PRESIDENT'S COLUMN PARTNERS IN HEALTH-CARE REFORM Richard 0. Butcher, MD President National Medical Association El Cajon, California
Greetings. It is a pleasure to be here and address a group of people for whom I have a lot of respect-the National Association of Black Journalists. I have respect for you because you have power-the power to correct information, the power to share issues with the public, the power to make sure that we African Americans are being represented with intelligence and dignity. Truly, the fact that we are often misrepresented or barely represented in the press is an issue for African Americans on situations across the board. African-American people need support in America. This need laid the foundation for organizations like the National Association of Black Journalists, the Urban League, the National Association for the Advancement of Colored People (NAACP), and the National Medical Association (NMA). The NMA was founded in 1895 for African-American physicians who were not allowed to join the American Medical Association-and correspondingly were not allowed to practice medicine in many of the community hospitals in America, because we were denied access to local and state medical societies. The mission of the NMA is twofold: to promote and protect the health status of communities of color and the underserved and to provide a forum for the professional development of our members. The NMA has played a large role in my life and in my career. As a student, I was mentored, nurtured, and supported by NMA
physicians. As an adult, I was able to form the San Diego chapter Presented at the National Association of Black Journalists, August 21, 1992, Detroit, Michigan. Requests for reprints should be addressed to Dr Richard 0. Butcher, National Medical Association, 1012 10th St, NW, Washington, DC 20001. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
of the NMA and serve on the national level. I am here today because we worked together to ensure each other's success-and that's what I am appealing for between the physicians and the journalists. Physicians in this country are at a crossroads where there are many complex issues converging simultaneously The health-care debate now focuses on: * access to health care, * affordable health care, * managed care and changing the incentives, * fragmentation in the delivery of care, * eliminating fee for service, * hospitals and the government seeking to control and underpay physicians, * insurance, and * professional liability. The clinical and technical issues in front of physicians are changing, and as African-American physicians, this list becomes more convoluted by: * the startling infant mortality rate of AfricanAmerican babies, * the increased risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) in African Americans, * the need for and lack of bone marrow donors-an important issue, particularly the waiting list for African-American patients needing transplants, * the realities of developing large Medicaid practices, * maintaining clinical skills in solo practices, * isolation from research and new health-care trends, and * institutionalized racism. It seems our biggest problem has been that if you look at who is controlling the debate, you do not find many African Americans even close to the table. This is an area in which we are undertaking a coordinated 833
PRESIDENTS COLUMN
strategy. In September, the National Medical Association is convening a meeting to develop broad-based consensus regarding our needs and priorities for national health-care reform. We have learned over the years that these are not just physician issues. Every corner of our community is impacted by the outcome of whether we will have universal coverage or whether coverage will be required for only the employed. If the latter is chosen, we will continue to have a disproportionate number of black men who will gain access to health care only if and when they are incarcerated. That's why we are convening with the nurses, the social workers, the religious leaders, the fraternities, and sororities. You will all receive a copy of the findings and policy statements-you have my word-just make sure my office knows how to reach you. More importantly, I believe our best interests can be served if you become partners with the local black physicians. I want you to take on the responsibility of becoming the specialist in your media organization on the health status and needs of African-American people. Once you adopt this specialization, we will know to route to you those articles and documents that will be of interest to your readers. We will need allies in the media if we are going to influence positive health behaviors of our constituents. Truthfully, much of the health status gap that African Americans face has two roots: access and lifestyle. The lifestyle issues we confront have much to do with how we, as a community, handle stress, obesity, physical exercise, and diet. It will also be important that as we move a strategic plan to improve the health status of our communities, we find new partners. For example, the media have the ability to not only report what happened, but also to influence that reality and a community's perception of it. Thus, you play an essential role in working through our various challenges, and we want to enroll you now. Traditionally, there has been a public policy level separation between church and state. Thus, many health promotion and disease prevention agendas have failed to access the one institution that can consistently reach the largest numbers of our constituents. We are going to have to develop a new partnership with black churches and work collaboratively to move our agenda. These are challenging and creative times. AfricanAmerican youth are going to see a new picture of their community physician. I have told my colleagues that physicians will have to come out of their offices and become more actively involved in the economic 834
development, education, and socialization of our communities. They have agreed. Managed care, access to care, fee for service, and questions regarding who controls the structure of the new health prototype will be determined during this decade. These issues have been building for a long time. Educating our patients will be necessary As access is declining through severe economic declines, many will find themselves with less access to health care than they had before. Only through improved prevention can some of the impact be ameliorated-offset until national health insurance becomes a reality. As Gil Scott Heron says, "Waiting for a train from Washington that is long overdue-maybe in November. . ." I cannot complete my presentation before you today without citing a few of the many issues that can be helped by education awareness campaigns, sponsored by the newspapers and magazines for which you work. Basic health issues such as: * Excess deaths due to cancer, cardiovascular conditions, and cirrhosis of the liver annually rob African Americans of thousands of years of life. Many of these conditions reflect terrible health habits and practicessuch as smoking. Thirty-two percent of all smokers are African-American males over the age of 18. This is 25% higher than the rate for their white counterparts. * Obesity rates among African-American women, aged 20 to 44, are twice as high as those of their white counterparts. The failure of African-American men aged 20 to 44 to manage their weight results in a radical increase in obesity, such that by the 45- to 54-age range, we reflect a 50% greater obesity than that of our white counterparts. A large percentage of the increased cardiac problems are rooted in the volume and type of food people consume on a daily basis-again a poor behavior pattern, one that with the right education and consistent monitoring can be broken. * The AIDS virus, which was not registered among causes of death in 1981, is now the largest killer of African-American women between the ages of 25 and 34 in New York City. Moreover, of the 21 225 women who have contracted AIDS in the decade between 1981 and 1991, some 53% of them are African American and another 21% are Latino. Correspondingly, 52% of the 3500 children with AIDS are also African American; three fourths of these children contracted the disease from their mothers. More alarming are the data on heterosexually transmitted AIDS. These are people who report no high-risk activity and have contracted the virus neverJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
PRESIDENT'S COLUMN
theless. The high-risk activity they engaged in was unprotected sexual intercourse. As of December 1992, there were 11 887 people in America who had contracted AIDS heterosexually. Of those, some 60% are African American. Managed care, which once was considered an alternate delivery system, will control some 35% of the insured market by the end of this year. More importantly, many state Medicaid agencies have been promoting managed care as a solution to cost containment. The question for you health specialists in the media is how many of the managed-care entities in your community have outreached to African-American physicians? For all of the health maintenance organization and cost containment activity in your community, how many black physicians are involved in maintaining the patient physician relationships, once managed care takes control of Medicaid. While we are not directly opposed to managed care (this would be like standing in front of an oncoming train), the impact of these major social shifts on the lives of patients and access to family
physicians could be devastating. Traditionally, AfricanAmerican physicians are aware of the history and the social dynamics and are culturally competent to deal with problems associated with stress and reactions to racism and oppression in their patients. Most of these newly formed Medicaid initiatives don't have any idea on how to address these problems-problems that comprise the everyday practice of our NMA member
physicians. In the end, it is you who will protect the best interests of our community by advising them of what is going on and by helping to promote healthy lifestyles-from a personal and a policy level (if you know what I mean). In other words, people do better when they are watched. And we urge you to be diligent in watching these major health-care system changes and their impact on persons of color. Thank you for letting me speak with you today. I know the task ahead of you is not an easy one. I hope you understand that you, our messengers, are respected and appreciated.
We'd like to introduce you to the newest spokesman for the American Heart Association. Just as soon as he's born. The same baby who, ten years ago, wouldn't have lived to speak his first word. But now doctors can look inside the hearts of unborn babies, detect disorders and correct them at birth. Thanks to research, he can have a healthy, normal life.
VAmerican Heart Association WERE FIGHTING FOR YOUR LIFE
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
835
Greetings. It is a pleasure to be here and address a group of people for whom I have a lot of respect-the National Association of Black Journalists. I have respect for you because you have power-the power to correct information, the power to share issues with the public, the power to make sure that we African Americans are being represented with intelligence and dignity. Truly, the fact that we are often misrepresented or barely represented in the press is an issue for African Americans on situations across the board. African-American people need support in America. This need laid the foundation for organizations like the National Association of Black Journalists, the Urban League, the National Association for the Advancement of Colored People (NAACP), and the National Medical Association (NMA). The NMA was founded in 1895 for African-American physicians who were not allowed to join the American Medical Association-and correspondingly were not allowed to practice medicine in many of the community hospitals in America, because we were denied access to local and state medical societies. The mission of the NMA is twofold: to promote and protect the health status of communities of color and the underserved and to provide a forum for the professional development of our members. The NMA has played a large role in my life and in my career. As a student, I was mentored, nurtured, and supported by NMA
physicians. As an adult, I was able to form the San Diego chapter Presented at the National Association of Black Journalists, August 21, 1992, Detroit, Michigan. Requests for reprints should be addressed to Dr Richard 0. Butcher, National Medical Association, 1012 10th St, NW, Washington, DC 20001. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
of the NMA and serve on the national level. I am here today because we worked together to ensure each other's success-and that's what I am appealing for between the physicians and the journalists. Physicians in this country are at a crossroads where there are many complex issues converging simultaneously The health-care debate now focuses on: * access to health care, * affordable health care, * managed care and changing the incentives, * fragmentation in the delivery of care, * eliminating fee for service, * hospitals and the government seeking to control and underpay physicians, * insurance, and * professional liability. The clinical and technical issues in front of physicians are changing, and as African-American physicians, this list becomes more convoluted by: * the startling infant mortality rate of AfricanAmerican babies, * the increased risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) in African Americans, * the need for and lack of bone marrow donors-an important issue, particularly the waiting list for African-American patients needing transplants, * the realities of developing large Medicaid practices, * maintaining clinical skills in solo practices, * isolation from research and new health-care trends, and * institutionalized racism. It seems our biggest problem has been that if you look at who is controlling the debate, you do not find many African Americans even close to the table. This is an area in which we are undertaking a coordinated 833
PRESIDENTS COLUMN
strategy. In September, the National Medical Association is convening a meeting to develop broad-based consensus regarding our needs and priorities for national health-care reform. We have learned over the years that these are not just physician issues. Every corner of our community is impacted by the outcome of whether we will have universal coverage or whether coverage will be required for only the employed. If the latter is chosen, we will continue to have a disproportionate number of black men who will gain access to health care only if and when they are incarcerated. That's why we are convening with the nurses, the social workers, the religious leaders, the fraternities, and sororities. You will all receive a copy of the findings and policy statements-you have my word-just make sure my office knows how to reach you. More importantly, I believe our best interests can be served if you become partners with the local black physicians. I want you to take on the responsibility of becoming the specialist in your media organization on the health status and needs of African-American people. Once you adopt this specialization, we will know to route to you those articles and documents that will be of interest to your readers. We will need allies in the media if we are going to influence positive health behaviors of our constituents. Truthfully, much of the health status gap that African Americans face has two roots: access and lifestyle. The lifestyle issues we confront have much to do with how we, as a community, handle stress, obesity, physical exercise, and diet. It will also be important that as we move a strategic plan to improve the health status of our communities, we find new partners. For example, the media have the ability to not only report what happened, but also to influence that reality and a community's perception of it. Thus, you play an essential role in working through our various challenges, and we want to enroll you now. Traditionally, there has been a public policy level separation between church and state. Thus, many health promotion and disease prevention agendas have failed to access the one institution that can consistently reach the largest numbers of our constituents. We are going to have to develop a new partnership with black churches and work collaboratively to move our agenda. These are challenging and creative times. AfricanAmerican youth are going to see a new picture of their community physician. I have told my colleagues that physicians will have to come out of their offices and become more actively involved in the economic 834
development, education, and socialization of our communities. They have agreed. Managed care, access to care, fee for service, and questions regarding who controls the structure of the new health prototype will be determined during this decade. These issues have been building for a long time. Educating our patients will be necessary As access is declining through severe economic declines, many will find themselves with less access to health care than they had before. Only through improved prevention can some of the impact be ameliorated-offset until national health insurance becomes a reality. As Gil Scott Heron says, "Waiting for a train from Washington that is long overdue-maybe in November. . ." I cannot complete my presentation before you today without citing a few of the many issues that can be helped by education awareness campaigns, sponsored by the newspapers and magazines for which you work. Basic health issues such as: * Excess deaths due to cancer, cardiovascular conditions, and cirrhosis of the liver annually rob African Americans of thousands of years of life. Many of these conditions reflect terrible health habits and practicessuch as smoking. Thirty-two percent of all smokers are African-American males over the age of 18. This is 25% higher than the rate for their white counterparts. * Obesity rates among African-American women, aged 20 to 44, are twice as high as those of their white counterparts. The failure of African-American men aged 20 to 44 to manage their weight results in a radical increase in obesity, such that by the 45- to 54-age range, we reflect a 50% greater obesity than that of our white counterparts. A large percentage of the increased cardiac problems are rooted in the volume and type of food people consume on a daily basis-again a poor behavior pattern, one that with the right education and consistent monitoring can be broken. * The AIDS virus, which was not registered among causes of death in 1981, is now the largest killer of African-American women between the ages of 25 and 34 in New York City. Moreover, of the 21 225 women who have contracted AIDS in the decade between 1981 and 1991, some 53% of them are African American and another 21% are Latino. Correspondingly, 52% of the 3500 children with AIDS are also African American; three fourths of these children contracted the disease from their mothers. More alarming are the data on heterosexually transmitted AIDS. These are people who report no high-risk activity and have contracted the virus neverJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
PRESIDENT'S COLUMN
theless. The high-risk activity they engaged in was unprotected sexual intercourse. As of December 1992, there were 11 887 people in America who had contracted AIDS heterosexually. Of those, some 60% are African American. Managed care, which once was considered an alternate delivery system, will control some 35% of the insured market by the end of this year. More importantly, many state Medicaid agencies have been promoting managed care as a solution to cost containment. The question for you health specialists in the media is how many of the managed-care entities in your community have outreached to African-American physicians? For all of the health maintenance organization and cost containment activity in your community, how many black physicians are involved in maintaining the patient physician relationships, once managed care takes control of Medicaid. While we are not directly opposed to managed care (this would be like standing in front of an oncoming train), the impact of these major social shifts on the lives of patients and access to family
physicians could be devastating. Traditionally, AfricanAmerican physicians are aware of the history and the social dynamics and are culturally competent to deal with problems associated with stress and reactions to racism and oppression in their patients. Most of these newly formed Medicaid initiatives don't have any idea on how to address these problems-problems that comprise the everyday practice of our NMA member
physicians. In the end, it is you who will protect the best interests of our community by advising them of what is going on and by helping to promote healthy lifestyles-from a personal and a policy level (if you know what I mean). In other words, people do better when they are watched. And we urge you to be diligent in watching these major health-care system changes and their impact on persons of color. Thank you for letting me speak with you today. I know the task ahead of you is not an easy one. I hope you understand that you, our messengers, are respected and appreciated.
We'd like to introduce you to the newest spokesman for the American Heart Association. Just as soon as he's born. The same baby who, ten years ago, wouldn't have lived to speak his first word. But now doctors can look inside the hearts of unborn babies, detect disorders and correct them at birth. Thanks to research, he can have a healthy, normal life.
VAmerican Heart Association WERE FIGHTING FOR YOUR LIFE
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 10
835
