[Congressional Record Volume 153, Number 65 (Monday, April 23, 2007)]
[House]
[Pages H3758-H3767]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


      HEALTH CARE ISSUES AFFECTING MINORITY COMMUNITIES IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentlewoman from California (Ms. Solis) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Ms. SOLIS. Mr. Speaker, I ask unanimous consent that all Members have 
5 legislative days within which to revise and extend their remarks on 
the subject of my special order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from California?
  There was no objection.
  Ms. SOLIS. Mr. Speaker, I thank the Speaker for the opportunity to 
serve as moderator for this special designated time for recognition 
under Special Orders for celebration of health care, and, in 
particular, the uninsured.
  Tonight I have several colleagues who will be joining me to speak on 
different topics with respect to health care issues affecting minority 
communities. Just to give you a brief summary of some of the topics we 
will touch on, obviously reauthorization of SCHIP, language access, 
obesity, diabetes, cancer, tobacco, HIV and AIDS, health professions, 
community health workers, environmental health and Medicaid 
citizenship.
  Mr. Speaker, tonight I rise to recognize National Minority Health 
Month. This week is Covering the Uninsured Week. Tonight you are going 
to hear from some of my colleagues representing the Congressional Black 
Caucus, the Congressional Hispanic Caucus and the Congressional Asian 
Pacific Islander Caucus and their efforts to improve health care in our 
communities.
  Did you know that life expectancy and overall health have improved in 
recent years for large numbers of Americans due to an increase in and 
focus on preventive medicine and new advances in medical technology? 
However, not all Americans are faring that well, particularly 
communities of color, which continue to suffer from significant 
disparities in overall rate of disease incidence, prevalence, 
morbidity, mortality and survival rates in the population, as compared 
to the health status of the general population.
  The National Minority Health Month was launched in an effort to 
eliminate health disparities and to improve health status of minority 
populations across the country. This month was created in response to 
Healthy People 2010, a set of comprehensive health objectives 
established by the U.S. Department of Health and Human Services. 
Disparities continue to persist, and we must eliminate health 
disparities by identifying significant opportunities to improve health 
care.
  There are disparities in the burden of illness and death experienced 
by African Americans, Hispanic Americans, Asian Americans, Pacific 
Islanders, and American Indian and Alaskan Natives as compared to the 
U.S. population as a whole.
  I am pleased to once again be working with my colleagues in the 
Congressional Black Caucus, the Hispanic Caucus, and the Congressional 
Asian Pacific Islander Caucus to develop a comprehensive tri-caucus 
health disparities bill. Our bill will address the importance of 
language access, health professions, training, data collection and 
health coverage for immigrants. Our colleagues in the Senate are also 
working on a disparities bill, and I hope that they too will pass 
legislation that will truly save the lives of millions of minorities. 
We must do more to better the health of our population, which includes 
all communities of color.
  With that, I want to just briefly touch on this issue of the 
uninsured. Today marks the start of the fifth year of Covering the 
Uninsured Week. Although the United States has one of the best health 
care systems in the world, not everyone has the means to access our 
health care system. The number of uninsured people affects us all and 
is a national problem that needs a national solution.
  We all know that lack of health insurance results in reduced access 
to care. Access can be defined as the ability to get to health 
services, receive service at the right time, and obtain the appropriate 
services necessary to promote the best health outcomes possible.
  Reduced access could mean that someone is less likely to have regular 
sources of care, less likely to receive preventive services and more 
likely to use emergency departments as primary sources of care. The 
long-term consequences of reduced access to care include lower quality 
of life, higher mortality rates and the decline of the population's 
overall health.
  Despite the growth of our economy, the number of uninsured persons 
continues to increase. In 2005, more than 44 million people were 
uninsured, and of that number, 14 million were Latinos.
  The cost of private health insurance continues to rise 
astronomically, and we hear that every single day when we go back home 
to our districts. Health insurance premiums continue to rise by double-
digit rates each year, and over 80 percent of the uninsured come from 
working families, people who are working and getting a paycheck. While 
two-thirds of uninsured children are eligible for public programs such 
as Medicaid and the SCHIP program, most are still uninsured.
  These adults also are low-income populations who are not eligible for 
public programs but have incomes below 200 percent of the Federal 
poverty level. This group is composed predominantly of parents and 
childless adults who work but may have difficulty in obtaining and 
affording coverage. Due to the low Medicaid eligibility level for 
parents, many uninsured parents have children who qualify for public 
coverage but do not qualify, themselves, as parents. What an irony.
  Members of racial and ethnic minority groups make up a large number, 
a disproportionate share, of the uninsured population. The uninsured 
rate for Latinos was 33 percent in 2005, 20 percent for African 
Americans and 18 percent for Asians and 30 percent for Native 
Americans. They lack health care coverage.
  In addition to impacting health and the finances of the uninsured 
themselves, the lack of health care coverage has had repercussions for 
all of us in America. Many hospitals, as you know, are currently 
struggling under the strain of providing uncompensated emergency care 
to uninsured individuals.

  In my own district in California, community health centers bear the 
brunt of responsibility for treating the uninsured. These community 
health centers are often the first place that the uninsured turn to 
when seeking health care services. These community health centers are a 
vital part of our health care safety net.
  Poor health leads to poor financial status, and a never-ending cycle 
of low socioeconomic status often leads to poor health. The core values 
for a strong and secure America should include the right to universal 
access to affordable, high-quality health care for all.
  In a country that prides itself on equality, it is evident that our 
health

[[Page H3759]]

care system is broken when people suffer from a lack of access to 
health insurance and to quality care. We must make health care services 
affordable and provide quality through linguistically and culturally 
competent services for all Americans. That must be our national 
priority.
  I want to refer myself to the State Children's Health Insurance 
program, known by many as SCHIP, which covers currently 6 million 
children, building on Medicaid's coverage of 28 million children. 
However, statistically speaking, 9 million children remain uninsured.
  Over the past decade, SCHIP and Medicaid together have reduced the 
uninsured rate among low-income children by one-third. We know that 
uninsured children are more likely to receive cost-effective preventive 
services and are healthier, which leads to greater success in school 
and life. Although programs such as SCHIP and Medicaid have decreased 
the number of uninsured children, the lack of funding and outreach 
efforts have left millions of those children ineligible without any 
coverage. Reducing disparities in children's access to health care is 
extremely important and should be one of our biggest priorities here in 
Congress.
  For example, uninsured African American and Latino children are less 
likely to have a personal doctor and are more likely to forego needed 
medical care than any other group of uninsured children. More than half 
of insured African American children, 51 percent, and insured Latino 
children, 50 percent, are covered by Medicaid and SCHIP. Nearly 95 
percent of eligible but uninsured children live in families with 
incomes below 200 percent of the Federal poverty level, which is 
$33,200 for a family of three, and over 40 percent of this population 
is Latino.
  Enrollment in SCHIP has proven to reduce disparities in access to 
health care services as well as reducing the coverage gap for minority 
children. More than 80 percent of African American children and 70 
percent of uninsured Latino children appear to be eligible for this 
public coverage, but currently are not enrolled.
  Additional funding for SCHIP, as you know, is necessary for the 
coverage of all uninsured. SCHIP plays a critical role for children of 
color. After SCHIP was created back in 1997, the percent of uninsured 
children steadily declined from a high of 15.4 percent in 1998 to a low 
of 10 percent in 2004, and for racial and ethnic minorities the decline 
was remarkable. In 1998, roughly 30 percent of Latino children, 20 
percent of African American, and 18 percent of Asian Pacific Islander 
children were uninsured. In 2004, those numbers had dropped to about 21 
percent, 12 percent and 8 percent respectively.
  In addition to reducing the coverage gap for minority children, SCHIP 
enrollment has helped to reduce disparities in access to health care 
services. For example, a study of children enrolled in New York's SCHIP 
program for one year found an almost complete elimination of these 
disparities and the number of children with unmet health care needs 
decreased. A study from California's SCHIP population confirmed those 
results as well. Across racial and ethnic groups, SCHIP enrollment was 
associated with a significant reduction in disparities and access to 
needed care.
  We need adequate SCHIP reauthorization. Currently there is 
insufficient Federal funding for SCHIP to cover the children currently 
enrolled. We need additional money to cover them and to expand coverage 
to uninsured children who are eligible.
  In order to expand health coverage for minority children, we also 
need to address the underlying barriers to enrollment in Medicaid and 
SCHIP that minorities are more likely to face; as an example, the 
distrust of government and a health care system where language may not 
be spoken adequately to the different groups that are affected. And 
misinformation about eligibility rules is often complicating the 
process for many who don't understand the paperwork.
  Enrollment strategies targeted to minority communities, including the 
use of community health workers, known as promotoras, could help guide 
families through the enrollment process and have been proven to 
increase enrollment and reduce disparities. We must improve outreach 
efforts and simplify enrollment in order to reach the millions of 
unenrolled children from communities of color who are eligible for 
Medicaid and the SCHIP program. This year, with the reauthorization of 
SCHIP, this is an opportunity for us to address racial and ethnic 
disparities in children's access to health care. I hope that we can 
work together with our colleagues across the aisle to begin the debate 
and see that we reauthorize these programs that are so vitally needed.
  I am very pleased this evening to have one of my colleagues, the 
gentlewoman from Guam, who has chaired the Congressional Asian Pacific 
Islander Caucus Task Force on Health who has joined me this evening. 
She has been a pioneer on health care access and will give us, I am 
sure, very informative data regarding the problems that are faced 
currently in the Asian Pacific Islander community. I welcome her this 
evening.
  I gladly yield to the gentlewoman.
  Ms. BORDALLO. Mr. Speaker, I want to thank my colleague and good 
friend, Hilda Solis, for bringing this forum together.
  Tonight I come to the floor to take part in a very important dialogue 
about National Health Month that has been organized, as I said earlier, 
by my colleague from California, Congresswoman Hilda Solis. 
Congresswoman Solis' leadership in the area of minority health 
disparities, particularly with regard to environmental health factors, 
is strong and it has raised awareness of these issues on Capitol Hill.
  I thank her for yielding me the time, and I commend her for her 
efforts, along with those of the members of the Congressional Hispanic 
Caucus, the Congressional Black Caucus, and my colleagues in the 
Congressional Asian Pacific American Caucus, in ensuring that minority 
health disparities are on the national agenda.

                              {time}  2130

  I am here tonight as the Chair of the Congressional Asian Pacific 
American Caucus Health Task Force to recognize April as National 
Minority Health Month. Designated in 2001, National Minority Health 
Month is sponsored by the National Minority Quality Forum, an 
organization dedicated to addressing and eliminating the disparity in 
care, treatment, and access faced by racial and ethnic minority 
populations.
  The National Minority Quality Forum has been a leader in addressing 
these disparities and since 2004 has hosted a national summit each year 
to address these issues. Because the fourth annual summit began today 
in Washington, D.C., this is an opportune time to bring further 
awareness of the increasing need to address health disparities. It is 
very important that within this dialogue surrounding minority health 
disparities, that the needs of Asian American and Pacific Islanders are 
included. Asian Americans and Pacific Islanders face a number of 
hurdles towards receiving adequate health care stemming from linguistic 
and cultural challenges, and a lack of data collection.
  Based on the following statistics, the health care disparities in the 
Asian American and Pacific Islander community become readily apparent, 
according to the President's Advisory Commission on Asian American and 
Pacific Islanders.
  Ms. Solis covered in detail the lack of insurance coverage. I am here 
to give statistics on the diseases prevalent among minorities.
  Asian American and Pacific Islander women have the lowest rate of 
cancer screening compared to other ethnic groups. Asian Americans and 
Pacific Islanders make up over half of the cases of chronic hepatitis 
B. Asian Americans and Pacific Islanders make up 20 percent of all 
cases of tuberculosis; and Vietnamese Americans are 13 times more 
likely to die of liver cancer than Caucasians.
  There are many diseases and illnesses that disproportionately affect 
communities of color, ranging from HIV/AIDS to diabetes. Hepatitis B, 
which disproportionately affects the Asian American and Pacific 
Islander community, is often overlooked.
  Today as we recognize National Minority Health Month, I would like to 
take this opportunity to raise awareness about this deadly disease. 
Hepatitis B is an infection caused by the

[[Page H3760]]

hepatitis B virus. Usually, people infected with the disease do not 
show early symptoms. But if left undetected, it may lead to cirrhosis 
of the liver, liver failure, and liver cancer. The statistics regarding 
hepatitis B are alarming. According to the Asian and Pacific Islander 
American Health Forum, one in 10 Asian Americans and Pacific Islanders 
are chronically infected with hepatitis B.
  And of all those infected with hepatitis B in the United States, 50 
percent are Asian Americans and Pacific Islanders, and liver cancer is 
the leading cause of death for Laotian American men in California.
  The promising thing with hepatitis B is there is a three-shot 
vaccination series that can prevent hepatitis B and its dire 
consequences. Unfortunately, only one in 10 Asian American and Pacific 
Islander children have received the vaccination series. So with the 
proper education, outreach, and funding, I hope that we can address the 
killer disease within the Asian-American and Pacific Islander 
community, increase the vaccination rate, address the need for early 
detection and monitoring, and improve the quality of life for the 
people and families that live with hepatitis B.
  Additionally, I hope we take this opportunity during National 
Minority Health Month to strengthen data collection and dissemination 
that will lead to improved access to health care for all racial and 
ethnic minority communities across the United States.
  Again, as the Chair of the Health Care Task Force for the 
Congressional Asian Pacific American Caucus, I want to thank my 
colleague, Ms. Solis, for organizing tonight's Special Order speech on 
the occasion of National Minority Health Month and for the purposes of 
generating greater attention and raising awareness to the disparities 
in access to quality health care that our minority communities face and 
that deserve to be eliminated.
  Ms. SOLIS. I thank the gentlewoman from Guam, and I would like to at 
this time thank her for her hard work and deliberations in the past few 
years as a strong member of the tri-caucus working on health care 
issues. I know she is going to continue to lead and be a voice for 
those underrepresented communities.
  I would like to now recognize a very special individual who is Chair 
of our Subcommittee on Health on Energy and Commerce, but also plays a 
very important role in representing the Native Americans in our great 
country and that is the gentleman from New Jersey (Mr. Pallone).
  Mr. PALLONE. Thank you. I want to thank my colleague from California 
and also my colleague from Guam. I know that for a number of years now 
they have both been involved in the health care disparities issue, and 
have actually put together legislation that we have tried to get passed 
for several years. It was a little difficult with the Republican 
majority. And hopefully now with the Democratic majority, we can 
address those health disparities and concerns.
  I would like to talk about the Native American aspect of this. And I 
also want to mention that addressing the concerns of minority health 
care is important in my district because we do have many Asian 
Americans. We have the largest number of Indian Americans of any 
congressional district, and by that I mean Asian Indian Americans, and 
also a large Latino and African American population in my district.
  I just know when I go and visit some of the hospitals or community 
health centers, many times the issue is brought to my attention, 
whether it is data collection which has already been mentioned tonight, 
or it is the need for more minority health care professionals, be they 
doctors, nurses or whatever, or even that more research attention needs 
to be paid to diseases or afflictions that basically impact the 
minority communities in disproportionate ways.
  It is very important that we address this and we need legislation, 
and we will move forward with the health care disparities legislation 
that my colleagues have really championed over the last few years.
  I want to talk about Native Americans. I actually don't have any 
federally enrolled Native American tribes in my district or even in New 
Jersey. We have quite a few, we just don't have any recognized tribes 
at a Federal level. We have five that are State recognized. Unless you 
are federally recognized and enrolled with the Department of the 
Interior, you are not for the most part eligible for the health 
service.
  American Indians are a little unique in that unlike most Americans, 
they have a right pursuant to their treaties and the Constitution to 
health care. When they gave their lands up to the Federal Government by 
treaty, they were given the right to health care. That, of course, 
doesn't necessarily mean they can all access it because a lot of them 
don't necessarily live on the reservation, and that is one of the 
reasons why we have urban health centers around the country, including 
several in California, because many Native Americans now do live in 
L.A. and in some of the larger cities, and don't necessarily live on 
their homelands on the reservations.
  So we need to address their concerns in not only providing hospitals 
and clinics in their homelands, on the reservations, but also in the 
urban areas where many now reside.
  Unfortunately, in the last few years, and I know I sound so partisan 
and I don't mean to be, but the amount of money that was made available 
in the last 12 years under the Republican Congress was really not 
sufficient. There is a need for a lot more dollars. This year we did 
budget significantly more for the Indian Health Service, but we also 
need to reauthorize the Indian Health Service because it hasn't been 
reauthorized since 2000.
  I have sponsored legislation called the Indian Health Care 
Improvement Act which will be marked up in the Resources Committee this 
year and will come to the Energy and Commerce Committee and the Health 
Subcommittee, and we will try to get it passed in this Congress.
  When you talk about Native Americans and the disparities, the 
disparities are just incredible. When we had a hearing on the Indian 
Health Care Improvement Act in the Resources Committee a few weeks ago, 
I asked a question about how many American Indian or Native American 
doctors there were in the United States. I could not believe the 
number. There are less than 500, somewhere between 400 and 500 Native 
American physicians for a Native American population that is probably 
over 2 million. I don't know what that works out to percentage-wise, 
but there is clearly a need for scholarship and grant and loan programs 
that would specifically target the Native American community so we can 
have not 400 doctors but at least 4,000 or maybe 40,000 when you talk 
about a community that has over 2 million people.
  And the same is true, and I don't have the statistics for nurses or 
other health care professionals, but there are really very few Native 
American health care providers, and we need to boost those numbers up 
and allow for opportunities to get more health care professionals.
  With regard to actual treatment, if they are not on the reservation 
and able to access the Indian health care hospital or clinic, it is 
very difficult. There is a huge unemployment rate. Even if you are on a 
reservation, sometimes distances are great because many Native 
Americans live in rural areas where health care is simply not 
available.
  We also have the phenomenon of diseases or aflictions that target 
that community. The incidence of diabetes, juvenile or type 2 diabetes, 
is for many tribes over 50 percent. I have been to some where the 
numbers are over 60 percent. We need a lot more research into the 
reasons why, in the example of diabetes, but I could talk about other 
diseases or health care problems, why the incidence is so high and what 
could be done.
  For example, there has been some effort to look at nutrition as an 
answer, the feeling that many Native Americans, for example, used to 
live on a subsistence diet. If they were a desert people, they would 
eat foods that they gathered in a desert. Or they may have lived on a 
ranch or in a situation where they were getting a lot more natural 
foods, and now as those opportunities have eased to exist and they are 
eating processed foods, there is a lot of evidence to suggest that is a 
major reason

[[Page H3761]]

for diabetes. This is the type of thing we need. We need research into 
those kinds of afflictions as to what is causing a better than 60 
percent diabetes situation for a number of tribes.
  Even transportation needs are there because of many of the problems 
that are in rural areas.
  So I just wanted to say when you talk about the Native American 
population in this country, the disparities problem is so great that it 
has actually gotten to the point of crisis, in my opinion; and that is 
why we need legislation to deal with these disparity issues, and we 
need to reauthorize the Indian Health Service through the Indian Health 
Care Improvement Act.
  And to the extent that we are looking at this from the Asian 
population, the Latino population, or whatever population, this type of 
initiative is very important. I just want to commend my colleagues 
again for being here tonight and speaking out because I do think we 
need to speak out. In many cases we are talking about people who don't 
have people to speak out for them other than a few of us. Thank you 
again.
  Ms. SOLIS. I thank the gentleman from New Jersey for his kind words 
and knowledge and always helping Members to better organize their 
messages, particularly when it comes to health care and the need to 
improve access for all people in our great country.
  As the gentleman says, the fact is that we are undergoing a change 
where our populations are exploding, our minority populations have 
increased, and we don't see more services provided, one of which is the 
Native American population. I have a significant Native American 
population in L.A. County and there is one center available for them. 
It is just horrifying to think that people have to travel so many 
counties just to get there. Lord help them if they have an episode of 
some sort, that they get there in time to receive the necessary care. 
To know that this is not a priority with the administration is very 
alarming. We need to prioritize this issue.

                              {time}  2145

  I again want to recognize my colleague from Guam to talk about some 
other very pressing health care issues that affect not just Asian 
Pacific Islanders but these other minority populations. So I would 
yield to her.
  Ms. BORDALLO. Mr. Speaker, I thank the gentlewoman from California 
(Ms. Solis) for organizing this forum, and I would also like to thank 
my colleague from New Jersey (Mr. Pallone) who joined us on the floor 
tonight to discuss this very important issue.
  I am to cover cancer, and today is a very sad day for the House of 
Representatives. We have lost a dear colleague to cancer, and this is 
the second cancer-related passing this year in the House of 
Representatives.
  Cancer is the second most common cause of death in the United States 
and accounts for one out of every four deaths. Unfortunately, health 
disparities in cancer continue to persist. Minority groups face unique 
problems and concerns about cancer, including higher rates of 
developing some cancers and barriers to early detection.
  In 2001, the National Cancer Institute formed the Center to Reduce 
Cancer Health Disparities. In 2005, the center launched a new program 
to reduce cancer deaths among minority and underserved populations 
through $95 million in grants that funded community-based projects in 
geographically and culturally diverse areas of our country.
  Dr. Harold Freeman, a leader in reducing cancer health disparities, 
and former surgeon at Harlem Hospital, said that cancer disparities are 
attributable to three interacting factors: first, low socioeconomic 
status; second, culture; and third, social injustice.
  Low socioeconomic status and lack of health insurance lead to 
disparities. Lack of coverage prevents many Americans from receiving 
optimal health care. Frequently, people are not getting screened and 
treated because they feel they cannot afford to pay for a test if they 
are uninsured. The same populations also express concern that if they 
are diagnosed with cancer they will not be able to get the care they 
need.
  Culture also plays a role. Some Native American tribes do not use the 
word ``cancer.'' When asked why they cannot discuss this disease, they 
say that in their culture, if they say the word ``cancer,'' it will 
bring disease to all of their families.
  It is necessary to understand the cultural beliefs of different 
populations when talking about diseases. According to Dr. Freeman, much 
of the disparity in cancer outcomes is a result of the cancer type, the 
time of diagnosis, and the continuity of cancer care, not the disease 
itself.
  Screening and early detection are extremely important to avoiding 
cancer-related deaths. Many deaths from breast, colon and cervical 
cancer could be prevented by increased usage of established screening 
tests.
  Although white and African American women aged 40 and older had the 
same prevalence of mammography use, other racial and ethnic groups of 
women were less likely to have had a mammogram. The lowest prevalence 
of mammography use occurred among women who lacked health insurance and 
by immigrant women who lived in the United States for less than 10 
years.
  The incidence of some cancers is much higher in communities of color. 
For example, African American men are at least 50 percent more likely 
to develop prostate cancer than men of any other racial or ethnic group 
in the United States.
  Latino males have the third highest incidence rate for prostate 
cancer after African Americans and whites. Death rates for Latino males 
reveal that they have the third highest death rates from prostate and 
colon and rectal cancer after African Americans and whites.
  Asian Pacific Islander males have the third highest rate for lung and 
bronchus cancer and colon and rectal cancer.
  Cervical cancer occurs most often in Latinas; the incidence rate is 
more than twice the rate for non-Latina white women. Among Latinas in 
the United States, cervical cancer ranks as the fourth most common type 
of cancer.
  Although African American women are less likely to develop breast 
cancer than other women, those who do are about twice as likely to die 
from it.
  Consequently, programs such as the National Breast and Cervical 
Cancer Early Detection Program are essential for low-income, uninsured 
and underserved women.
  Although breast cancer is the leading cause of cancer death for 
Latina women, cancer screening rates are lower for Latinas.
  Providing culturally appropriate health education and health services 
is so essential to preventing and treating cancer.
  Again, I want to thank Congresswoman Solis for providing and 
organizing this forum.
  Ms. SOLIS. Mr. Speaker, I thank the gentlewoman for joining us this 
evening and representing the caucus so well, the Asian Pacific Islander 
Caucus, and demonstrating a willingness to work across the aisle and in 
a coalition so that we can better improve access to health care for all 
underrepresented groups.
  I want to talk very briefly before I recognize one of our other 
colleagues who has joined us here from the Congressional Black Caucus, 
Sheila Jackson-Lee.
  I want to talk about diabetes because diabetes, in my opinion, is one 
of the major chronic illnesses. It does not just affect ethnic minority 
or underrepresented groups, but many, many people in our country.
  One of the goals that I mentioned earlier of the Healthy People 2010 
program, a campaign underway, by the way, by the Department of Health 
and Human Services, is to reduce the disease and economic burden of 
diabetes and to improve the quality of life for all people who have or 
are at risk of getting diabetes.
  Diabetes, as you know, is a chronic disease affecting both children, 
Type I, and adults, Type II. The number of people with diabetes has 
increased steadily in the past decade, and the increase has occurred 
within certain racial and ethnic groups.
  Today, approximately 20.8 million Americans have diabetes, and of 
these people, an estimated 6.2 million individuals have not even been 
diagnosed. According to the Centers for Disease Control and Prevention, 
another 54 million people have pre-diabetes.
  Complications of diabetes include heart disease, stroke, blindness, 
kidney

[[Page H3762]]

failure, dental disease, pregnancy complications and amputations. These 
are very serious illnesses, and diabetes is now the sixth leading cause 
of death in the United States and costs the Nation over $132 billion 
per year in direct and indirect costs.
  Diabetes, as you know, is the leading cause of nontraumatic 
amputations, and about 150 amputations per day are due to diabetes.
  Two million Latinos have been diagnosed with diabetes, and Latinos 
are 1.5 times more likely to have diabetes than whites, on the average, 
and many children with Type II diabetes are Latino or African American.
  Reducing the incidence of diabetes and thus reducing racial and 
ethnic disparities involves diet and lifestyle changes. However, 
strategies to manage the disease and prevent the disease also need to 
be culturally sensitive and targeted to specific populations.
  The number of overweight minority children has increased in recent 
years, and more of them are being diagnosed with adult-type diabetes. 
It is estimated that now at least 40,000 children now have Type II 
diabetes, which is the type of diabetes associated with adult obesity.
  Regular diets of low-cost, high-calorie fast food and sodas, in 
addition to inadequate daily physical activity, have contributed to the 
prevalence of diabetes. Health education, as you know, is extremely 
important, and we need to teach people how to prevent diabetes because 
it is preventable. For people who already have diabetes, we need to 
teach them how to manage that disease.
  In order to prevent or delay complications and early death from 
diabetes, patients need to understand the disease, take charge of blood 
glucose management, comfortably talk to their provider about diabetes 
care, and have access to equipment, supplies and prescriptions. 
Cultural competence and access to health care play a very large role in 
preventing deaths due to diabetes.
  Sixty percent of my district, as you know, is Latino, and I have seen 
firsthand the community clinics that have helped my constituents who 
are diagnosed with this deadly but preventable disease. A large 
proportion of the people who visit these clinics in my district are 
uninsured. When I see the packed waiting rooms, I understand how hard 
it is to manage this chronic illness. Even with appointments, people 
can have waiting times of several hours, resulting in loss of work.
  A 2005 Commonwealth Fund study of public hospitals also found that 
African American and Latino patients were less likely than their white 
counterparts to have well-controlled diabetes, and uninsured patients 
received even less care. Public hospitals serve a high number of 
patients at high risk for not receiving access to needed health care. 
In the study, about two out of five patients with diabetes were 
uninsured, and two-thirds were members of racial and ethnic minority 
groups, and up to two-thirds of patients primarily spoke a language 
other than English.
  Insurance status and race influences health care use and outcomes for 
diabetes patients. Uninsured patients have the worst diabetes control, 
and 33 percent do not have their condition under control now, which is 
almost double the rate for Medicare patients.
  The routine costs for managing diabetes, to test and control glucose 
levels, can reach hundreds of dollars per month. Uninsured patients 
have difficulties paying for equipment to effectively manage their 
treatment. Consequently, the higher prevalence of diabetes and the 
inability to manage diabetes leads to more diabetes-related deaths in 
communities of color.
  This is just one example of how social determinants impact our health 
care status, and I wanted to draw your attention to that.
  This evening we have been joined by two members of the Congressional 
Black Caucus, and I would first like to recognize the gentlewoman from 
Texas (Ms. Jackson-Lee). Thank you for joining us this evening.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, let me thank the gentlewoman 
from California for convening us this evening and providing such 
leadership to the issue of health disparities. And also I believe it is 
enormously important to emphasize the collaborative work between the 
Asian Pacific Caucus, of which I am a member, the Hispanic Caucus, of 
which I am an adopted daughter, and the Congressional Black Caucus.
  I am also very pleased to be on the floor with our chair of the 
Congressional Black Caucus health brain trust, which I have been a 
Member on, I believe, for as long as I can remember, to join us for 
what is really an indictment of American society. It is an indictment 
of this government, frankly, and the correction that is due is long 
overdue. That is the whole question of health disparities.
  We have heard an eloquent presentation by Hilda Solis on the question 
of diabetes. We heard from the distinguished gentlewoman from Guam who 
spoke about the Pacific illnesses that impact the Asian Pacific 
community, and I rise to speak holistically about the health crisis in 
America that does not address the longstanding question of disparities 
in health care.
  I am reminded of an African American gentleman in a Florida hospital 
just a few years ago who was to go into surgery and hopefully had all 
the T's crossed and I's dotted. Lo and behold, the wrong leg was 
amputated. He obviously suffered from, as we call in our community, 
sugar diabetes, and rather than be cured, unfortunately, his situation 
was made worse by amputating the wrong leg.
  There is extensive documentation that indicates that the question of 
health access or access to health care falls heavily on minorities, and 
particularly African Americans. In fact, there is data to suggest that 
African Americans, when given access to the Nation's hospitals and 
other health facilities, that the care is less than it is for other 
populations. That, in itself, does not speak to the greatness of this 
Nation and the fact that this Nation is considered a world power.

                              {time}  2200

  If you want to speak to inequities of language, you will find in 
Hispanic communities, in particular, that before we started moving on 
community health clinics and really making a push to have culturally 
sensitive treatment, you will find in many instances that there was a 
lack of ability to communicate with Hispanic populations because of the 
language barrier. These, my friends, were citizens, people who were 
permanent legal residents, who could not get the proper health care.
  Today, I rise to acknowledge the importance of National Minority 
Health Month, but really to give us a challenge that we maybe have come 
this far by faith, as many of us have been known to say, but we have a 
mighty long way.
  Let me just share some of the indictments of poor health care in 
America. African American adolescents accounted for 65 percent of new 
AIDS cases reported among teens in 2002, although they only account for 
15 percent of American teenagers.
  We also recognize that the leading cause of death of young African 
American males between the ages of 15 and 24, that cause is not disease 
or accidental death, but homicide.
  We recognize, as has been already noted, that obesity is an 
increasing dilemma for America. It certainly is a dilemma for minority 
populations and African Americans.
  Let me express appreciation for joining Congressman Donald Payne a 
few weeks ago for a very exciting conference on obesity, so much so 
that it was contagious. Those of us, as Members of Congress who were 
able to attend, with the University of New Jersey medical and dental 
school, are going to repeat that conference around the country. I know 
that we in Houston look forward to hosting a conference on obesity.
  A few weeks ago, the Congressional Children's Caucus hosted, with the 
Congressional Black Caucus Foundation, a briefing on obesity, where we 
focused on what happens to obese children and obese infants as well.
  Just a couple of days ago, I believe Friday, I was very gratified to 
participate with the Congressional Black Caucus Foundation and the CBC 
Health Brain Trust on the status of African American men, questions of 
mental health, the question of homicide, HIV/AIDS, domestic violence, 
abuse, and the preservation of the good health of African American men.
  Every time I rise to speak about this question, I pay tribute to my 
father,

[[Page H3763]]

my late father, a man who worked hard for his family, who believed that 
no job was beneath him to support his family, a man who was a brilliant 
artist. But because of segregation, the work that he had, he was, if 
you will, replaced when men came back who happened to be white, from 
World War II.
  But even with all of those trials and tribulations, he kept his hand 
involved in art, and in the later part of his life, he got another 
chance to work 10 years for one of the comic book companies in New 
York. Who would have thought that he would have been a victim of 
prostate cancer. When I say a victim, not diagnosed, so much so that 
ultimately it metastasized to his lung and his brain. My most visual 
memory of him was him laying in a fetal position in a hospital bed, way 
before the time, and he died of that dastardly disease.
  But I think one of the challenges was that in the male line of our 
family, that cancer is prevalent, but not being diagnosed, or having 
access to health care that would inform us, we saw uncles pass without 
really knowing what they were dying of.
  So today, now, 2007, a tribute to my father, Ezra Jackson, and 
relatives across America who have died undiagnosed, whose families were 
not aware of, maybe, the DNA or their characteristics for these 
diseases, because of the poor access to health care. We stand today, 
one, wanting a universal access to health care system; two, passing the 
Congressional Black Caucus and the bill that went to the Senate, 
dealing with disparities in health care, that, as I understand, Dr. 
Christensen, we never got passed. We need to get it passed in this 
Congress.
  Then I would just simply say that each of us must hold forums in our 
districts on the question of disparities in health care. As I do the 
obesity one, we look forward to putting together an advisory committee 
on black males that talks about health care as well.
  Let me close by simply saying that I could recount for you any number 
of statistics on health care. I think my colleagues have accurately 
pronounced these challenges. But let me give a roll call to show you 
where we have these devastating, if you will, disparities, so that you 
won't think that we are limited, hypertension, high cholesterol, type 2 
diabetes, coronary heart disease, stroke, gall bladder disease, 
osteoarthritis, asthma, bronchitis, sleep apnea and other respiratory 
problems, cancer, which is breast, colon and endometrial.
  We expect that we will do a better job of trying, if you will, of 
trying to improve the health conditions in America. We must do so. It 
is a civil rights issue. I want to thank you so much for highlighting 
and provoking us to be part of the change of creating opportunities for 
better health for all Americans, and particularly those experiencing 
these health disparities.
  Mr. Speaker, I rise to honor and recognize the importance of National 
Minority Health Month. National Minority Health Month is a very 
important time to bring awareness to the many health concerns facing 
minority communities. My colleagues in the Congressional Black Caucus 
and I understand the very difficult challenges facing us in the form of 
huge health disparities among our community and other minority 
communities. We will continue to seek solutions to those challenges. It 
is imperative for us to improve the prospects for living long and 
healthy lives and fostering an ethic of wellness in African-American 
and other minority communities. I wish to pay special tribute to my 
colleague, Congresswoman Donna Christensen, the Chair of the CBC Health 
Braintrust, for organizing an important conference last week on the 
health and wellness of African-American males. I thank all of my CBC 
colleagues who been toiling in the vineyards for years developing 
effective public policies and securing the resources needed to 
eradicate racial and gender disparities in health and wellness.
  Let me focus these brief remarks on what I believe are three of the 
greatest impediments to the health and wellness of the African-American 
community and other minority communities. The first challenge is 
combating the scourge of HIV/AIDS. Second, we must reverse the 
dangerous trend of increasing obesity in juveniles and young adults. 
Finally, we must confront the leading cause of death of young African-
American males between the ages of 15-24; that cause is not disease or 
accidental death, but homicide.


                                HIV/AIDS

  In 1981, HIV/AIDS was thought by most Americans to be a new, exotic, 
and mysterious disease which seemed to inflict primarily gay white 
males in New York City and San Francisco. But since then we have 
learned that in the America of 2006, AIDS is overwhelmingly a black and 
brown disease. And that means that we have to assume the major 
responsibility for finding the solutions to rid our communities of this 
scourge. Consider the magnitude of the challenge confronting us:
  HIV/AIDS is now the leading cause of death among African-Americans 
ages 25 to 44--ahead of heart disease, accidents, cancer, and homicide.
  The rate of AIDS diagnoses for African-Americans in 2003 was almost 
10 times the rate for whites.
  Between 2000 and 2003, the rate of HIV/AIDS among African-American 
males was seven times the rate for white males and three times the rate 
for Hispanic males.
  African-American adolescents accounted for 65 percent of new AIDS 
cases reported among teens in 2002, although they only account for 15 
percent of American teenagers.
  Billions and billions of private and federal dollars have been poured 
into drug research and development to treat and ``manage'' infections, 
but the complex life cycle and high mutation rates of HIV strains have 
only marginally reduced the threat of HIV/AIDS to global public health.
  Although the drugs we currently have are effective in managing 
infections and reducing mortality by slowing the progression to AIDS in 
an individual, they do little to reduce disease prevalence and prevent 
new infections. It simply will not suffice to rely upon drugs to manage 
infection. We can make and market drugs until we have 42 million 
individually tailored treatments, but so long as a quarter of those 
infected remain detached from the importance of testing, we have no 
chance of ending or even ``managing'' the pandemic.

  Currently, the only cure we have for HIV/AIDS is prevention. While we 
must continue efforts to develop advanced treatment options, it is 
crucial that those efforts are accompanied by dramatic increases in 
public health education and prevention measures.
  Learning whether one is infected with HIV before the virus has 
already damaged the immune system represents perhaps the greatest 
opportunity for preventing and treating HIV infection. According to the 
Centers for Disease Control (CDC), between 2000 and 2003, 56 percent of 
late testers--defined as those who were diagnosed with full-blown AIDS 
within one year after learning they were HIV-positive--were African-
Americans, primarily African-American males.
  African-Americans males with HIV have tended to delay being tested 
because of psychological or social reasons, which means they frequently 
are diagnosed with full-blown AIDS soon after learning they are 
infected with HIV. This is the main reason African American males with 
AIDS do not live as long as persons with HIV/AIDS from other racial/
ethnic groups.
  Researchers have identified two unequal tracks of HIV treatment and 
care in the United States. In the first, or ``ideal track,'' a person 
discovers she or he is HIV-infected, seeks medical care, has regular 
follow-ups, and follows a regimen without complications. Persons in 
this track can now in most cases lead a normal life.
  But some individuals follow a second, more-dangerous track. These 
individuals come to the hospital with full-blown AIDS as their initial 
diagnosis. They may have limited access to care because of finances or 
because other social or medical problems interfere. The vast majority 
of deaths from HIV/AIDS are among this second group. And the persons 
making up this group are disproportionately African-American males.
  I have strongly supported legislation sponsored by CBC members and 
others to give increased attention and resources to combating HIV/AIDS, 
including the Ryan White CARE Act. I support legislation to reauthorize 
funding for community health centers (H.R. 5573, Health Centers Renewal 
Act of 2006), including the Montrose and Fourth Ward clinics in my home 
city of Houston, and to provide more nurses for the poor urban 
communities in which many of these centers are located (H.R. 1285, 
Nursing Relief Act for Disadvantaged Areas). I have also authored 
legislation aimed to better educate our children (H.R. 2553, 
Responsible Education About Life Act in 2006) and eliminate health 
disparities (H.R. 3561, Healthcare Equality and Accountability Act and 
the Good Medicine Cultural Competency Act in 2003, H.R. 90).
  Twenty-five years from now, I hope that we will not be discussing 
data on prevalence and mortality of HIV/AIDS among African-American 
males, but rather how our sustained efforts at elimination have come 
into fruition. But for us to have that discussion, we must take a 
number of actions now. We must continue research on treatments and 
antiretroviral therapies, as well as pursue a cure. We absolutely have 
to ensure that everyone who needs treatment receives it. And we simply 
must increase awareness of testing, access to testing, and the accuracy 
of testing. Because we

[[Page H3764]]

will never be able to stop this pandemic if we lack the ability to 
track it.
  African-Americans males are eleven times as likely to be infected 
with HIV/AIDS, so we must make eleven times the effort to educate them 
until HIV/AIDS becomes a memory. If we do not, then the African-
American male will indeed become an endangered species.
  When it comes to the scourge of HIV/AIDS, the African-American 
community is at war. It is a war we absolutely have to win because at 
stake is our very survival. With HIV/AIDS we need not wonder whether 
the enemy will follow us. The enemy is here now. But so is the army 
that can vanquish the foe. It is us. It is up to us. For if not us, 
who? If not now, when? If we summon the faith of our ancestors, the 
courage of our great grandparents, and the determination of our 
parents, we will march on until victory is won.


                                OBESITY

  Although the obesity rates among all African-Americans are alarming, 
as Chair of the Congressional Children's Caucus, I am especially 
concerned about the childhood obesity epidemic among African-American 
youth. More than 40 percent of African-American teenagers are 
overweight, and nearly 25 percent are obese.
  Earlier this year, my office in concert with the office of 
Congressman Towns and the Congressional Black Caucus Foundation, held a 
widely- attended issue forum entitled, ``Childhood Obesity: Factors 
Contributing to Its Disproportionate Prevalence in Low Income 
Communities.'' At this forum, a panel of professionals from the fields 
of medicine, academia, nutrition, and the food industry discussed the 
disturbing increasing rates of childhood obesity in minority and low-
income communities, and the factors that are contributing to the 
prevalence in these communities.
  What we know is that African-American youth are consuming less 
nutritious foods such as fruits and vegetables and are not getting 
enough physical exercise. This combination has led to an epidemic of 
obesity, which directly contributes to numerous deadly or life-
threatening diseases or conditions, including the following: 
hypertension; dyslipidemia (high cholesterol or high triglyceride 
levels); Type 2 diabetes; coronary heart disease; stroke; gallbladder 
disease; osteoarthritis; asthma, bronchitis, sleep apnea, and other 
respiratory problems; and cancer (breast, colon, and endometrial).
  When ethnicity and income are considered, the picture is even more 
troubling. African-American youngsters from low-income families have a 
higher risk for obesity than those from higher-income families. Since 
the mid-1970s, the prevalence of overweight and obesity has increased 
sharply for both adults and children. According to the Centers for 
Disease Control and Prevention CCDC), among African-American male 
adults aged 20-74 years the prevalence of obesity increased from 15.0 
percent in 1980 survey to 32.9 percent in the 2004.
  There were also increases in overweight among children and teens. For 
children aged 2-5 years, the prevalence of overweight increased from 
5.0 percent to 13.9 percent; for those aged 6-11 years, prevalence 
increased from 6.5 percent to 18.8 percent; and for those aged 12-19 
years, prevalence increased from 5.0 percent to 17.4 percent.
  As the debate over how to address the rising childhood obesity 
epidemic continues, it is especially important to explore how 
attitudes, environmental factors, and public policies influence 
contribute to obesity among African-American males. Some of these 
contributing factors are environmental, others are cultural, still 
others are economic, and others still may be lack of education or 
information. But one thing is clear: we must find ways to remove them.


                       GUN VIOLENCE AND HOMICIDE

  The third and final health challenge confronting the African-American 
community, and African-American males in particular, involves the issue 
of gun violence and homicide. This must be a priority health issue for 
our community. Over 600,000 Americans are victimized in handgun crimes 
each year, and the African-American community is among the hardest hit.
  One week ago, on Monday, April 16, 2007, at Virginia Tech University, 
one of the nation's great land grant colleges, we witnessed senseless 
acts of violence on a scale unprecedented in our history. Neither the 
mind nor the heart can contemplate a cause that could lead a human 
being to inflict such injury and destruction on fellow human beings. 
The loss of life and innocence at Virginia Tech is a tragedy over which 
all Americans mourn and the thoughts and prayers of people of goodwill 
everywhere go out to the victims and their families. In the face of 
such overwhelming grief, I hope they can take comfort in the certain 
knowledge that unearned suffering is redemptive.
  Thirty-three persons died in the massacre at Virginia Tech. But there 
is a much less noticed, though no less devastating, massacre and loss 
of life going on in African-American communities across the country. 
Since 1978, on average, 33 young black males between the ages of 15 and 
24 are murdered every 6 days. Three-quarters of these victims are 
killed by firearms.
  In 1997, firearm homicide was the number one cause of death for 
African-American men ages 15-34, as well as the leading cause of death 
for all African-Americans 15-24 years old. The firearm death rate for 
African-Americans was 2.6 times that of whites. According to the 
Centers for Disease Control, the firearms suicide rate amongst African-
American youths aged 10-19 more than doubled over a 15 year period. 
Although African-Americans have had a historically lower rate of 
suicide than whites, the rate for African-Americans 15-19 has reached 
that of white youths aged 15-19.
  A young African-American male is 10 times more likely to be murdered 
than a young white male. The homicide rate among African-American men 
aged 15 to 24 rose by 66 percent from 1984 to 1987, according to the 
Centers for Disease Control. Ninety-five percent of this increase was 
due to firearm-related murders. For African-American males, aged 15 to 
19, firearm homicides have increased 158 percent from 1985 to 1993. In 
1998, 94 percent of the African-American murder victims were slain by 
African-American offenders.
  In 1997, African-American males accounted for 45 percent of all 
homicide victims, while they only account for 6 percent of the entire 
population. It is scandalous that a 15-year-old urban African-American 
male faces a probability of being murdered before reaching his 45th 
birthday that ranges from almost 8.5 percent in the District of 
Columbia to less than 2 percent in Brooklyn. By comparison, the 
probability of being murdered by age 45 is a mere three-tenths of 1 
percent for all white males.
  Firearms have become the predominant method of suicide for African-
Americans aged 10-19 years, accounting for over 66 percent of suicides. 
In Florida, for example, African-American males have an almost eight 
times greater chance of dying in a firearm-related homicide than white 
males. In addition, the firearm-related homicide death rate for 
African-American females is greater than white males and over four 
times greater than white females.
  As the tragedy this week at Virginia Tech University revealed, school 
shootings are sobering and tragic events that cause much concern for 
the safety of children. Homicides involving children and youth that are 
school related make up one percent of the total number of child and 
youth homicides in the United States. Most school associated violent 
deaths occur during transition times such as the start or end of the 
school day, during the lunch period, or the start of a semester.

  Nearly 50 percent of all homicide perpetrators give some type of 
prior warning signal such as a threat or suicide note. Among the 
students who commit a school-associated homicide, 20 percent were known 
to have been victims of bullying and 12 percent were known to have 
expressed suicidal thoughts or engage in suicidal behavior.
  My legislative agenda during the 110th Congress includes introducing 
legislation to assist local governments and school administrators in 
devising preventive measures to reduce school-associated violent 
deaths. In devising such preventive measures, at a minimum, we must 
focus on:
  Encouraging efforts to reduce crowding, increase supervision, and 
institute plans/policies to handle disputes during transition times 
that may reduce the likelihood of potential conflicts and injuries.
  Taking threats seriously and letting students know who and where to 
go when they learn of a threat to anyone at the school and encouraging 
parents, educators, and mentors to take an active role in helping 
troubled children and teens.
  Taking talk of suicide seriously and identifying risk factors for 
suicidal behavior when trying to prevent violence toward self and 
others.
  Developing prevention programs designed to help teachers and other 
school staff recognize and respond to incidences of bullying between 
students.
  Ensuring that each school has a security plan and that it is being 
enforced and that school staff are trained and prepared to implement 
and execute the plan.
  My legislative agenda during the 110th Congress also includes 
introducing sensible legislation to assist law enforcement departments, 
social service agencies, and school officials detect and deter gun 
violence.
  Again, thank you all for your commitment to working to find workable 
solutions to the heath and wellness challenges facing our communities. 
I look forward to working with you in the months ahead to achieve our 
mutual goals.
  Have a successful and inspiring conference.
  Ms. SOLIS. I thank the gentlewoman from Texas for joining us this 
evening.
  Before I conclude with our discussion on the uninsured and 
celebrating, actually, a call to action, a call to action

[[Page H3765]]

for all people of color and all Americans, that we have a balanced 
health care system that serves all of us, one last item I would like to 
bring up, before I recognize the gentlewoman from the Virgin Islands 
for the last 5 minutes is to talk a little bit about one of the biggest 
killers in our community, and it is about tobacco. Each year tobacco 
use kills more than 400,000 Americans and costs our country more than 
$96 billion in health care costs.
  According to the Centers for Disease Control and Prevention, tobacco 
use by pregnant women alone costs at least $400 million per year due to 
complications such as low birth weight, premature birth and sudden 
infant death syndrome. Every day, 1,000 kids become regular smokers, 
one-third of whom will die prematurely as a result. Smoking is 
responsible for 87 percent of lung cancer deaths in the U.S.
  Tobacco-related cancers are disproportionately higher among low-
income and ethnic-minority communities. Because these groups have been 
repeatedly targeted by the tobacco industry, they unfairly carry a 
greater weight of the health and economic burden tobacco has in our 
country. For communities of color, tobacco addiction brings a 
disproportionate amount of death and disease to communities with low 
rates of health insurance coverage. Lung cancer is the leading cause of 
cancer among Latino men and second leading cause of death among 
Latinas.
  Approximately 25,000 Latinos will die from smoking-related illnesses 
this year, surpassing all other causes of cancer. Each year, 
approximately 45,000 African Americans die from smoking-caused illness.
  Native American adults have the highest tobacco use rates for all 
major ethnic groups. The prevalence of smoking is 37.5 percent among 
Native American, 26.7 among African American, and 24 percent among 
white men. This year it is expected that the rate of lung and cancer 
deaths for white males will be 73.8 per 100,000, while for African 
Americans it will be 98.4 per 100,000. Tobacco use is an important risk 
factor for coronary heart disease, the leading cause of death among 
Latinos.
  Unfortunately, tobacco companies have increased their marketing to 
our minority communities, and I have seen advertisements in magazines 
popular with Latino youth. RJ Reynolds is running ads for Kool 
cigarettes with images that appeal to Latinos.
  I recently learned that the Kool Mixx campaign focused its marketing 
images around music and hip-hop, which appeals to African American and 
Latino youth. The Kool Mixx campaign included 14 music concerts around 
the country and a DJ competition, as well as a special theme park with 
cartons displayed on them.
  In addition, the tobacco company placed advertisements in 
publications popular with Latino youth, like this one here, including 
``Latina'' and ``Cosmopolitan en Espanol.'' The ads include slogans 
like: ``It's about pursuing your ambitions and staying connected to 
your roots.'' To reach everybody in our community, they not only use 
attractive Latino models, but they also make sure ads are in English 
and Spanish.
  The cigarette companies have focused on African American populations 
as well. One company created a line of cigarette flavors like Caribbean 
Chill and Mocha Taboo and used images of African Americans to promote 
their cigarettes. This targeted marketing is having an impact on the 
rates that we are seeing, higher number of people smoking. In 2005, 22 
percent of Latino high school students smoked, a 19 percent increase 
over 2003, when the smoking rate was down to 18 percent.
  Smoking continues to be a huge public health risk for us, and we must 
not tolerate it in our communities. We have to stand up to these big 
corporations and say, enough advertising, let's speak the truth, let's 
talk about prevention, let's talk about awareness, let's talk about 
alternative lifestyles so we can have healthier communities.
  I am pleased that we were able to entertain this discussion on the 
uninsured, the celebration of Uninsured Week and to talk about the 
disparities that exist in our communities and communities of color.
  I am pleased to give the remainder of my time to the distinguished 
woman from the Virgin Islands, who is chairperson of the task force for 
the Black Caucus, the Congressional Black Caucus.

                              {time}  2210

  Mrs. CHRISTENSEN. Mr. Speaker, I came to the floor to speak on 
another issue, but let me say a few words about health disparities 
before I do.
  Health disparities is one of the remaining issues and causes of our 
civil rights struggle. And because our country does not recognize 
health care as a right, African Americans, Latino Americans, Native 
Americans, Alaskan natives, and other people of color, poor and rural 
people, do not receive the same kind of health care, prevention, or 
health maintenance. And because of that, you will find that in this 
country more than half of the uninsured are people of color.
  We have two times more diabetes than the white population, and all 
people of color suffer from more complications.
  African Americans have higher rates of death from heart disease and 
several cancers, prostate, colon, lung, and breast. We are over 50 
percent of all new HIV cases and over 50 percent of new AIDS cases. 
African American and Latino women are 70 to 80 percent of all AIDS 
cases among women. Hypertension we find is becoming a worldwide 
epidemic, and African American women are the most impacted by 
hypertension; however, more African American men die from hypertension.
  Our infant mortality is twice as much as our white counterparts, and 
the New York Times yesterday reported that it is growing in the 
southeast region of our country. So we really have an obligation in 
this Congress to address the health care disparities and the health 
disparities and the lack of coverage in this country to ensure that 
health care is provided equally to every American.
  And so, Mr. Speaker, I want to pay tribute to a woman who was a 
champion of health for minorities and other people of color. The 
extremely sad news of Congresswoman Millender-McDonald's death came as 
a shock to all of us, and it is with a deep sense of loss that I join 
my colleagues who were here earlier in mourning her passing. Not only 
have I lost a colleague, but also a mentor, a sister, and a friend.
  I am honored to work alongside Congresswoman Millender-McDonald as 
members of the Congressional Black Caucus together, and the Small 
Business Community. Juanita was a true champion for minority and women-
owned small businesses, and played a pivotal role in proposing and 
passing legislation to expand financing and contracting opportunities 
for our Nation's small businesses. Her dedication to helping women-
owned businesses was evident in her dedication to increasing funding to 
expand women's business centers throughout our Nation.
  Her commitment to improving the lives of minorities is reflected in 
her lifelong work in affiliations with organizations such as the NAACP, 
Alpha Kappa Alpha, and a number of other organizations devoted to the 
advancement of minorities. She will also be remembered for her 
outstanding stewardship in the areas of transportation, education, 
health, and FEMA legislation.
  We are grateful for the leadership and the innovation that she 
brought to the Committee on House Administration, which led to her 
historic achievement as the first African American woman to chair a 
committee in Congress.
  I know that the House staff and all of the Members appreciate her 
role in establishing the House Fitness Center and creating an outlet 
for mental and physical activity. She has truly left a legacy for all 
of us through her distinguished service on this important committee.
  Juanita will also be remembered for her passion for education, which 
was evident in her many eloquent speeches on the floor. She was truly a 
gifted and skilled orator. Juanita had the distinct ability to 
captivate and engage her audiences. Although she possessed strong and 
determined qualities, she personified grace, compassion, and beauty 
both inside and out.
  On a more personal note, it was through Juanita, a minister's 
daughter, that I began attending Thursday morning prayer breakfast when 
I first

[[Page H3766]]

came to Congress. Her godliness was seen in all that she did.
  Juanita championed the cause of AIDS long before it was fashionable 
to do so. Every year she held a race in her district. And while I could 
never get away to attend, she always had all of our support, and we 
never missed a t-shirt or any of the other paraphernalia that she gave 
out each year.
  Juanita always spoke of her district with great affection and 
dedication. She frequently remarked that she had the most diverse 
district in the country, that she was able to bring them together. And 
to be reelected over and over is a testament to her leadership and her 
abiding belief that we are all children of God, equal in His sight and 
made in His image. Her mission was one of justice, fairness, and 
opportunity for all.
  One cannot speak of Juanita Millender-McDonald without remarking on 
her exquisite taste and her unequaled sense of style. She was always 
dressed to the nines and was always the epitome of elegance and grace.
  Mr. Speaker, although her passing leaves a void in the halls of 
Congress, her spirit and legacy will forever be with us. Words are not 
enough to express our profound sorrow. On behalf of my family, staff, 
and the people of the U.S. Virgin Islands, my deepest sympathy goes out 
to her husband, James McDonald, their children, grandchildren, extended 
family, and dedicated staff. May God bless and comfort them at this 
time in grief as we know He is welcoming our sister home.
  Ms. WATERS. Mr. Speaker, I would like to thank Congresswoman Hilda 
Solis, the Chair of the Congressional Hispanic Caucus Task Force on 
Health and the Environment, for organizing this evening's Special Order 
in honor of National Minority Health Month.
  Martin Luther King, Jr., said, ``Of all the forms of inequality, 
injustice in health care is the most shocking and inhumane.'' 
Unfortunately, injustice in health care is widespread and growing in 
American society today.


                             The Uninsured

  Over 46 million Americans don't have health insurance.
  That is a 15 percent increase in the number of uninsured since the 
President took office.
  Twelve percent of white Americans, 19 percent of Asian Americans, 20 
percent of African Americans, 27 percent of Native Americans and 35 
percent of Hispanic Americans have no health insurance.
  Nationwide, 9 percent of children under the age of 18 and 19 percent 
of adults ages 18 to 64 are uninsured.


                           Los Angeles County

  In Los Angeles County, 8 percent of children under the age of 18 and 
22 percent of adults ages 18 to 64 are uninsured.
  In the Southern Service Planning Area of Los Angeles County [SPA6], 
where my district is located, lack of access to health insurance is 
especially high: 11 percent of children under the age of 18 and 32 
percent of adults ages 18 to 64 are uninsured.
  In the same area, an alarming 44 percent of adults reported 
difficulty accessing medical care, and 21 percent of children have 
difficulty accessing medical care.
  Furthermore, in the Southern Area of Los Angeles County, 35 percent 
of adults and 19 percent of children did not obtain dental care in the 
past year, because they could not afford it.
  We cannot continue to ignore these alarming statistics.


                            Infant Mortality

  Infant mortality rates are considered to be one of the most important 
indicators of the health and well-being of a population. In 2003, the 
last year for which nationwide data is available, the infant death rate 
was 6.9 deaths for every one thousand live births.
  Infant death rates among African Americans are considerably higher. 
Among whites, there were 5.7 infant deaths per thousand live births in 
2003; while among blacks, there were 14.0 infant deaths per thousand 
live births.
  In Los Angeles County, there are 5.0 infant deaths per thousand live 
births. Among African Americans, there are 11.7 infant deaths per 
thousand live births.
  According to an article in Sunday's New York Times, infant deaths in 
the South are growing.
  In Mississippi, the infant death rate had fallen to 9.7 in 2004 but 
then jumped sharply to 11.4 in 2005. In concrete human terms, a total 
of 481 babies died in Mississippi in 2005. That's 65 more babies than 
died the previous year.
  Among African Americans in Mississippi, infant deaths rose from 14.2 
per thousand in 2004 to an astonishing 17 per thousand in 2005.
  Infant death rates also increased in 2005 in Alabama, North Carolina, 
and Tennessee.
  Clearly, injustice in health care is taking its toll.
  If we truly believe that all men and women are created equal, we 
cannot allow these disparities to continue.


                                HIV/AIDS

  Racial and ethnic minorities have disproportionately high rates of 
HIV and AIDS in the United States.
  According to the Centers for Disease Control and Prevention, racial 
and ethnic minorities represent 71 percent of new AIDS cases and 64 
percent of Americans living with AIDS.
  African Americans account for half of new AIDS cases, although only 
12 percent of the population is black.
  Hispanics account for 19 percent of new AIDS cases, although only 14 
percent of the population is Hispanic.
  Asian Americans and Pacific Islanders account for 1 percent of new 
AIDS cases, and American Indians and Alaska Natives account for up to 1 
percent.
  Racial minorities now represent a majority of new AIDS cases, a 
majority of Americans living with AIDS, and a majority of deaths among 
persons with AIDS.
  It was because of the severe impact of HIV and AIDS on minorities 
that I developed the Minority AIDS Initiative back in 1998. The 
Minority AIDS Initiative provides grants to community-based 
organizations and other health care providers for HIV/AIDS treatment 
and prevention programs serving African American, Hispanic, Asian 
American and Native American communities.
  Unfortunately, the Republicans in Congress cut the funding for the 
Minority AIDS Initiative from its maximum level of $411 million in 
fiscal year 2003 to under $400 million today. Meanwhile, the need for 
the initiative has continued to grow as the disease has continued to 
spread.
  This year, I am calling for an appropriation of $610 million for the 
Minority AIDS Initiative in fiscal year 2008. So far, a total of 62 
Members of Congress have agreed to sign a letter in support of this 
level of funding. I am hoping to convince additional Members to support 
the expansion of the initiative before this week is over.


                                Diabetes

  Diabetes is the sixth leading cause of death in the United States, 
and it has a particularly severe impact on minorities.
  The Centers for Disease Control and Prevention estimates that 9.5 
percent of Hispanic Americans, 12.8 percent of American Indians and 
Alaska Natives, and 13.3 percent of African Americans over the age of 
20 have diabetes. Many Asian Americans are also at high risk.
  Diabetes can lead to serious and sometimes deadly complications, 
including high blood pressure, heart disease, stroke, blindness, kidney 
disease, and nerve damage.
  Too often, some of these complications result in lower-limb 
amputations.
  Minorities with diabetes often lack access to proper health care and 
are more likely to suffer from complications.
  Because of these disparities, I introduced H.R. 1031, the Minority 
Diabetes Initiative Act.
  This bill would establish an initiative to provide grants to 
physicians, community-based organizations, and other health care 
providers for diabetes prevention, care, and treatment programs in 
minority communities.
  The Minority Diabetes Initiative is based on the successful model of 
the Minority AIDS Initiative.
  This bill would help to reduce diabetes disparities and improve the 
ability of minorities with diabetes to live healthy and productive 
lives.
  The bill has 40 cosponsors, representing both political parties.


                                 Cancer

  Health disparities also affect minorities who suffer from cancer.
  Blacks have a cancer death rate that is about 35 percent higher than 
whites.
  The mortality rates for blacks with breast, colon, prostate and lung 
cancer are much higher than those for any other racial group.
  Black and Hispanic women are less likely to receive breast cancer 
screening with mammograms than white women.
  Black and Hispanic men are more likely to be diagnosed with more 
advanced forms of prostate cancer than white men.
  The incidence of prostate cancer is approximately 60 percent higher 
among African-American men than white men, and the death rate from 
prostate cancer is 2.4 times higher in African-American men than white 
men. This is the largest racial disparity for any type of cancer.
  Earlier this year, I introduced H.R. 1030, the Cancer Testing, 
Education, Screening and Treatment (Cancer TEST) Act. This bill would 
provide grants for cancer screening, counseling, treatment and 
prevention programs for minorities and underserved populations.
  The Cancer TEST Act would authorize grants for the development, 
expansion and operation of programs that provide public education on 
cancer prevention, cancer

[[Page H3767]]

screenings, patient counseling services and treatment for cancer.
  Grants would be made available to community health centers and non-
profit organizations that serve minority and underserved populations.
  The Cancer TEST Act would emphasize early detection and provide 
comprehensive treatment services for cancer in its earliest stages, 
when treatment is most likely to save lives.
  The bill has 29 cosponsors.

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