Health Disparities in Rochester: What Needs to be Done

June 18, 2008 at 2:35 pm Leave a comment

In a follow-up to the previous post (Report Details Disparities in Care), Nancy Bennett, M.D. and Wade Norwood have written a piece that appeared in today’s Democrat & Chronicle. Bennett is director of the URMC Center for Community Health and Norwood is director of Community Engagement for the Finger Lakes Health Systems Agency.

The piece (which appears below) addresses the underlying factors behind disparities in our community, the progress that has been made, and the challenges that remain.

Spread good health to all corners of Rochester

Dr. Nancy Bennett and Wade Norwood

In the World Health Organization’s comparison of the health of nations, the United States ranks 24th, below most industrialized nations. However, the United States spends more per capita, and our expenditures are rising faster than those in any other country. While the reasons for this paradox are many, one critical factor is the persistence of health disparities based on race, ethnicity and socioeconomic status.

To improve our country’s health, we must improve the health of our most vulnerable populations. While we all are cared for by the same health systems, white suburban populations enjoy relatively good health, but poor urban and rural populations do not.

One example of these horrible inequalities was reported this month by the Dartmouth Atlas Project: African Americans are more likely to suffer leg amputations than white people.

The reasons for such differences are complex.

  • African Americans have higher rates of obesity and smoking, putting them at greater risk for diabetes and peripheral vascular disease, heightening the risk of amputation.
  • African Americans are likely to have poorer access to primary and specialty care, which might improve the management of chronic disease, thus preventing complications.
  • African Americans often have poorer access to advanced surgical alternatives to amputation.

Although these differences may be related to the adequacy of insurance, studies have shown that differences remain even when coverage is equal. We need to understand, through public health and health services research, the complexities of this pathway so that we can eliminate inequalities.

What can our community do to reduce racial, ethnic and socioeconomic disparities? The first step is to acknowledge that these disparities hurt all of us and lead to increased health care costs. We must all come together to eliminate them and thus improve the health of our whole community. We need to refocus our attention on prevention and on ensuring that all members of our community have access to the best health information and primary care. We must develop effective programs to help everyone change deeply rooted health behaviors that put us at higher risk – smoking, physical inactivity and poor nutrition – and thereby prevent more than 40 percent of premature deaths. We need to be sure that we not only provide insurance but also readily accessible, culturally competent, high-quality medical care.

And we need to pay for disease prevention and health care access – that’s the hard part.

There are many promising approaches to improving health and reducing costs, but they require an investment. Many organizations in our community are doing their part – the Monroe County Department of Public Health, the University of Rochester Medical Center, Finger Lakes Health Systems Agency, the Greater Rochester Health Foundation, the Monroe Plan, the many community health centers and community-based organizations – but these organizations cannot solve this problem alone.

The FLHSA’s African American and Latino Health coalitions lead efforts to identify priority health disparities and develop solutions that the community can implement. The work of the coalitions is a critical component of our community’s response to health disparities.

While the recent report “dinged” the community for shortcomings, we should note the areas in which we have done well. More people had access to primary care in 2006 compared with 2000, more received annual mammograms and fewer were admitted to the hospital for complications of chronic disease. We know from our own local health data that we have almost eliminated racial and ethnic disparities in immunization rates for both children and adults, and in mammography and cervical cancer screening. Much of this success can be attributed to specific, targeted programs that improve our overall measures while reducing racial disparities.

We still have work to do in many other areas, but our successes prove that it is possible to eliminate disparities and improve health. We just need the desire and the dollars.

Bennett is director, Center for Community Health, University of Rochester Medical Center; Norwood is director of community engagement, Finger Lakes Health Systems Agency.

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Entry filed under: Access to Health Care, Adults, In the News.

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