[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.

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