[Congressional Record Volume 150, Number 57 (Thursday, April 29, 2004)]
[Senate]
[Pages S4673-S4674]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NATIONAL MINORITY CANCER AWARENESS WEEK
Mr. DASCHLE. Mr. President, last week was National Minority Cancer
Awareness Week, an annual event for the past 18 years. Though we have
been monitoring disparities in cancer for nearly two decades, the gap
in some cancer mortalities has widened rather than narrowed.
One of the most important reasons for this disparity is poor access
to health care. People who do not get mammograms, colon exams, and Pap
tests on schedule are more likely to be diagnosed with cancer at a
later stage of the disease, when survival rates are lower. And why
don't they get these necessary tests on time? Members of racial and
ethnic minority groups are more likely to be poor, have lower education
levels, and less likely to have health coverage or a source of primary
care.
Recently, I told the story of a young Indian girl who was
misdiagnosed with heartburn at an under-funded Indian Health Service
clinic. It turned out that she really had stomach cancer that had
already spread and was, therefore, untreatable. I will remind you that
this is not some rare exception. For Native Americans and other
minority communities across the country, the miracles of modern
medicine--and sometimes even the most basic primary care--are beyond
their reach.
The disparities within our health care system have reached a crisis
point, and the consequences for America's minority communities are
staggering.
Overall, African Americans are more likely to develop cancer than
persons of any other racial or ethnic group.
Cervical cancer incidence in Hispanic women has been consistently
higher at all ages than for other women.
Only 52 percent of American Indian/Alaska Native women aged 40 years
and older have had a recent mammogram.
American Indians and Alaska Natives have the poorest survival rate
from all cancers combined when compared to other racial and ethnic
groups.
I am grateful that National Minority Cancer Awareness Week causes us
to reflect on these facts. America faces few more important or complex
challenges than building a world-class health care system for everyone,
regardless of race, income, or geography.
There are no quick fixes. The factors that have led to these
inequities in our health system are complex and interrelated.
Minorities are far less likely to have health insurance or a family
doctor, making regular preventive visits less likely. And many of those
who do have insurance report having little or no choice in where they
seek care.
Minority communities are more frequently exposed to environmental
risks, such as polluted industrial areas, cheap older housing with lead
paint, or asbestos-laden water pipes.
For Hispanics, Native Americans, and others who do not speak English
as a first language, the lack of translators and bilingual doctors
makes it more difficult to communicate with doctors and nurses.
The Native American community has been forced to cope with a system
suffering from decades of neglect and underfunding of the Indian Health
Service. The IHS has consistently grown at a far slower rate than the
rest of the HHS budget, and at only a fraction of health care
inflation.
America is obligated, by statute and by treaty, to provide health
care for American Indians--a commitment the U.S. Government made to the
Indian people in exchange for their lands. America is not honoring that
commitment. The White House's budget this year included only $2.1
billion for IHS clinical services. That is more than 60 percent below
the bare minimum needed to provide basic health care for people already
in the IHS system.
The problems run still deeper. Even when minorities and white
Americans have roughly the same insurance coverage, the same income,
the same age and the same health conditions, minorities receive less
aggressive and less effective care than whites.
The racial and ethnic disparities in our health care system are not
merely minority issues or health care issues. They are moral issues. A
health care system that provides lesser treatment for minorities
offends every American principle of justice and equality.
The Republican Leadership has promised to address these issues.
After seeing no action for almost a year, House and Senate Democrats,
led by the House Minority Caucuses, introduced the Healthcare Equality
and Accountability Act of 2003.
This legislation would reduce health disparities and improve the
quality of care for racial and ethnic minorities. There are several
elements of this bill that would specifically address minority cancer
rate reduction. I would like to highlight four particularly important
issues.
First, this bill will provide adequate funding for the Indian Health
Service--so that we can finally stop the shameful underfunding of
Indian health needs.
Second, it will provide funds to increase cancer prevention and
treatment programs. This includes the development of screening
guidelines for minority populations for chronic diseases, including
prostate, breast, and colon cancer.
Third, this bill will provide funding through the Health Research and
Services Administration, the Indian Health Service, and the National
Cancer Institute for patient navigators. Patient navigators work in
underserved communities to bring individuals into the health care
system sooner, so they can learn about preventing and detecting
diseases--especially cancer--before they become ill. Patient navigators
also help individuals overcome language and cultural barriers to
setting up appointments and understanding their doctors' instructions.
Patient navigators can also be important resources to individuals
living in rural areas, since they often have to travel outside their
communities to receive certain health services. The American Cancer
Society notes that ``Patient navigator programs offer a low-cost,
tangible fix in a part of our health care system that is broken, giving
hope to millions of medically underserved individuals, saving lives and
reducing health care costs.''
The last item I would like to highlight in this bill is the focus on
improved health literacy, the degree to which individuals can obtain,
process, and understand basic health information. The bill will provide
funds to support programs that remove language and cultural barriers.
Just two weeks ago, the Institute of Medicine released its report on
health literacy and recommended that ``Government and private funders
should support the development and use of culturally appropriate new
measures of health literacy.''
[[Page S4674]]
On that same day, the Agency for Healthcare Research and Quality
released findings that showed that individuals with low literacy--
lower-than-average reading skills--are less likely than other Americans
to get potentially life-savings screening tests such as mammograms and
Pap smears.
In addition, Secretary Thompson remarked that, ``We must ensure that
all Americans get the prevention and health information that they can
understand and use to keep themselves and their families healthy.'' He
pointed out, ``Health literacy can save lives, money, and improve the
health of millions of Americans.''
The Healthcare Equality and Accountability Act would move us closer
to the goal of ensuring equal access to quality health care.
Last year, the majority leader said, ``Inequity is a cancer than can
no longer be allowed to fester in health care.''
I agree. We know what happens when cancer is allowed to spread.
Too many Americans in minority communities have lost their lives
because they are not getting the care they need. We cannot afford to
wait any longer to confront the minority health gap in our country.
Americans are asking for our leadership on a challenge that is
quickly becoming a national emergency. We have an obligation to answer
their call.
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