Addressing Health Disparities Through Comprehensive Initiatives

The gap between at risk population health and the general public is widening. From cradle to grave health outcomes among ethnic and racial populations are best defined as acute and the prevalence of chronic diseases like diabetes and stroke are generally accepted as epidemic among at risk population. Co-morbidities, further intensifies the disparity worsening health outcomes of those suffering from chronic diseases. The greater the co-morbidity factor the worse the health outcomes. For example, a person with diabetes, who also suffers from hypertension and high cholesterol, is significantly more at risk for stroke, kidney disease, heart disease and other critical health conditions. Primary care providers’ and specialist principal focus now becomes treating the co-morbidities like strokes and kidney diseases rather than successfully controlling blood sugar levels. Blood sugar becomes almost impossible to regain control once acute morbidities have developed. This poor health outcome is preventable. Yet among certain racial and ethnic group this scenario is a leading factor in adverse health outcomes. Properly managed and control diabetes, blood pressure and cholesterol will greatly improve health outcomes and prevent the progression of co-morbidities and premature death.

Infant mortality among African Americans is among the highest with mortality rates worse than many developing countries. These rates can be reversed by early and consistent prenatal care, proper diet with augment dosage of vitamin D therapy for the expectant mothers; and greatly improve chances of these newborns of being healthy. Data shows that low birth weight and high birth weight babies are more prone to infant mortality or a life infused with chronic diseases. The first years of their lives are under constant threat of complication arising from their low birth weight or high birth weight. These babies are more likely to develop kidney disease, diabetes and other chronic diseases and have a below average life expectancy. Unfortunately the high cost of medical treatment of infants suffering from life threatening conditions does not equate to improve health or extended life. The current system of medical treatment focuses on “sick care”; this treatment focus does not improve health outcomes or life expectancy, but maintains life until the next acute series of conditions develops further threatening the infant’s life.

The episodic nature of treating chronic diseases in hospitals’ emergency rooms and the lack of a comprehensive community health intervention initiative are factors driving the disparity gap. Those suffering from chronic diseases without a primary care physician are more likely to seek treatment in emergency rooms. Studies have shown that among those racial and ethnic groups suffering from chronic diseases, that a highly disproportionate number have not been seen by a primary care provider in twelve months or more. Studies also show that the cost of treatment of chronic diseases in the emergency room is among the highest cost for treating chronic diseases and the least effective. Yet for many, the emergency rooms treatment is a revolving door seeing the same patient repeatedly for the same health issues or related health issues, which ultimately result in hospitalization. Since many communities do not have any community health intervention programs to buffer against emergency room treatment those most at risk have little or no options in the treatment of their chronic diseases.

The argument has been made that one’s social and economic conditions are as much a contributory factor to the health disparity gap. Clearly, poor people, people with limited formal education, the unemployed and underemployed, people living in high density populations with inadequate housing accommodations have a greater risk for poor health outcomes. And those who live in such conditions are disproportionately people of color. However the health disparities gap reaches beyond just “poor people of color”. African American men regardless of their socio-economic status have the worse health outcomes among whites, Latinos and Asians Americans. African American men have the lowest life expectancy of those racial and ethnic groups. However, Native Americans without exception have among the worse health outcomes of all ethnic and racial populations. And of course, whites living in Appalachia have health outcomes as bad and in some cases worse than other racial and ethnic populations. But this nation’s chronic disease epidemic is driven in general by racial and ethnic populations of color and specifically the African American population.

The current trends reflect that chronic diseases will only widen the health disparity divide. Within the next ten years, diseases like diabetes will be a disease that primarily affects African Americans and Latinos. And that trend among infectious diseases is reflected through the HIV prevalence; where twenty-five years ago HIV rates where highest within the gay community, today HIV rates are the highest among African American women. Today, HIV rates among the gay population have been successfully reduced demonstrating that HIV is very preventable.

Prevention however remains the most cost effective method for closing the health disparity gap among at risk populations. Balance diets, with regular physical activities and addressing stress are the basis for prevention. However, among at risk populations good nutrition and regular exercise are compromised by socio economic factors that negatively impact healthy choices. Since socio economic factors are a strong determinant for health outcomes greater community health intervention is needed to address challenges and remove barriers. Community Health Intervention (CHI) workers have shown great success in addressing such barriers by creating access to affordable medical intervention, food distributions systems and prenatal intervention.  CHI workers across the nation serve a diverse base and have developed a set of practices that have greatly enhanced health outcomes of newborns, children, adults and seniors.

Data, studies, personal accounts have illustrated the scope of the health disparity. These sources of information have not been effectively utilized to solve the growing health disparity divide. An alternative perspective is needed to identify solutions. Principally, health disparity is driven by the “lack ofs” and manifested by acute co-morbidities and premature death. In a broader sense the lack of access to healthcare, the lack of community health intervention initiatives, the lack of fundamental health literacy and the lack of good nutrition regardless of socio economic conditions lies where a proactive address must take place. These “lack ofs” reach into every geographic area adversely affected by health disparity linking neighborhoods, cities and states to poor health outcomes. The pervasiveness of the “lack ofs” on a national basis provides us with a unique perspective on how others communities across the nation are successfully addressing health disparities. It is indeed ironic that the answers lies not in the copious amount of data and studies detailing the depth of the health disparity but by the solution base approach that communities have been united by in addressing health disparities.

At risk populations affected by adverse health outcomes is in part triggered by the lack of medical intervention and community health intervention. Early medical intervention has shown a significant decrease in the prevalence of chronic diseases, through regular monitoring of blood glucose, blood sugar and cholesterol. If medication is needed to maintain proper metabolic rates primary care providers can get an early jump before the conditions escalate to chronic diseases with acute co-morbidities. The community health intervention workers work in tandem by identifying at risk people and providing the necessary referral to primary care providers and later providing support to ensure those patients’ successes in achieving and maintaining good health. Community Health Intervention workers provide a vital bridge between at risk communities and the medical community by addressing challenges that contribute to health disparities. Yet, beyond successful early medical intervention and community health intervention efforts a campaign is necessary to promote the intervention union.

National radio personality Tom Joyner promotes a national “Take your loved one to the doctor day”. His daily listening audience of sixteen million consisting primarily of African Americans are encourage to take love ones to their primary care provider for medical intervention. This once a year campaign creates great awareness, but a more effective campaign would be to link and expand the campaign during Black History Month (BHM) in the month of February.

BHM is recognized nationally with programs and activities celebrating African American achievements and milestones. It is within the African American community a significant month that promotes accomplishments, pride and awareness. It is a model platform for such a campaign to address and promote a community health intervention. BHM provides an ideal opportunity to address annually medical intervention, among a population that ranks among the highest in health disparities. During the month of February the medical community would extend hours for medical intervention services and promote mobile units for mammography’s screening within African American communities. Primary care providers would offer Saturday hours and extended hours to accommodate greater participation. Cancer screening for prostate, colon and breast would be a high priority during BHM, as well as, blood sugar, blood press and cholesterol screening. Elementary schools would showcase contributions of African American doctors and connect the dots for their students to associate prevention and wellness care as a vital part of staying healthy into and through adulthood. Private health insurance companies would encourage their consumers to go to their doctors for annual screenings during BHM and employers would encourage their employees to participate in smoking cessation classes and wellness doctor visits. These initiatives working together would have a lasting benefit and positive impact within the African American community.

Organizations who seek to address health disparities could build upon these initiatives of early medical intervention, community health intervention workers and in the case of the African American community promoting medical intervention during BHM. The first step would be support the utilization of community health workers in at risk communities. Where such efforts currently exist, expanding those efforts into other communities. Second, the medical community would agree to promote and support greater utilization of its services during BHM for medical intervention within the African American population. Other groups such as the Asian and Latino populations would replicate such efforts around holidays. For instance, the month of May could be used for such an awareness campaign for Latinos, celebrating Cinco De Mayo. The Chinese New Year could also be the start of a thirty day campaign for promoting medical intervention among the Asian populations.

Groups organize to address health disparities should focus on a solution oriented approach. It is important to have an understanding of the base, but it is more important to advocate approaches that are proven and support ideas and concepts that show promise and can be replicated in other communities. Communities adversely affected by the health disparity have limited resources and lack of comprehensive information, therefore organizations developed to address health disparities should focus their primary efforts in providing communities with resources that focus on a solution oriented approach. They are not intended to be the only recommended solution, but to be enhanced with other solution oriented approaches that can be replicated across the nation in improving health disparities among those most at risk.

Finally, these ideas and initiatives explored here represent a solution oriented approach rather than fixing the problem. The critical differences between fixing the problem and being solution oriented are:

• Fixing the problem involves tremendous amount of analysis and data to understand why the problem exits; and identifying tremendous resources to fix the problem. Often times the analysis fails to produce any meaningful initiative for change. This approach is the least effective in transformation.

We have all attended community health forums where experts explain why the problems exist, and then make recommendations on solving the problem. Yet the problem never gets fixed.

• The solution oriented approach seeks out examples that work well and replicates those them with modification if needed. Its’ practice is simple; identify successful engagements regardless of its scope, understand why it is successful (its impact) and replicate to other groups facing similar conditions. This approach has the greatest success in achieving transformation. To fully appreciate this approach it is recommended that one reads the book “Switch: How to change things when change is hard”, written by brothers, Chip Heath and Dan Heath.