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The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication. 1. Minority Births on Track to Outnumber White Births 7. Minority Leaders Call for Response to Racial Disparity in Unemployment Rate 9. Employers Target Racial, Ethnic Health Disparities DISPARITIES IN RESEARCH 10. Racial/Ethnic Differences in Early-Life Risk Factors for Childhood Obesity 11. Doctors' and Nurses' Explanations for Racial Disparities in Medical Treatment 12. Reducing Disparities and Improving Quality: Understanding the Needs of Small Primary Care Practices DISPARITIES DATA SPOTLIGHT Reduced Access to Medical Care in the Past Year Due to Cost, by Race/Ethnicity, 2007
DISPARITIES IN THE NEWS 1. Minority Births on Track to Outnumber White Births Experts say that 2010 could be the year in which babies born to minorities outnumber babies born to whites, the Associated Press reports. According to the Census, 52% of U.S.-born babies in 2008 were white, compared to 25% who were Hispanic, 15% black, 4% Asian, and 4% who were multiracial. Only 37% of the children born in 1990 were of a racial or ethnic minority group. Kenneth Johnson, a sociology professor at the University of New Hampshire explained that the trend of increasing minority births is due in part to a greater number of Hispanic women of childbearing age, who tend to have more children on average than women of other racial or ethnic groups. In addition, he said that more white women are waiting to have children, but it is unclear what effect this may have on the increasing share of minority births. This trend also has implications for the 2010 Census, which is "used to distribute federal aid and redraw legislative boundaries with racial and ethnic balance, as required by federal law." Young children, and particularly those from racial and ethnic minority groups, are often missed in the population count which occurs only once every 10 years. Census Bureau director Robert Groves, explains, "If we fail to count a newborn that is born this month, that newborn misses all the benefits of the census for 10 years" (Yen, 3/10) A limited number of black bone marrow donors means black patients are less likely than whites to get potentially lifesaving bone marrow transplants, The Herald News (West Paterson, NJ) reports. As the marrow of donors and recipients must match closely in order to have a successful transplant, patients are more likely to match someone of their own race or ethnicity. But with blacks accounting for only 7% (~600,000) of the 8 million people registered with the National Marrow Donor Program, their chances of being matched are limited. Donor shortage is also a problem among Asians and Hispanics, and people of mixed-race are also difficult to match. These shortages have "prompted Congress and health officials to launch initiatives aimed at encouraging minorities to sign up as potential donors." "'The greatest problem, the reason we don't have more African-American bone marrow donations is that awareness is lacking,' said Dr. Dorian J. Wilson, an associate professor of surgery at the University of Medicine and Dentistry of New Jersey" (Groves, 3/7). 3. Healthcare Gap Persists for Minority Women According to a new report from the Los Angeles County Department of Public Health, low-income and minority women in Los Angeles County report poor access to care and poor health status, The Los Angeles Times reports. The report, "Health Indicators for Women in Los Angeles County," found that Asian women reported relatively low rates of preventive care, including the lowest Pap test and mammography rates of any racial and ethnic group; uninsured women had lower rates of mammography than their publicly or privately-insured counterparts (54% vs. 68% and 79%); and "Latinas reported the poorest health status of women in all ethnic groups…with more than a third lacking health insurance." In addition, "[o]ne of the most important or startling findings is the fact that African American women continue to have the greatest health disparities and have far higher mortality rates than other women," said Dr. Rita Singhal, a report author. Lark Galloway-Gilliam, executive director of the L.A. health advocacy group, Community Health Councils, said, "[w]e have to look at the role of public policy in dictating the access to care and the ability for people to stay healthy," noting a recent example of the governor restricting access to a free breast cancer screening program at sites that serve many low-income women of color (Hennessy-Fiske, 3/6). 4. Lessons at Indian Hospital About Births The hospital of The Tuba City Regional Health Care Corporation in Arizona—operated by the Navajo Nation and partly financed by Indian Health Service—outperforms many richer and more well-known hospitals in the U.S. in keeping rates of Caesarean births low, which are more costly than vaginal births, expose mothers and infants to surgical risks, and are considered "overused" by some, The New York Times reports. The hospital, which has about 500 births per year, had a Caesarean rate of 13.8% last year, compared to a national rate of 31.8% in 2007 (the most recent year for which data were available)—a rate that has been rising steadily for the past 11 years. This is despite high rates of diabetes and high blood pressure among the population which can result in higher Caesarean rates. In addition, 32% of women with prior Caesareans had vaginal births in Tuba City last year, a practice that peaked in the U.S. in 1996 and is still being debated today. The lower rates of Caesareans in Tuba City are thought to be due, in part, to the hospital and doctors being protected against malpractice even if they allow vaginal births after Caesarean (VBAC), as they are insured through the federal government. The use of nurse-midwives for vaginal births has also been cited as midwives "often wait longer than obstetricians before recommending a Caesarean," and "are also less likely to try to induce labor before a woman's due date, something that increases the odds of a Caesarean." In addition, doctors and midwives in Tuba City are salaried, and have no financial incentives to perform Caesarians. Navajo culture and customs are also thought to play a role (Grady, 3/6). 5. Congressional Black Caucus Calls for More Equality in Health Care Reform In identical letters sent to President Obama and the Democratic congressional leaders prior to the recent White House health care summit, Congressional Black Caucus (CBC) Chairwoman, Barbara Lee (D-CA), and Chairwoman of the CBC's Health Braintrust, Donna Christensen (D-VI), urged leaders to ensure that the final health reform proposal includes, "robust provisions to ensure that our nation's health system is one that will be an integral part of the solution to health disparity elimination," POLITICO reports. While Lee and Christensen praised some efforts to include provisions aimed at addressing racial and ethnic disparities in previous versions of the reform proposals as well as in the proposal recently put forth by the President, they note important four areas not addressed by Obama's plan: "Giving parity to Americans who live in U.S. territories, many of whom are minorities; strengthening the Health and Human Services Department's ability to measure and address disparities; bolstering language services and expanding community health centers." Lee and Christensen write that they want to ensure that health care is reformed in a way that "improves the health, wellness and thus life opportunities of every American, regardless of race, ethnicity, language preference, or geography" (Allen 2/25). 6. Recession Hits Older Blacks in What Should Be Their Prime According to a study by the American Association of Retired Persons (AARP), the current economic recession has impacted African Americans ages 45 and older harder than the rest of the older population over the past year, McClatchy Newspapers reports. The telephone-based survey of 1,407 adults aged 45 and older, including a sample of 405 African Americans, found that twice as many older blacks reported cutting back on medications, problems paying rent or mortgage, borrowing money to pay living expenses, seeking cash assistance from outside sources, and taking training to find a different job in the past year compared to the rest of the older population. In addition, a higher proportion of older blacks than all older adults reported losing a job (18% vs. 10%), having problems paying for essential items like food and utilities (44% vs. 23%), and losing employer-based health insurance (23% vs. 13%). "The data reinforces what many experts have said for months: that the recession is really a depression for many blacks, particularly in areas where black unemployment hovers around 20 percent" (Pugh, 2/23). 7. Minority Leaders Call for Response to Racial Disparity in Unemployment Rate "[L]eaders of minority and civil-rights groups are calling for a stronger response from Congress and the Obama administration" to high unemployment rates among racial and ethnic minorities, the Denver Post reports. With the unemployment rate for blacks (16.5%) nearly twice that of whites (8.7%), and a high rate for Latinos (12.6%) as well, Rep. Emanuel Cleaver (D-MO), chairman of the Congressional Black Caucus' (CBC) jobs task force says, "The times require that the federal government step in and provide temporary employment opportunities…We are alarmed and trying desperately to alarm the House and Senate leadership along with the White House that we are either going to create jobs or create havoc." Education levels, the types of jobs that minorities hold, and insufficient job training, coupled with the current economic recession, are among the factors that contribute to these high rates. Minority groups recommend "extending unemployment insurance, fast-tracking public-sector job creation and giving more fiscal relief to states." The CBC is looking to create a summer employment program for disadvantaged youth as a way to help combat the number of uninsured blacks and Latinos, overall. *** In Colorado, 14.7 percent of blacks and 10.5 percent of Latinos, compared with 6.9 percent of whites were unemployed last year. Denver-area employment agencies said they are seeing heavy use of their services by blacks and Latinos (Griffin, 2/22). 8. In San Diego, Hispanics Now Dominate HIV/TB Cases According to a study in American Journal of Public Health, Hispanics now account for 80 percent of the cases of tuberculosis/HIV co-infection in San Diego, "a significant change in the racial profile of the disease," HealthDay News reports. Analyzing 5,172 tuberculosis (TB) cases in San Diego County between 1993 and 2007, the study authors found that 8.8 percent of these patients were co-infected with HIV. While the number of new TB/HIV cases did not change significantly during this period, the proportion of cases among Hispanics increased significantly, while the proportion of cases among whites and blacks decreased. Dr. Timothy Rodwell, an author of the study from the University of California, San Diego, said in a university news release that this change "indicates that the benefits of prevention and treatment of TB and HIV over the last decade have been uneven in the different ethnic/racial groups in the region." He also noted that interventions to address this disparity would require the effort of both the U.S. and Mexico, as they found that most of the new TB/HIV co-infection cases occurred among Hispanics born in Mexico (Preidt, 2/17). 9. Employers Target Racial, Ethnic Health Disparities Some employers are promoting interventions to help address racial and ethnic health disparities among their employees, Business Insurance reports. "Employers invest millions of dollars in the health and well-being of their employees by providing disease management and wellness programs, but if these programs fail to take into account beneficiaries' racial and ethnic differences, employers miss opportunities to maximize their return on investment," explains Don Weber, managing director at PricewaterhouseCoopers L.L.P. in Atlanta. The H.E. Butt Grocery Co., based in San Antonio Texas, for example, is launching outreach programs designed to educate the company's Hispanic employees about the importance of a primary medical home and knowing their health status, after reviews of claims data revealed that many of their Hispanic employees did not have a primary care doctor and were not receiving adequate preventive care. Other employers tackle disparities through their health plans as many collect data on health disparities and develop targeted interventions to address them. Some stress, however, that race is only one of several factors employers need to consider when addressing health disparities among their workforce. "Race matters, but income and education matters even more," said H-E-B's director of benefits, Kathy Durbin. Employers "need to consider the socioeconomics of their workforce" (Wojcik, 2/15).
DISPARITIES IN RESEARCH 10. Racial/Ethnic Differences in Early-Life Risk Factors for Childhood Obesity In a new study in the journal, Pediatrics, researchers found that several early-life risk factors known to be associated with childhood obesity were more prevalent among black and Hispanic children than among their white counterparts. Analyzing 1,826 mother/child pairs (1343 white, 355 black, and 128 Hispanic) across a range childhood obesity-related risk factors from the prenatal, infancy, and early childhood periods, the authors found that black and Hispanic mothers had higher rates of maternal depression (odds ratio [OR]: 1.55 black; 1.89 Hispanic), lower rates of exclusive breastfeeding (OR: 1.50 black; 2.84 Hispanic), were more likely to introduce solid foods before 4 months of age (1.91 black; 2.04 Hispanic), and had higher rates of restrictive feeding (OR: 2.59 black; 3.35 Hispanic) than white mothers. Black and Hispanic children also had shorter amounts of daily sleep during infancy than white children (3.70 black; 2.53 Hispanic). After 2 years of age, the authors found that black and Hispanic children were much more likely than white children to have a television in their room (7.65 black; 7.99 Hispanic), drink more sugar-sweetened beverages (OR: 4.11 black; 2.48 Hispanic), and consume more fast food (OR: 1.65 black; 3.14 Hispanic). The authors suggest that black and Hispanic children's higher prevalence of early-life risk factors for childhood obesity may help to explain racial and ethnic disparities in rates of childhood obesity. They note that while more research is needed, their findings "provide a strong rationale for testing comprehensive interventions in early life to reduce disparities in obesity prevalence." 11. Doctors' and Nurses' Explanations for Racial Disparities in Medical Treatment A new study in the Journal of Health Care for the Poor and Underserved found that the doctors and nurses they interviewed tended to explain racial health care inequalities in four main categories of responses: Black patients' perceived shortcomings, White patients' demands, provider discrimination, and access to care. The research team conducted "semi-structured" interviews with 26 providers (18 doctors and 8 nurses) working in primary care or internal medicine clinics at a university-affiliated hospital or in Veteran's Administration medical centers. In explaining why Black patients are less likely to receive the same levels of medical care as Whites, 73% of the participants explained it in terms of Black patients' perceived shortcomings, including treatment adherence and substance abuse issues; 50% cited White patients' greater demands for care; 46% cited provider bias; and 50% explained it in terms of access to care issues, including Black patients having inferior levels of insurance coverage compared to Whites. While not the primary focus of their study, the authors also found that "[o]ver half of respondents responded to the interviewers' questions about racial disparities in care by questioning the details or validity of the research studies documenting the inequality." The researchers concluded that their findings should help to foster educational programs and campaigns and future research addressing perceptions of racial inequality in health care. 12. Reducing Disparities and Improving Quality: Understanding the Needs of Small Primary Care Practices A study in the journal, Ethnicity & Disease, found that small primary care practices—which provide a substantial proportion of care in the U.S.—are challenged in providing care for minority patients due, in part, to the disproportionate affect of resource and staff limitations on their ability to reduce disparities. Surveying 22 small practices from California and New Jersey with at least 25% minority patients about their ability to conduct quality improvement activities for minority and limited English proficiency patients, the authors found that practices cited challenges to reducing racial and ethnic disparities in care including the availability of health information technology, such as fully functioning electronic medical record systems; staffing and high staff turnover; language barriers, including the ability to arrange linguistically-appropriate specialty care; and patients' adherence to treatment. "[N]eeds assessments also identified opportunities for improvement related to caring for diverse patients and work processes and quality of care." "[I]t is imperative that small practices be specifically included in efforts to improve the quality of care for minority patients," the authors said, while also noting that support from organizations on the national, regional, and local levels will be required.
Individuals of all racial and ethnic groups face health care challenges due to the cost of care. In 2007, for example, 8.1% of whites compared to 7.5% of Hispanics and 7.6% of blacks reported delaying medical care due to cost in the past year. To view slides like the one above that present data minority health statistics and trends from studies by the Kaiser Family Foundation and others, and are available download, print, or use in presentations and handouts, please visit Kaiser Slides.
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This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities. 
