[Congressional Record Volume 153, Number 91 (Thursday, June 7, 2007)]
[Senate]
[Pages S7350-S7353]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KENNEDY (for himself, Mr. Cochran, Mr. Obama, Mr. 
        Bingaman, Mrs. Clinton, Mr. Brown, and Mr. Durbin):
  S. 1576. A bill to amend the Public Health Service Act to improve the 
health and healthcare of racial and ethnic minority groups; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. KENNEDY. Mr. President, serious and unjustified health 
disparities continue to exist in our Nation today. Forty five million 
Americans have no health insurance and often don't get the health care 
they need or get it too late. We know that the uninsured are more 
likely to delay doctor visits and needed screenings like mammograms and 
other early detection tests which can help prevent serious illness and 
death. The Institute of Medicine estimates that at least 18,000 
Americans die prematurely each year because they lack health coverage.
  Some of the most shameful health disparities involve racial and 
ethnic minorities. African Americans have a lower life expectancy than 
Whites. They are much more likely to die from stroke, and their 
uninsurance rates are much higher than those of their White 
counterparts.
  Many Americans want to believe such disparities don't exist, but 
ignoring them only contributes more to the widening gap between the 
haves and have-nots.
  It is a scandal that people of color have greater difficulty 
obtaining good health care than other Americans. Your health should not 
depend on the color of your skin, the size of your bank account, or 
where you live. In a nation as advanced as ours, with its state-of-the-
art medical technology for preventing illness and caring for the sick, 
it is appalling that so many health disparities continue to exist.
  That is the reason why I am introducing the Minority Health and 
Health Disparity Elimination Act, as part of our effort to reduce or 
eliminate these unacceptable differences in the health and health care 
of racial and ethnic minorities.
  The bill includes grants and demonstration projects that will help 
communities promote positive health behaviors and improve outreach, 
participation, and enrollment of racial and ethnic minorities in 
available health care programs. The bill will also establish 
collaborative partnerships led by community health centers. In 
particular it will support the Delta Health Initiative Rural Health, 
Education, and Workforce Infrastructure Demonstration Program to 
address longstanding, unmet health and health care needs in the 
Mississippi Delta
  In addition, the bill codifies the Centers for Disease Control and 
Prevention's Racial and Ethnic Approaches to Community Health Program, 
so that this successful program can continue to assist communities to 
mobilize and organize resources to support effective and sustainable 
programs to help close the health and health care gap. It also 
establishes Health Action Zones to support State, tribal or local 
initiatives to improve minority health in communities that have been 
historically burdened by health disparities.
  Greater diversity in the health care workforce is essential to 
creating a healthy America. Studies demonstrate that minority health 
professionals are more likely to care for minority patients, including 
those who are low-income and uninsured. African Americans, Hispanic 
Americans, and Native Americans account for only 6 percent of the 
Nation's doctors and 5 percent of nurses and dentists, even though they 
are almost one-quarter of the U.S. population. The disparity in the 
health workforce must be closed, not just to fulfill our commitment to 
equality and opportunity, but also because of the impact it has on the 
health of America.
  The act reauthorizes the title VII health care workforce diversity 
programs, including the Centers of Excellence at Historically Black 
Colleges and Universities and institutions that educate Hispanic and 
Native American students.
  A diverse health care workforce is essential for a healthy country. 
Emphasizing workforce diversity does not mean that health care workers 
should not be prepared to work with diverse patients. We must also make 
a more serious effort to train culturally competent health care 
professionals, and to create a health care system that is accessible 
for the more than 48 million Americans who speak a language other than 
English at home. The bill creates an Internet clearinghouse to increase 
cultural competency and improve communication between health care 
providers and patients. It also supports the development of curricula 
on cultural competence in health professions schools.
  Language barriers in health care obviously contribute to reduced 
access and poorer care for those who have limited English proficiency 
or low health literacy. The legislation recognizes the importance of 
this issue for the quality of our health care system and provides funds 
for activities to improve and encourage services for such patients.
  The bill reauthorizes the National Center for Minority Health and 
Health Disparities that was created as part of the Minority Health and 
Health Disparities Research and Education Act of 2000. It strengthens 
the center's role in coordinating and planning research that focuses on 
minority health and health disparities at the National Institutes of 
Health. The bill also requires the Agency for Health care Research and 
Quality to establish a grant program to support private research 
initiatives and a public-private partnership to evaluate and identify 
the best practices in disease management strategies and interventions.
  In addition, the bill ensures that research on genetic variation 
within and between populations includes a focus on racial and ethnic 
minorities. It also promotes the participation of racial and ethnic 
minorities in clinical trials and intensifies efforts throughout the 
Department of Health and Human Services to increase and apply knowledge 
about the interaction of racial, genetic, and environmental factors 
that affect people's health.
  Finally, the bill reinforces and clarifies the duties of the Office 
of Minority Health and instructs the office to develop and implement a 
comprehensive department-wide plan to improve minority health and 
eliminate health disparities. It also encourages greater cooperation 
among federal agencies and departments in meeting these serious 
challenges.
  We have worked diligently with a wide variety of organizations on 
this bill that are eager for strong legislation to eliminate health 
disparities. The following groups have expressed their support: Aetna, 
American Association of Colleges of Pharmacy, American Heart 
Association/American Stroke Association, American Public Health 
Association, Asian American and Pacific Islander Health Forum, 
Association for Community Affiliated Plans, Association of Minority 
Health Professions Schools, California Pan-Ethnic Network, Charles R. 
Drew University of Medicine and Science, Families USA, Harvard Medical 
School, Massachusetts General Hospital, Meharry Medical College, 
Morehouse School of Medicine, National Association of Community Health 
Centers, National Association of Public Hospitals and Health Systems, 
National Coalition for Hispanic Health--Campaign for Tobacco Free Kids, 
Hispanic Association of Colleges and Universities, League of United 
Latin American Citizens, National Council of La Raza, National Hispanic 
Caucus of State Legislators, National Hispanic Medical Association, 
National Puerto Rican Coalition--National Council of La Raza, National 
Health Law Program, National Hispanic Medical Association, National 
Medical Association, Network Health, Racial and Ethnic Health 
Disparities, REHDC, and Summit Health Institute for Research and 
Education.
  I look forward to working with these dedicated groups as we work 
towards final passage of this bill.
  I greatly appreciate the cooperation of Senator Cochran, Senator 
Obama, Senator Bingaman, Senator Clinton, Senator Brown, and Senator 
Durbin on this legislation, and I look forward to working with my 
colleagues to enact this much needed legislation.
  Mr. OBAMA. Mr. President, this Nation has witnessed dramatic 
improvements in public health and health care technology and practice 
over the last century. Diseases that were once life-threatening are now 
curable; conditions that once devastated are now treatable. Our Federal 
investment in

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medical research has paid off handsomely, with new and more effective 
tests and treatments and near daily reports of new scientific 
breakthroughs. Yet still today too many Americans have not and will not 
derive full benefit from these advances.
  We know that minority Americans and other vulnerable populations 
needlessly continue to experience higher rates of disease and lower 
rates of survival, and this is simply unacceptable. As we in the 
Congress work to combat the serious health issues that threaten the 
well-being of all Americans, we must also remain vigilant and committed 
in our fight to address the persistent and pervasive health disparities 
that affect millions of minorities, low-income individuals and other 
at-risk populations.
  Congress has passed legislation before to address the health of 
minority populations and eliminate health disparities--the Minority 
Health and Health Disparities Research and Education Act of 2000. That 
bill created the National Center for Minority Health and Health 
Disparities, supported the landmark IOM report Unequal Treatment, 
required annual reporting on health care disparities by AHRQ, and 
strengthened the research base for many HBCU's, among many other 
provisions.
  Since that bill passed, our knowledge and understanding about the 
root causes of these disparities has dramatically increased. Efforts to 
strengthen the research infrastructure needed to investigate health 
concerns among people of color have been quite effective. Momentum has 
also accelerated in the medical and public health communities as 
advocates' voices are heard more and more, with new interventions being 
implemented and evaluated. All of these positive steps and advances 
have helped to raise minority health as a national priority. However, 
despite this activity, much work remains to be done in order to close 
the gap and eliminate health and health care disparities.
  Study after study reveals the stark line of health disparity drawn 
between minorities and whites. In cancer alone, the numbers are hard to 
overlook. In 2004, African American men were 2.4 times as likely to die 
from prostate cancer, as compared to white men. For heart disease, the 
statistics are equally compelling: 2004 data show that when compared to 
white men, African American men were 30 percent more likely to die from 
heart disease, and American Indian adults were 30 percent more likely 
to have high blood pressure.
  The underlying factors for health disparities are multi-factorial. 
Our individual genetic makeup certainly contributes to differences in 
rates of disease and mortality in diverse populations. However, other 
factors play an equal if not greater role. We know that minority and 
low-income Americans are disproportionately less likely to live in 
communities that promote healthy behaviors and choices through access 
to wholesome foods and opportunities for physical activity, and that 
protect from exposure to environmental toxins and violence. In 
addition, minority Americans are less likely to have health coverage 
and thus more likely to experience difficulties accessing the health 
care system, which leads to delayed diagnoses and foregone care. And 
last but not least, we know that minority Americans are less likely to 
receive medical care that meets recommended or accepted standards of 
practice, when compared to White Americans. As an example, the American 
Journal of Public Health has reported that more than 886,000 deaths 
could have been prevented from 1991 to 2000 if African Americans had 
received the same level of health care as Whites.
  For all of these reasons, I am joining my colleagues Senator Kennedy 
and Senator Cochran in introducing the Minority Health Improvement and 
Health Disparity Elimination Act of 2007. This critical legislation has 
a number of important provisions to help us achieve our goal to improve 
the health status of minority and other underserved populations. First, 
this bill strengthens education and training in cultural competence and 
communication, which is the cornerstone of quality health care for all 
patients. It also reauthorizes the pipeline programs in title VII of 
the Public Health Service Act, which seek to increase diversity in the 
health professions. We all know that the door to opportunity is only 
half open for minority students in the health professions. The 
percentage of minority health professionals is shockingly low--African 
Americans, Hispanics and American Indians account for one-third of the 
Nation's population but less than 10 percent of the Nation's doctors, 
less than 5 percent of dentists and only 12 percent of nurses. We can--
and must--do better.
  Lack of workforce diversity has serious implications for both access 
and quality of health care. Minority physicians are significantly more 
likely to treat low-income patients, and their patients are 
disproportionately minority. Studies have also shown that minority 
physicians provide higher quality of care to minority patients, who are 
more satisfied with their care and more likely to follow the doctor's 
recommendations.
  Second, this bill expands and supports a number of initiatives to 
increase access to quality care. Specifically, the legislation 
authorizes demonstration grants to improve access to healthcare, 
patient navigators, and health literacy education services. 
Additionally, partnerships modeled after the Health Disparity 
Collaboratives at the Bureau of Primary Health Care are supported 
through established grants. The REACH program at Centers for Disease 
Control and Prevention--designed to assist communities in mobilizing 
and organizing resources to support effective and sustainable programs 
to reduce health disparities--is established under this bill. And I am 
pleased that the Health Action Zone Initiative has also been 
authorized. This new environmental public health program was introduced 
as part of the Healthy Communities Act of 2007 that I introduced 
earlier this year, and guides and strengthens community efforts to 
improve health in comprehensive and sustained fashion.
  A third area of focus is expansion and acceleration of data 
collection and research across the agencies, including the Agency for 
Healthcare Research and Quality and the National Institute of Health, 
with special emphasis on translational research. The tremendous 
advances in medical science and health technology, which have benefited 
millions of Americans, have remained out of reach for too many 
minorities, and translational research will help to remedy this 
problem. The National Center on Minority Health and Health Disparities, 
which has a leadership role in establishing the disparities research 
strategic plan at the National Institutes of Health, is reauthorized. 
And a new advisory committee has been established at the Food and Drug 
Administration to focus on pharmacogenomics and its safe and 
appropriate use in minority populations, another issue area that I 
championed as part of my Genomics and Personalized Medicine Act of 
2006.
  Last but not least, I want to highlight that the bill strengthens and 
clarifies the duties of the Office of Minority Health. This office has 
been critical in providing the leadership, expertise and guidance for 
health improvement activities across the agencies of the Department of 
Health and Human Services, and has helped to ensure coordination, 
collaboration and integration of such efforts as well.
  In conclusion, I want emphasize that it is past time to expand and 
accelerate our work in a of minority health beyond the initial 
bipartisan effort Congress achieved in 2000. We have got to translate 
the knowledge we have gained into practical and effective interventions 
that will improve minority health and eliminate disparities, and this 
bill will help us do just that.
  I urge my colleagues to join me in cosponsoring and passing this 
critical legislation. Regardless of how you measure it, whether by 
needless suffering, lost productivity, financial costs, or lives lost, 
disparities in health and health care are a tremendous problem and a 
moral imperative for our Nation, and one that is within our power to 
address right now.
  Mrs. CLINTON. Mr. President, I am pleased to join Senators Kennedy, 
Cochran, Bingaman, Obama, Durbin and Brown in introducing the Minority 
Health Improvement and Health Disparity Elimination Act 2007.
  As we debate health care issues, we often discuss what is wrong with 
our health care system: Costs are spiraling upward, the ranks of 
uninsured have

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increased, and the strains on our system and its ability to provide 
quality care have worsened. And while the impact of these situations 
are felt by all Americans, the problems with our health care system 
often disproportionately impact our racial and ethnic minority 
populations.
  We continue to have disparities in health care for our minority 
populations--disparities in access, disparities in quality, and 
disparities in outcomes. The Agency for Healthcare Research and Quality 
(AHRQ) tracks these in its annual National Healthcare Disparities 
Report, aggregating data from a variety of Federal health surveys and 
databases. And the findings from the report are staggering, inc1uding 
the following: Minorities had worse access to care than whites; Blacks 
and Hispanics received poorer quality care than Whites on more than 70 
percent of the measures used by AHRQ; and While gains were made on 
approximately one-quarter of the quality indicators, disparities 
actually got worse for all minority populations on one-third of the 
quality indicators.
  These system wide disparities have translated into increased burden 
of disease for our racial and ethnic minority populations.
  HIV/AIDS is devastating our African-American communities. Blacks 
account for about half of all new HIV/AIDS diagnoses. In New York City, 
the rate of new HIV diagnoses is six times higher among Blacks than 
Whites. In addition, the AIDS case rate among Hispanic populations is 
about 3.5 times higher than that of Whites.
  The incidence of asthma is highest among Puerto Rican populations, 
with 22 percent of these individuals receiving a diagnosis of asthma, a 
rate roughly double that of White populations. Although African-
Americans have slightly higher rates of asthma than White populations, 
they experience disparities in asthma management and access to care. 
The emergency department visit rate for Blacks seeking asthma treatment 
was 350 percent higher than that of the rates for Whites, while the 
hospitalization rate for Blacks with asthma was 240 percent higher than 
that for Whites with asthma.
  One out of every 10 Asian Americans will be diagnosed with diabetes. 
Among all Americans with diabetes, Blacks are about two times more 
likely to require amputations, two to five times more likely to have 
kidney disease, and twice as likely to suffer from diabetes-related 
blindness.
  The impact of health disparities are experienced not only by racial 
and ethnic minority communities but by all of us. They are symptomatic 
of the underuse and misuse of health care. And the costs associated 
with these disparities--such as delayed diagnoses and complications 
that result from lack of access to primary care--add unnecessary costs 
to our health care system.
  The Minority Health Improvement and Health Disparity Elimination Act 
of 2007 would allow us to address healthcare disparities through a 
variety of mechanisms.
  The bill will create a cultural competency clearinghouse, helping 
providers to understand, first of all, the concept of cultural 
competence, and second, how to better tailor care to their patients of 
diverse backgrounds. We cannot, for example, ask a person with diabetes 
to make changes to their diet if we do not understand what foods are 
part of their diet. Having a culturally competent health care system is 
especially important in my home State of New York, where our residents 
come from all over the world. With the information that will be 
available in this clearinghouse, we will make it easier for both 
patients and providers to communicate and understand essential concepts 
of care.
  The Minority Health Improvement and Health Disparity Elimination Act 
will improve health professions programs that increase recruitment and 
retention of underrepresented minorities in the health professions. New 
York's population is 15 percent Black and 15.6 percent Hispanic, yet 
the percentage of Black physicians practicing in our State is 3.2 
percent, and the percentage of Hispanic physicians practicing in our 
State is 2.3 percent. This bill will reauthorize the Centers of 
Excellence established by the Health Resources and Services 
Administration, HRSA--a program that has benefited the Mt. Sinai School 
of Medicine--and establish new programs to train mid-career individuals 
in the health professions.
  It will codify currently existing health promotion and disease 
prevention activities targeted toward racial and ethnic minorities, 
including the Centers for Disease Control and Prevention's Racial and 
Ethnic Approaches to Community Health, REACH. REACH grantees working in 
northern Manhattan have managed to increase childhood immunization 
rates by 10 to 15 percent. It will also codify the Health Disparities 
Collaboratives program operated by HRSA, through which health centers 
across the country focus on improving their treatments for specific 
diseases, or implementing models to improve patient care. These centers 
include Whitney Young Health Center in Albany, NY, which, through this 
collaborative, successfully helped more than 200 patients learn how to 
manage their asthma.
  The legislation will establish new programs to increase community 
health workers, address environmental health concerns, and improve 
outreach and enrollment, thus reducing barriers to accessing care. It 
will increase support for the Agency for Healthcare Research and 
Quality's research into healthcare disparities and help to improve 
overall data collection.
  The Minority Health Improvement and Health Disparity Elimination Act 
will reauthorize the National Center for Minority Health and Health 
Disparities at the National Institutes of Health, which is designed to 
conduct and support health disparities research; disseminate 
information about disparities, and reach out to racial and ethnic 
minority disparity communities. Through the Center, New York University 
received support for its Center for the Study of Asian American Health, 
a collaboration between researchers, health providers, and community 
organizations that is designed to reduce the disparities faced by Asian 
Americans in New York City.
  Finally, the legislation would reauthorize and strengthen the Office 
of Minority Health, OMH, at HHS, requiring it to develop a National 
Action Plan to address disparities in collaboration with other Federal 
health agencies. The OMH has provided support to New York's Office of 
Minority Health, as well as community-based organizations in Syracuse, 
Buffalo, and Lower Manhattan, and this reauthorization of the office 
will allow them to support and sustain more programs at the State and 
local level.
  I am excited about this legislation because I have seen what happens 
in communities when we come together--providers, researchers, and 
neighborhood leaders--to address these concerns. Last month, the 
University of Rochester and the Monroe County Health Department 
announced that an initiative to increase pneumococcal immunization 
rates in African-American seniors resulted in a more than 30-percent 
gain in immunization rates--protecting more New Yorkers against 
pneumonia and reducing the vaccination disparity between Blacks and 
Whites.
  I believe that the Minority Health Improvement and Health Disparity 
Elimination Act will allow us to create, maintain, and support this 
type of collaboration across the Nation. It will make a real change in 
the health care for our minority communities and improve the quality of 
care received by all Americans. I look forward to working with my 
colleagues in Congress to pass this legislation as quickly as possible.
  Mr. DURBIN. Mr. President, Abraham Lincoln once said, ``The 
declaration that `all men are created equal' is the great fundamental 
principle upon which our free institutions rest.''
  As a Senator representing the distinguished land of Lincoln, I take 
seriously our Nation's promise for equality, particularly when it comes 
to health care.
  I rise today as a strong and proud cosponsor of the Minority Health 
Improvement and Health Disparity Elimination Act of 2007--an important 
piece of legislation, long in the making, and long overdue.
  Not since 2000 has our Congress made a concerted effort to address 
the health of some of our most at-risk populations--people of color.

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  In these 7 years, we have not seen a substantial improvement in the 
health status of people of color.
  Cervical cancer, a disease that can be greatly reduced by effective 
health care, is five times more common among Vietnamese women in the 
United States than it is among Caucasian women.
  African Americans with diabetes are seven times more likely to have 
amputations and develop kidney failure than are Caucasians with 
diabetes.
  In Chicago's Latino community, you will likely find one in two Latino 
children who are obese, a condition that often leads to the onset of 
diabetes.
  In the hospitals of East St. Louis, it's likely that African-American 
babies die at more than double the rate of White infants.
  In the small town of Cairo, families have to travel hours to other 
parts of the State and sometimes even to other States to obtain the 
right care.
  In general, we are making progress in prolonging life. Death rates 
for Whites, African Americans, and Latinos from many of our most 
debilitating diseases have declined during the last decade. But what 
progress are we making on quality of life during those extra years? Is 
the answer different depending on the racial or ethnic minority groups? 
Simply speaking, yes.
  Even when controlling for insurance coverage and economic status, 
racial and ethnic minorities tend to have less access to health care 
and a lower quality of health care than their Caucasian counterparts.
  The Centers for Disease Control and Prevention has reported that, 
among a wide range of health indicators, ``relatively little progress 
has been made toward the goal of eliminating racial/ethnic 
disparities.''
  In general, yes, Americans are healthier, but the shameful gaps 
between minority groups and Caucasians remain nearly the same as a 
decade ago.
  When will we as a nation demand more and work harder to reach that 
ideal of equality that is a pillar of our Nation's moral strength?
  This legislation is a critical step toward achieving that notion of 
equality: the belief that we are all created equal and as such should 
have equal access to quality care.
  Why is it that this country spends so much more than any other 
industrialized country on its health care, but has consistently lagged 
behind other countries in delivering better health outcomes? Why is it 
that one in six Americans, almost one in three African Americans, 
almost one in two Latino Americans, are uninsured? Why do our health 
outcomes not reflect the $2 trillion investment we make in health care 
each year? There is a disconnect between the rhetoric around our 
Nation's health crisis and where our resources are placed. It is a 
shame, and we can do better.
  Our health workforce should reflect, understand, and respect the 
backgrounds, experiences, and perspectives of the people it serves. We 
need to recruit, train and retain health care professionals from 
underrepresented groups and underserved areas.
  In areas like downstate Illinois, small communities rely heavily on 
Federal incentives, such as loan repayment, the Health Careers 
Opportunity Program, and Centers of Excellence to create a critical 
pipeline of professionals.
  Graduates of title VII programs are more likely to serve in 
underserved areas. That is the outcome we want, so we need to support 
successful programs like these.
  In addition to improving the diversity of our workforce, we need to 
redouble efforts to fight diseases that disproportionately affect 
racial and ethnic minorities--diseases like diabetes, heart disease, 
breast cancer and so many others.
  To accurately respond to the presence of health care disparities and 
try to address them, we need better data on health care access and 
utilization that includes race, ethnicity, primary language, and socio-
economic status. To develop accurate solutions, we need accurate 
information on prevalence, contributing factors, and effects of health 
care disparities.
  The Minority Health Improvement and Health Disparity Elimination Act 
of 2007 is a critically important step toward improving the access, 
workforce, research and information that will close the color gap that 
exists in health care today. I look forward to working with my 
colleagues to improve the health of all Americans and, specifically, to 
eliminate health disparities that hurt our communities of color, and 
all of us.
  I did not always agree with the former majority leader, Senator 
William H. Frist, but I couldn't agree more with his statement that, 
``Inequity is a cancer that can no longer be allowed to fester in 
health care.''
  I urge my colleagues to support the health disparity legislation 
introduced today.
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