The Health Disparities Movement: Looking back, looking ahead

May 20, 2015 | by Abe Rosenberg

“Of all forms of inequality, injustice in the health care system is the most shocking and inhumane.”

Health Disparities movement CCARE helps underserved populations learn more, live healthier and receive better care.

By the time the Rev. Martin Luther King Jr. spoke those words in Chicago in 1966, the Civil Rights Act had been passed, the Voting Rights Act was the law of the land and the March on Washington was a 3-year-old memory. Yet King clearly recognized his work was far from complete. He knew he needed to advocate for what's been called “America's forgotten civil right.”

At about the same time, a group of psychologists gathered at the Swampscott Conference in Boston, where they began to shift their thinking from individual practice to the still-new realm of community psychology. It wasn't enough, they realized, to treat a single patient when his or her community may be in crisis. A broader view was needed, one that examined social justice, diversity, empowerment, citizen participation ... and yes, prevention and health promotion.

Nevertheless, it would be nearly two more decades before minority health inequality received the national attention it deserved. The big change came in 1985 when Health and Human Services Secretary Margaret M. Heckler issued the landmark Report of the Secretary's Task Force on Black and Minority Health. The Heckler Report, as it became known, laid out for the first time extensive data documenting health disparities in minority communities, calling the situation "an affront both to our ideals and to the ongoing genius of American medicine." The Heckler Report helped motivate Congress to create the federal Office of Minority Health, reauthorized in 2010 as part of the Affordable Care Act.

So, 50-plus years after those first stirrings, and 30 years after Washington took notice, where are we today?

“We've made great strides,” says Kimlin Tam Ashing, Ph.D., director of City of Hope's Center of Community Alliance for Research & Education (CCARE). “Medical advances have trickled down to all communities, improving all of our lives. But gaps still persist. African-American women, for example, still have a lower breast cancer survival rate than white women, and whites of both genders have a higher colorectal cancer survival rate compared to blacks.”

How CCARE makes a difference

CCARE plays a critical role in advancing the health disparity movement and reducing minority health care gaps. Building on the foundation created by the Heckler Report, CCARE goes into neighborhoods, identifies inequalities and crafts programs to alleviate them. Embracing the community psychology concept, CCARE helps underserved populations learn more, live healthier and receive better care.

The people of CCARE bring their personal passions to that mission. They see progress being made, as well as challenges still in place.

Noe Chavez, Ph.D., a population researcher, grew up in El Paso, Texas. He remembers visiting family across the border in Juarez, Mexico, and seeing shanty homes with no running water. We are better off in America, he says, but pockets of poverty remain, as does a lingering ignorance of Latino history in many quarters, including parts of the medical education community.

“I was struck by the lack of inclusion of issues of race and racism in the manuscripts and medical school curriculum presented,” he said.

Chavez's colleague Aria M. Miller, Ph.D. comes from a middle-class African-American family that “wasn't poor, but we didn't have all we need.” Her parents experienced overt racism that's less evident today, though not entirely gone.

“My parents were kids in the early days of the Civil Rights movement," she said. "Their birth certificates listed my grandparents' race as 'Negroid.' Dad thought about becoming a doctor but he saw too much discrimination in his way, even though he'd been a medic in Vietnam.”

Much work remains

Such direct bias may no longer exist, but it's a fact that, while the percentage of Asian and Latino men in medical schools is growing, the African-American percentage stands at a paltry 2.5 percent, and it's dropping.

The contradictions can seem maddening. “We have a biracial, African-American president,” Ashing said, “while we have a lower proportion of African-American men earning doctoral degrees. We have a health secretary who is a person of color while the number of chronic illnesses linked to early deaths continues to climb, particularly among ethnic minorities.”

Many hope the Affordable Care Act will be a powerful equalizer, bringing quality health care to more people of all backgrounds. It's too soon to tell. But all agree that better education, especially among the young, can make a substantial difference. CCARE puts that belief into practice with a variety of youth programs including a partnership with Neighbors Acting Together Helping All and its unique “Eat, Move, Live” program.

“The better educated our young people are,” said  Miller, “the more they can influence their wider communities, change old attitudes and really make a difference. That's the key.”

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