Minority health disparities focus of UAlbany forum

ALBANY — New York has gotten a lot healthier since 1990, when it was ranked America's 40th healthiest state. Today, nearly two decades later, it ranks 10th, thanks to improvements in disease and death rates, behaviors like smoking, environmental factors like pollution and policy measures like eligible food stamp participation.

But that overall improvement obscures alarmingly poor and stagnant outcomes for one group of New Yorkers. Black men and women remain the single most likely demographic in the state to die before the age of 75 or to die from heart disease and diabetes. Black women are more likely to die during childbirth. And black babies are more likely to die before the age of 1.

Black New Yorkers and Americans in general are more likely to die and suffer poor health due to a variety of biological and social factors including poverty, ZIP code and rent burden, studies have found.

"The sobering fact is at no time in the history of this great country has the health status of minority populations equaled or come close to that of non-minorities," said SUNY Downstate Medical Center President Wayne Riley at the first-ever University at Albany President's Forum on Health Disparities, held Tuesday.

"It's complex, it's difficult, it's messy, it's biological, it's genetic, it's social. It's everything," Riley said, on the reasons for the disparities.

The forum, hosted by the university's Center for the Elimination of Minority Health Disparities and the Office of the Vice President for Research, convened experts to discuss the future of minority health disparities in New York and nationwide. It was the first in a series of forums at a time when more attention is being paid to disproportionate deaths among black women who give birth and stubbornly high HIV rates among gay, black men.

On Monday, Gov. Andrew Cuomo announced an initiative aimed at ending these disparities, with a focus specifically on lowering maternal mortality rates statewide. Among other efforts, New York will pilot an expansion of Medicaid coverage for doulas and convene a task force to examine racial disparities and recommend actions to end them.

Riley said such disparities have long existed in the United States, and while they were known to black communities, a small group of government officials and academics, they were not appreciated by the general public until a groundbreaking 1985 report commissioned by Health and Human Services Secretary Margaret Heckler.

The report found nearly 86 percent of "excess" or preventable deaths among black Americans were primarily due to six medical conditions, including cancer, infant mortality, heart disease, diabetes and stroke.

Since then, some of these outcomes have improved but many remain, particularly in the area of heart disease.

"Frustrating to me as a primary care physician dealing with one of the major killers of Americans is that minorities are less likely to be given appropriate cardiac medications or undergo bypass surgery or — as a standard of care — a simple aspirin or beta blocker for the treatment of their conditions," said Riley.

A 2003 report by the Institute of Medicine found myriad factors at play, including differences in help-seeking behavior (some people are more likely to seek care than others), cultural or linguistic barriers (explaining symptoms can be difficult for patients with limited English), fragmentation of health care systems (insurance coverage may impact where and how often someone seeks care), prejudice toward minorities, clinical uncertainty and stereotypes.

Some things have helped.

The vast expansion of Medicaid eligibility and overhaul of individual insurance markets under the Affordable Care Act brought health insurance coverage to millions of Americans and a 7 percentage point drop in the adult uninsured rate.

"I am one of those guys who firmly believes one of the first things you do to address health care disparities is to get people an insurance card," said Riley. "Whether it's a Medicaid card or an exchange group insurance card, that is one of the first things we can do to address health care disparities."

Community-driven and population health initiatives are some of the best ways to create health equity, he said. The use of interpreters in clinical settings, while perhaps more time consuming, is another way.

Increasing minority representation in the health professions could have the most profound impact, he said.

"These young people here who are pursuing your doctoral degrees: we need you," he said. "We are just so short of black, Latino, Asian talent in terms of studying these issues and not just among physicians and clinical care workers, but among policy workers and investigators."