disparities at the National
Institutes on Health (NIH), and requiring DHHS in 2003 to
annually produce a report on the nation's progress in
reducing health care disparities as a companion to the
National Healthcare Quality Report.
From the leadership of the former Surgeon General and the
Congress have come a number of DHHS agency-wide related
efforts, including the establishment of Healthy People 2010
goals that are the same for everyone, regardless of race/
ethnic identity. Also, DHHS agencies have developed strategic
plans for their efforts to eliminate disparities and have
funded new initiatives--both research and interventions--to
address disparities. Most relevant to eliminating health care
disparities are the nine centers of excellence grants of the
Agency of Healthcare Research and Quality (AHRQ), which are
financed through funds of AHRQ and NIH. These initiative also
have served as the catalyst for a number of foundation and
other private sector efforts to reduce disparities.
These efforts are an incredibly important start.
Government, however, can and should do more. The
interventions recommended by the IOM report are critical next
steps. Moreover, the DHHS initiative now appears to lack
visible senior leadership to direct and garner support for
the efforts underway in the various agencies. Such leadership
is essential for such a controversial initiative. To
strengthen the federal response the initiative also will
require, at the very least:
[[Page H1720]]
First, a strategic linking of the work to existing
Department efforts around improving the quality of medical
care and patient safety.
Initiatives on quality and patient safety have new dollars
and the attention of clinicians and policymakers. It would be
a missed opportunity if the medical care needs and concerns
of people of color are not well integrated into the plans for
research and new interventions in these areas. Also, efforts
regarding disparities appear to be competing for scare new
resources. The view that focused efforts need new resources
rather than an integration and allocation of some of the
existing resources will hamper the short-term progress that
can be achieved. This shift in direction will be no small
feat to accomplish since DHHS staff and funded projects
focused on quality issues and those focused on racial
disparities generally are moving on separate tracks
without much collaboration.
Second, an improvement of the information systems and the
data used to answer questions about the health and medical
care use of people of color.
DHHS has an important role to play in data collection and
analysis. One reason we know so little about the health of
Latinos, Asians, and Native Americans is that we simply have
not collected the data. Even most national surveys that now
over-sample African Americans and Latinos to produce reliable
estimates are unable to provide estimates for Asian ethnic
subgroups or Native Americans. Further complicating an
assessment of disparities is that many health plans serving
privately and publicly insured enrollees (whether in fee-for-
service or managed care arrangements) do not collect data on
the race and ethnicity of their patients. DHHS must encourage
the collection of data in the private sector and collect and
analyze the data on those who are publicly insured.
Third, a continuation of the Department's efforts to
improve the public's awareness that the nation continues to
be challenged in assuring that every American has timely
access to high-quality medical care.
DHHS, through its partnerships and conferences, has already
been engaged in efforts to promote dialogue and understanding
about disparities. These efforts are extremely important. The
Foundation, working in partnership with the medical
community, is about to launch an initiative to raise
physician awareness about racial disparities in medical care
and encourage physicians to review the evidence and engage in
a national dialogue about the issue. This is, at best, the
beginning of national dialogue among one segment of the
public--physicians. DHHS, working through respected and
trusted leadership, should continue to improve awareness of
disparities among the public generally. Whites need to be
more aware of the real-life circumstances that face people of
color. People of color need to be more aware of disparities
so they can be more proactive in seeking needed care. This
knowledge should result in greater acceptance of initiatives
to remedy disparities.
In closing, let me say that race clearly matters in our
health system, but so do many other factors--especially
insurance coverage. Attention should be given to assuring
that existing sources of coverage are not undermined.
Medicaid, for example, is an essential source of coverage for
about 1 in 5 non-elderly African Americans, Latinos, and
Native Americans. In addition, people of color are
disproportionately uninsured, and priority attention should
be given to efforts to eliminate the insurance gap. It is
also important to remember, however, that racial disparities
among persons who are insured are an indication that
expansions in coverage, though necessary, are not sufficient.
The IOM report provides a blueprint for comprehensive reform
to close the racial/ethnic divide in the health system.
Thank you for the opportunity to testify. I welcome any
questions.
Mr. BILIRAKIS. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. BROWN of Ohio. Mr. Speaker, I yield 4 minutes to the gentlewoman
from Texas (Ms. Eddie Bernice Johnson), Chair of the Congressional
Black Caucus, who also is a nurse.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, let me express my
appreciation for those who have helped to work on this resolution,
because it is one that hopefully will start the ball rolling in getting
some corrective action taken.
I stand before my colleagues today as a former health care
professional to share really disturbing news. Sadly, in the year 2002,
decades after the end of legal segregation, inequality based on race
and ethnicity exists within our health care system. African Americans
are 30 percent more likely to die of heart disease and cancer than
Anglo Americans. Hispanics are more likely to be diagnosed with a
chronic disease or a condition such as a heart attack, diabetes, or
cancer than Anglo Americans. Infant mortality rates are more than twice
as high for African Americans than Anglo Americans. In 2000, 47 percent
of all HIV/AIDS cases reported in the U.S. were among African Americans
and 21 percent among Hispanics.
Unfortunately, the bad news gets worse. Despite this glaring data
revealing the health disparities between minorities and white
Americans, the National Academy of Sciences tells us that minorities
lag behind white Americans on nearly every measure of health care and
treatment and are dying at higher rates. Minorities are less likely to
be given appropriate cardiac medication or to undergo bypass surgery to
treat a cardiovascular disease. Minorities are less likely to be placed
on a waiting list for kidney transplants or to receive kidney dialysis
or transplants.
My father was one of those. Minorities with HIV infection are less
likely to receive antiretroviral therapy and other state-of-the-art
treatments which could forestall the onset of AIDS. And minorities are
less likely to receive appropriate cancer diagnostic tests and
treatment.
There is really more bad news. Significantly, these disparities in
treatment exist even when insurance status, income, age, and severity
of conditions in minorities and whites are the same.
The good news is that we can address this problem by educating the
public and the medical community about these disparities and take
action to reduce them. House Concurrent Resolution 388 is a step in the
right direction.
I agree with the gentleman, the chairman of the committee, it should
not be a campaign issue. It is a serious issue that must be addressed.
It would establish a National Minority Health and Health Disparities
Month and calls for the government, private and nonprofit sectors, and
the medical community to promote educational efforts, perform research,
and conduct health care programs so that we may end health care
disparities.
I urge my colleagues to support this resolution and work toward the
elimination of racial and ethnic disparities in health care so that we
can have some good news to share in the future.
Mr. BILIRAKIS. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman
from the District of Columbia (Ms. Norton).
Ms. NORTON. Mr. Speaker, I thank the gentleman for yielding me this
time, and I want to congratulate the gentlewoman from the Virgin
Islands (Mrs. Christensen) for her continuing work as chair of the CBC
Brain Trust and for bringing her practice of medicine, which she had to
leave in order to become a Member of the House, right into this House
in the way in which she fastens our attention on health care, and
particularly for improved health care for minorities.
But I have to say, Mr. Speaker, when they give you a whole month, it
is because of what you do not have. And what minorities in this country
do not have is health. And that is like saying what you do not have is
the difference between life and death.
The racial and ethnic disparities are quite intolerable. About 10
percent of whites in this country do not have health care; three times
as many Hispanics; twice as many blacks. The fact is minorities have to
do for themselves, because we know that a lot of health care is related
to life-style. And I am a strong proponent, for example, of harnessing
overweight and obesity. I am a race walker. You have to do what you can
do to deal with your health care. But obesity and overweight is a
national problem, and yet there are some folks who have some health
care to get them some advice as to what to do about it.
The current recession and the consequences of September 11 and
anthrax have simply exacerbated the health care crisis in our country.
And we are not close to closing this intolerable gap with placebos like
tax credits. Let me tell my colleagues something: Low-income people do
not pay a lot of taxes because they do not have a lot of money. So tax
credits, for example, is like throwing crumbs at people who are very
hungry.
But let me tell my colleagues something else. The American middle
class has a very sensitive barometer to health care. In the early
1990s, there were Members who lost their seats in this House and in the
Senate over the single issue of health care. And the reason is that
health care is always a
[[Page H1721]]
sleeper issue. And when we have the volatile mix of a recession and
people losing their health care, watch out, Congress of the United
States.
But we deserve to be called to account. The permanently uninsured are
unable to raise the issue because they are the least powerful people in
the society. It is only when there is a recession, when people who have
a little bit of clout, the middle class, who lose their health care,
that health care then rises to the top of the agenda. It is close to
being there now.
In the 1990s, we were kind of creeping up on universal health care,
going toward universal health care for children. And of course, there
is universal health care for the very poor. But what about the working
poor? What about the disincentive to go to work when you lose your
health care? What about saying to welfare mothers you better go to
work, and yet in the long run, lose your health care?
Poor health care in the United States has a disproportionately black
and brown face, and yet in countries where there are nothing but black
and brown faces, in many Third World countries, there is universal
health care. Hey, what happened to the United States of America?
Some minimum of health care is what everybody deserves simply for
being human. It is time we met that minimum standard in our own great
country.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may consume
to advise the gentlewoman that in our Committee on Energy and Commerce,
as the gentleman from Ohio (Mr. Brown) knows, just last week we marked
up a piece of welfare legislation which afforded transitional Medicaid
assistance for those people, with a recognition that of course the
words of the gentlewoman are so very true. And so, hopefully, we are
helping towards that.
Mr. Speaker, I continue to reserve the balance of my time, but also
make available to the gentleman from Ohio (Mr. Brown) any additional
time he may need for his speakers.
Mr. BROWN of Ohio. Mr. Speaker, I thank my friend for the generous
offer. We have a couple more speakers. We may not need that time.
Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr.
Davis).
Mr. DAVIS of Illinois. Mr. Speaker, I want to thank the gentleman for
yielding me this time, and I also want to commend the gentlewoman from
the Virgin Islands for her outstanding work on this issue and commend
all of these who have been instrumental in bringing this matter to the
floor.
I rise in enthusiastic support of H. Con. Res. 388, which expresses
the sense of Congress that there should be established a National
Minority Health and Health Disparities Month. Dr. W.E.B. Dubois
suggested that the problem of the 20th Century would be that of the
color line. Dr. Dubois was profound and prophetic in his analysis, but
we still have not solved the problem of the color line in the 21st
century and it is vivid in our health care delivery system.
The persistent problem of health disparities continues to be the
reality; that there is serious separation in this Nation. I stand here
today to suggest that as long as health disparities persist, we will
remain a Nation divided; divided along the lines of those who have and
those who have not.
According to the report that we have been discussing, issued by the
Institute of Medicine last month, racial and ethnic minorities
experience a lower quality of health services and are less likely to
receive even routine medical procedures than whites. The report goes on
to suggest that when it comes to diagnostic exams for heart disease,
cancer, end-stage renal disease, and kidney transplantation, African
Americans and other minority groups receive less care than whites.
This report suggests that African Americans and other racial
minorities die early and often because of a lack of quality care. The
report, which is extensive, entitled ``Unequal Treatment,'' really
underscores the need to establish a National Minority Health and
Disparities Month, a month that is set aside so that we can refocus,
take a hard look, better understand, better realize the disparities,
and then find the resources that are necessary to move us from the
position of inequities to equality, to equal treatment, equal
understanding, and equal recognition.
So again, I commend all of those who have been instrumental. I
commend the chairman, the gentleman from Florida (Mr. Bilirakis), the
gentleman from Ohio (Mr. Brown), and certainly the gentlewoman from the
Virgin Islands (Mrs. Christensen) for all of their serious leadership
on these matters.
Mr. BILIRAKIS. Mr. Speaker, I continue to reserve the balance of my
time, but make available to the gentleman from Ohio (Mr. Brown) any
time he may need.
Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman
from Texas (Ms. Jackson-Lee).
{time} 1700
Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the ranking member,
the gentleman from Ohio (Mr. Brown), for his constant and persistent
leadership as it relates to health issues in general. I thank the
gentleman from Florida (Mr. Bilirakis) for his leadership, and I
acknowledge the gentlewoman from the Virgin Islands (Mrs. Christensen),
the gentleman from Oklahoma (Mr. Watts), and the gentleman from Georgia
(Mr. Norwood) for bringing this resolution to our attention.
Clearly this is a resolution that will speak loudly in its passage to
the American people. In my district, I am often spoken to by
constituents of their caring and concern about those individuals far
and wide that we have to address, such as the catastrophe in
Afghanistan, the crisis in Africa with HIV-AIDS; and at the same time,
they are clearly concerned with the home front.
This legislation deals with the importance of dealing with the
questions of minority health. With some 50 percent of the minority
community without insurance, with the impact on rural areas, with
African Americans and Hispanics being impacted in large numbers by HIV-
AIDS, and in particular with a study that was just recently issued that
suggested that even when minorities access health care, the difficulty
is that there is unequal treatment. There are determinations made as to
whether or not the individual that accessed the health care should be
treated long term for diabetes, should be given the opportunity for
triple or quadruple bypass and surgery. We have a crisis.
What we want to do with this resolution is focus on changing the
attitude. At the same time, let me acknowledge that I hope this
legislation will encourage the Bush administration to not repeal the
requirement of low-income children being tested for lead poisoning.
That would put thousands of our children in minority communities at
risk. My district happens to be a very multicultural district. It has
people from all walks of life; but one of the most crowded places in my
district is the Harris County Public Hospital system. It is because
people desire health care, and do not have the ability to access
private health coverage, so they are at our public hospital systems.
Those institutions need assistance from the Federal Government to
assist them in lead poisoning testing for our children. They need
assistance in making sure that Medicaid payments are being paid, and
making sure that if someone needs quadruple heart surgery, that they
can be referred out to our very fine institutions in the medical
center. The partnership is extremely important.
So this resolution is of utmost importance. I thank the members of
the Committee on Energy and Commerce, the Congressional Black Caucus
and the Hispanic Caucus Health Task Force, which the gentlewoman from
the Virgin Islands (Mrs. Christensen) and Congressman Rodriguez lead,
and I am a member of, and for the leadership behind educating both
Congress and the American public.
Finally, racial and ethnic minorities tend to receive lower-quality
health care than whites do, even when insurance status income, age, and
severity of conditions are comparable according to the National
Academies Institute of Health. Thousands of people suffer in America
that is why we must pass this legislation to create a responsive and
equal health system in America.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Maryland (Mr. Cummings).
[[Page H1722]]
Mr. BILIRAKIS. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman
from Maryland (Mr. Cummings).
Mr. CUMMINGS. Mr. Speaker, this afternoon I rise in support of H.
Con. Res. 388, a resolution to designate April as National Minority
Health and Health Disparities Month.
In 2000, the Department of Health and Human Services and the U.S.
Surgeon General established National Minority Health Month to promote
national health and disease prevention. The goal was to build a public-
private partnership, foster cultural competency among health care
providers, encourage health education and training, and expand the use
of state-of-the-art technology.
It is intended to be an inclusive initiative that addresses the
health needs of African Americans, Hispanics, Asians, Native Americans,
Pacific Islanders, Alaskan Natives and Native Hawaiians. Because the
month will be nationally recognized, it will serve to raise awareness
and reduce the problem of minority health disparity.
Mr. Speaker, a few weeks ago, the Congressional Black Caucus held its
annual Health Braintrust. This year's focus was on minority health
disparities. Testifying at the hearing from my district were Dr. Martha
N. Hill, Dean of the Johns Hopkins School of Nursing; Professor Thomas
E. Perez, who was the immediate past director of the Office on Civil
Rights at HHS; and Dr. Thomas LaVeist, Johns Hopkins University, and an
active health care researcher, including the role of race in health
care services.
Also testifying were the authors of the Institute of Medicine's
report, ``Unequal Treatment: Confronting Racial and Ethnic Disparities
in Health Care.'' The primary finding of this report publication,
``Unequal Treatment,'' states that due to disparities in health care
treatment, blacks and other minorities do not live as long as
Caucasians.
Why is that? Because according to the Institute of Medicine's
publication of ``Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care,'' even those of us who are fortunate enough
to have health insurance receive inferior medical care compared to our
caucasian counterparts, even when insurance coverages are the same.
I would like to cite some of the specific facts for the record, and I
think my colleagues might find them very, very disturbing.
African Americans were 1.5 times more likely to be denied managed
care authorization in an urban emergency room. For senior citizens,
African American patients were four times less likely than Caucasians
to receive needed coronary bypass surgery. Black male seniors were
nearly two times less likely to receive treatment for prostate cancer.
And this is incredible, but black seniors were 3.6 times more likely to
have lower limbs amputated due to diabetes. Think about it. Due to poor
health care, African Americans and other minorities do not live as long
as Caucasians. Blacks are 24 percent less likely to receive life-
preserving medications for HIV and AIDS; 20 percent of blacks and 33
percent of Hispanics lack health insurance. This is two and three times
greater than the rate for Caucasians. These disparities permeate in
minority communities.
For example, as a Social Security issue, blacks collect fewer
retirement benefits because we die earlier. I guess on the upside,
while we comprise about 12 percent of the United States population, we
collect about 23 percent of the Social Security disability benefits.
Think about it. This is not a Social Security issue; it is a health
issue.
Mr. Speaker, if there were equity in health care, African Americans
would be able to work longer and live longer. Think about it. The
economic impact of poor health care created for all Americans is
crucial.
Mr. Speaker, I urge all Members to vote in favor of this. I thank the
gentlewoman from the Virgin Islands (Mrs. Christensen), and I thank the
other side for their courtesy and kindness.
Mr. DINGELL. Mr. Speaker, I rise to voice my strong support for H.
Con. Res. 388, establishing a National Minority Health and Health
Disparities Month. This resolution has been crafted by my good friend
and colleague, Representative Christensen. The resolution was reported
unanimously by the Committee on Energy and Commerce last week.
Mr. Speaker, this resolution will help to keep our attention focused
on a disturbing fact of life. That fact is that people of color face
devastating disparities in research, quality, access, and other
measures of health care. Women are particularly hard hit, as reflected
in the statistics. The prestigious Institute of Medicine recently
published yet another study that shows we still have a long way to go
before we can say that all Americans share equally in the benefits of
modern medicine.
Mr. Speaker, I am pleased that this resolution specifically mentions
the Minority Health and Health Disparities Research and Education Act
of 2000. I was proud to join my colleagues, including Representatives
John Lewis and Jesse Jackson, Jr., in that effort. That bill recognized
that disparities exist throughout the development and delivery of
health care. It was a good step, but clearly much more needs to be
done. The entire health care system, from ``bench to bedside,'' needs
to be vigilant and to address disparities wherever and however they
occur.
I applaud Representative Christensen for bringing this resolution to
the floor. I urge my colleagues to support her work and to support
substantive efforts to eradicate health disparities in all programs
that come before this body.
Ms. WATERS. Mr. Speaker, I rise to support H. Con. Res. 388, which
would support the establishment of a National Minority Health and
Health Disparities Month. The United States is a nation with a health
system marked by its disparities. Too often, low-income Americans,
racial minorities and individuals who lack health insurance find that
quality health care is unavailable to them. At the request of Congress,
the Institute of Medicine released a report this year confirming the
existence of serious racial disparities in American health care.
Racial disparities in access to cancer screening contribute to higher
cancer death rates for minorities. Black and Hispanic women are less
likely to receive breast cancer screening with mammograms than white
women, and black and Hispanic men are more likely to be diagnosed with
more advanced forms of prostate cancer than white men. Last year, I
introduced H.R. 3336, The Cancer Testing, Education, Screening and
Treatment (Cancer TEST) Act, to provide cancer screening and treatment
services for minorities and low-income populations. This bill now has
49 cosponsors.
Racial minorities have been disproportionately impacted by the HIV-
AIDS epidemic. They now represent a majority of new AIDS cases and a
majority of Americans living with AIDS. I am circulating a letter to
the Chairman and Ranking Member of the House Subcommittee on Labor,
Health and Human Services and Education Appropriations to request an
appropriation of $540 million for the Minority AIDS Initiative in
fiscal year 2003. Ninety Members of Congress have agreed to sign my
letter.
Unfortunately, the problems in our nation's health system are only
getting worse. A survey of California employers by the Kaiser Family
Foundation shows that health insurance premiums increased by 9.9
percent in 2001. That is more than double California's 4.3 percent
inflation rate. Furthermore, Calpers, the State of California's
employee benefits system, plans to raise rates for its HMO premiums by
25 percent next year.
I urge my colleagues to vote in favor of H. Con. Res. 388 and support
legislation that will guarantee every man, woman and child in America
quality health care services, regardless of race, level of income or
place or employment. Quality health care should be for everyone.
Mr. BILIRAKIS. Mr. Speaker, I have no further requests for time, and
I yield back the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Whitfield). The question is on the
motion offered by the gentleman from Florida (Mr. Bilirakis) that the
House suspend the rules and agree to the concurrent resolution, H. Con.
Res. 388.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the concurrent resolution was
agreed to.
A motion to reconsider was laid on the table.
____________________