PRESI DENT'S COLUMN "The Status of Health Care Among Black Americans": Address Before the Congress of National Black Churches Charles Johnson, MD President, National Medical Association Durham, North Carolina
INTRODUCTION Thank you for this opportunity to appear before the Congress of National Black Churches today to address "the Status of Health Care Among black Americans." The contents of my presedtation are drawn from both my daily observations as a practicing internist and as the president of the National Medical Association (NMA). The NMA is an organization which represents over 16 000 physicians from throughout the United States, the Virgin Islands and Puerto Rico, who are among the primary providers for the medically underserved and minority populations. The majority of NMA members are black American physicians, however, we welcome as active participants any health care professional who is interested in promoting the science of medicine and better health care for all Americans.
BACKGROUND The primary care providers of NMA are painfully aware of the disparity between the health status of uninsured and underinsured minority populations in comparison to the general population of the United States; we view firsthand the disproportionately high rates of infant mortality, cancer, heart disease, acquired From Duke University Medical Center, Durham, North Carolina. Delivered before the Congress of National Black Churches, Detroit, Michigan, December 11, 1990. Requests for reprints should be addressed to Dr Charles Johnson, Duke University Medical Center Bakerhouse, Room 281, Duke South, PO Box 3217, Durham, NC 27710. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
immunodeficiency syndrome (AIDS), and other diseases among the indigent, particularly indigent black Americans and other minorities. Statistics from the 1985 Report of the Secretary's Task Force on Black and Minority Health indicated 60 000 excess deaths among blacks and minorities could have been prevented if they had received health care equivalent to that received by most non-minorities. Health care must become more accessible in both cost and a liability to the nation's minority communities.
SIGNIFICANCE OF THE PROBLEM In September 1990, the Department of Health and Human Services released the Healthy People 2000; National Health Promotional Prevention Objectives. In this report, it was revealed that black Americans make up 12% of the United States population, thereby constituting the nation's largest minority group. We live in all regions of the country and are represented in every socioeconomic group. One third of blacks live in poverty, a rate three times that of our white counterparts. Over half of black Americans live in central cities, in areas often typified by poverty, poor schools, crowded housing, exposure to a pervasive crime, drug culture and periodic street violence. Life expectancy for blacks has lagged behind that for the total population throughout the century. Since the mid-1980's the gap has actually widened, with the life expectancy rising to 75 years for the overall population while slightly decreasing for blacks from a high of 69.7 years in 1984 125
PRESIDENTS COLUMN
to 69.4 years in 1987. The leading chronic diseases as causes of death for black Americans are the same as those for the majority population. However, blacks die at a faster rate from the following: * Strokes - At almost twice the rate of non-blacks; * Coronary Heart Disease - Death rates are higher for black women; * Cancer - Black men experience a higher risk of cancer than non-black men, with a 25% higher risk of all cancer and a 45% higher incidence of lung cancer; * Diabetes - 33% more common among blacks than whites; * Black Babies - are twice as likely as white babies to die before their first birthday and have higher rates of low birth weight that account for many of these deaths; and * AIDS - Among blacks is more than triple than that of whites: black children account for more than 50% of all children with AIDS.
BLACK ELDERLY The black American elderly community in particular, is currently the fastest growing segment of the total black American population. Between 1970 and 1980, the black American population increased by 34%. Whereas the total population of the United States increased by only 16%. Data from the United States Census Bureau indicates that as of March 1988, 2 million black Americans were over age 55, 1 million over age 65, and approximately 900 000 were over age 75. It is projected that by the year 1999, the number of black Americans over the age of 65 will increase to 3 million. Black Americans have and continue to be victims of adverse economic and social conditions, and the elderly community is particularly susceptible to problems associated with these societal ills. Economically, black Americans generally have less personal post-retirement income than their white counterparts, and are more dependent on social security benefits for the majority of their retirement income. The median income of the black American elderly is considerably less than that of the white elderly, ie, $4113 for black American men; $2825 for black American women; as compared to $7408 for white men and $3994 for white women. Geographically, approximately one fifth of the black American elderly live in rural areas as compared to a somewhat lower population than white elderly. In these rural areas, one in every two black American elderly lives in poverty. Broken down by sex, almost two-thirds or 68% of black American women are in or near poverty, as compared to 40% of white women. In urban 126
areas, one in three of every black American elderly lives in poverty, as compared to a ratio of one in nine by the elderly white community. In terms of mortality, black Americans have a lesser life expectancy than whites, a gap which continues to demonstrate the excess deaths occurring among blacks which has been well documented in the Heckler Report of 1984, and which has not been seriously addressed in any meaningful way to this date. Although black Americans who may reach the age of 70 enjoy a higher survival, they usually suffer from higher rates of poverty and illness. At this juncture, let us review the particular impact of some of the leading killers on the black elderly population.
Heart Disease The number one health problem facing the elderly population, as a whole, is heart disease. A senate special committee on aging reported that heart disease accounted for 10% of all doctor visits, 18% of short-stay hospital and bed disability days, and 45% of all deaths in 1980, a large number of the 750 000 Americans who die each year of heart disease are elderly. While heart disease remains a strong contributor to poor health and death among the elderly in the general population, and there has generally been a marked decline in death rates from this disease. This has not been true of the black American population. The decrease could be the result of the public awareness of the link between dietary fat and heart disease. A national survey recently revealed that public awareness rose from 45% in 1982 to 80% in the mid-1990's; however, the report also showed that misunderstandings remain about the terms "fat" and cholesterol. For example, only 29% of the surveyed population knew that a product characterized as "cholesterol-free" could still be high in saturated fat these factors as well as the traditional ethnic eating habits of the target population could be an explanation for the absence of a decline in the disease among black American elderly also we must remind you that one's socioeconomic status plays a significant role in determining the types and quantities of foods purchased. Many of those foods have the potential to impact negatively when eaten without regard to proper distribution of calories. Thus, there appears to be a particular need for better educational programs focused on this population, if we are to obtain equivalent advances in reversing the negative trend in the target population.
Cancer and High Blood Pressure The death rate for esophageal cancer is 10 times JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
PRESIDENT'S COLUMN
higher for black American men. We have a 25% higher incidence of cancer, with cancer of the lungs, prostrate, stomach colon and pancreas being more frequent, breast cancer is also highly prevalent in black American women. While high blood pressure affects more than 28 out of every 100 white adults, it affects more than 38 out of every 100 black Americans, and black American women over the age of 65 are more at risk than any other group in the United States.
SPECIAL PROBLEMS OF BLACK AMERICAN WOMEN Today, there are 17 million women over the age of 65, many of these women suffer from inadequate health care due to the lack of research concerning the health of older women, misunderstandings and ignorance of older women's needs, and a disproportionately high level of limited insurance coverage. While women comprise 50% of the population over 65, they make up 72% of the elderly poor. One third of older single women rely on social security benefits for at least 90% of their incomes. In 1986, it was reported that 35% of older black American women and 25% of older Hispanic women lived in poverty. Medicare pays only 33% of medical bills for single women. The Department of Health and Human Services reported that the average American woman with a life expectancy of 85 years has a 1 in 10 chance of getting breast cancer. While many older women believe that they have to worry less about getting this disease as they age, the fact is, 80% of all breast cancers occur in post-menopausal women, despite these statistics, early detection allows more options and presents a better prognosis for women diagnosed with'breast cancer. Yet a study by the American Cancer Society showed that less than 50% of physicians refer women over 40 for a mammogram. Periodic mammogram screening, however, is not a benefit covered under Medicare. It is important that older women ask their physician for a mammogram, and, if possible, get one through available community programs. The particular difficulty as relates to elderly black American women is that since a disproportionately high number of these individuals are drawn from the lower economic sector of the population, they are less likely to have competent, regular medical advice, care, and attention. The American Cancer Society also reports that there is an increase in the incidence of lung cancer among women, to the extent that it has surpassed breast cancer. Additionally, heart disease, which is mentioned earlier JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
as the number one health problem facing the elderly, is the leading cause of death among women. Previously thought to be a man's problem, statistics reveal that 350 000 of the 750 000 Americans who die each year of heart disease are women. All of these ailments continue to adversely affect elderly black American females at a greater rate than it does their white counterparts.
HEALTH PROMOTION AND DISEASE PREVENTION PRIORITIES I have had the opportunity in other forums to comment on the unusual manner in which minorities use the health care delivery system. Indigent minorities in inner cities use the hospital emergency room as the primary source of access for medical treatment. The visit to the emergency room is usually precipitated by a critical occurrence. The treatment in the emergency room could be the only medical treatment these families receive. This is sharply contrasted with the use that a substantially larger portion of non-minorities and more affluent minorities make of the emergency room; they generally use it as an urgent, temporary replacement for the care of a regular family physician, that may not be immediately available. It has been estimated that 31 million Americans alone have no form of health insurance coverage. This figure includes 11 million children and 15 million women of childbearing age. When one considers that the greatest threats to the health of minorities in this country include cancer, poor nutrition, and infant mortality, the exclusion of these groups from the benefits derived from early detection of disease and general health education is unconscionable. These figures, which include only those Americans with no health insurance, do not include the millions of Americans who are minimally and often inadequately insured. There has been a failure of specific programs to address the needs of uninsured and underinsured
minorities.
THE DISADVANTAGED MINORITY HEALTH IMPROVEMENT ACT Congressman Stokes and Senator Kennedy should be commended on their efforts in introducing legislation which begins to address several of the key health care needs of minority populations. NMA supported the disadvantaged minority health improvement act, which seeks to address the inequities in medical service delivery to that significant segment of the chronically underserved minority community. NMA is encouraged by the recognition in this act that 127
PRESIDENT'S COLUMN
health promotion of disease prevention and increased assistance to medical students are essential components of any plan to improve the health status of Americans. NMA presented testimony on Capital Hill earlier this year in support of the Disadvantaged Minority Health Improvement Act. I am pleased to report that this bill was signed into public law 101-527 by President Bush on November 6, 1990. Title I of the act authorizes $10 million for the Office of Minority Health Research and demonstration projects and an additional $10 million for the Secretary of Health and Human Services (HHS) to fund grants and contracts, is a commendable first step. These funds will allow the medical community to obtain data on the best methods to meet the unique challenges of serving underserved minority populations. Additionally, the findings of this act highlight the glaring need to increase the number of minorities in the health profession. Blacks, Hispanics, and Native Americans represent approximately 20% of the population of the nation; however, these minorities constitute only 7% of physicians, 4% of dentists, and 6% of nurses practicing in the. United States. The new law provides for increased scholarship and loans to medical students and nursing students, which are positive steps in addressing the gross under representation of minorities in the health profession, but more is needed.
LOANS AND SCHOLARSHIPS NMA has a special interest in increasing the number of minorities in the health professions. The National Medical Association, along with representatives of the American Medical Association, the Association of American Medical Colleges (AAMC), and the American Association for the Advancement of Science have formed a special task force on the black and minority applicant pool in an attempt to address the significant deficiency in the provision of health care to the minority and medically underserved populations of this country. During this past year we have begun efforts to identify and alleviate factors which will not only increase the numbers of qualified blacks and minorities in the applicant pool, but also to increase the recruitment, training and retention of minorities in medical and other health professions. The enhancement of scholarship and loan programs for the support of minority students in the health care professions is one essential measure crucially needed to enhance our efforts to increase the numbers of minorities in health care roles. Black and minority medical school graduates have been more likely to serve the medically indigent and 128
underserved populations, especially the minority populations whose disparate health status has been well documented, the AAMC medical student graduation questionnaires have indicated that this trend has and will continue. Statistics from the AAMC show that approximately 80% of black, and 90% of minority graduates are from majority medical schools. Yet, the percentage of under-represented minority enrollees in medical schools has not increased significantly since 1974. In 1988-89, the percentage of minority students enrolled at 61 of 127 medical schools was less than it was in 1983-84. Five medical schools had no minorities enrolled in their programs. While the minority population of this country, especially that of blacks and Hispanics, will be rapidly increasing during the next decades, there are not adequate efforts to increase the number of minority students interested in and qualified to pursue careers in the health professions, although they are urgently needed. A national reemphasis on and recognition of this contribution to alleviating the health care crisis for those with disparate health status is long overdue.
CONCLUSION Thank you for allowing me the opportunity to address the critical heath care issues of our nation, in particular those affecting black Americans. After presenting you with these grim and depressing statistics. You may be asking yourself why did the Congress of National Black Churches ask me to speak before you today. The reasons are many and significant. Black churches have been and continue to be the heart and soul of the black American community. Churches have been the vital lifeline in our lives, a forum for exchange of ideas, and during the civil rights movement, churches were the staging area for the war against poverty and the war for equal rights. Now our churches are needed to help fight a new war - the war for equal access to quality health care. The first step in solving any problem is to identify it, then make efforts to educate "the masses" regarding the problem, this problem is so severe it will require the combined efforts of the minority and majority communities nationwide. Government, private sector and individual involvement is vital to the success of this latest war confronting the black community. The urgency of the health care status of black Americans demands that the black churches must play the role of the town criers and educators of society. You must ring out from the pulpit to educate those regarding this JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
PRESIDENT'S COLUMN
plague on our communities. In doing so, it is essential that we start with our own community but quickly spread that word to the news media, the congress, the executive branch, and every responsible unit of government and of the institutional community.
NMA has been in the forefront in addressing many of the issues affecting black Americans in the health arena. We look forward to working with you to ensure that health care for all Americans will be improved during the decade of the 1990's.
The National AIDS Information Clearinghouse Now-one toll-free number for reference assistance and to order publications:
|
~1-800-458-5231 FAX: 1-301-738-6616 Call us. We're your centralized resource for information on HIV/AIDS programs, services, and materials. A service of the U.S. Department of Health and Human Services Putblic Health Service * Centers for Disease Control
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
129
INTRODUCTION Thank you for this opportunity to appear before the Congress of National Black Churches today to address "the Status of Health Care Among black Americans." The contents of my presedtation are drawn from both my daily observations as a practicing internist and as the president of the National Medical Association (NMA). The NMA is an organization which represents over 16 000 physicians from throughout the United States, the Virgin Islands and Puerto Rico, who are among the primary providers for the medically underserved and minority populations. The majority of NMA members are black American physicians, however, we welcome as active participants any health care professional who is interested in promoting the science of medicine and better health care for all Americans.
BACKGROUND The primary care providers of NMA are painfully aware of the disparity between the health status of uninsured and underinsured minority populations in comparison to the general population of the United States; we view firsthand the disproportionately high rates of infant mortality, cancer, heart disease, acquired From Duke University Medical Center, Durham, North Carolina. Delivered before the Congress of National Black Churches, Detroit, Michigan, December 11, 1990. Requests for reprints should be addressed to Dr Charles Johnson, Duke University Medical Center Bakerhouse, Room 281, Duke South, PO Box 3217, Durham, NC 27710. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
immunodeficiency syndrome (AIDS), and other diseases among the indigent, particularly indigent black Americans and other minorities. Statistics from the 1985 Report of the Secretary's Task Force on Black and Minority Health indicated 60 000 excess deaths among blacks and minorities could have been prevented if they had received health care equivalent to that received by most non-minorities. Health care must become more accessible in both cost and a liability to the nation's minority communities.
SIGNIFICANCE OF THE PROBLEM In September 1990, the Department of Health and Human Services released the Healthy People 2000; National Health Promotional Prevention Objectives. In this report, it was revealed that black Americans make up 12% of the United States population, thereby constituting the nation's largest minority group. We live in all regions of the country and are represented in every socioeconomic group. One third of blacks live in poverty, a rate three times that of our white counterparts. Over half of black Americans live in central cities, in areas often typified by poverty, poor schools, crowded housing, exposure to a pervasive crime, drug culture and periodic street violence. Life expectancy for blacks has lagged behind that for the total population throughout the century. Since the mid-1980's the gap has actually widened, with the life expectancy rising to 75 years for the overall population while slightly decreasing for blacks from a high of 69.7 years in 1984 125
PRESIDENTS COLUMN
to 69.4 years in 1987. The leading chronic diseases as causes of death for black Americans are the same as those for the majority population. However, blacks die at a faster rate from the following: * Strokes - At almost twice the rate of non-blacks; * Coronary Heart Disease - Death rates are higher for black women; * Cancer - Black men experience a higher risk of cancer than non-black men, with a 25% higher risk of all cancer and a 45% higher incidence of lung cancer; * Diabetes - 33% more common among blacks than whites; * Black Babies - are twice as likely as white babies to die before their first birthday and have higher rates of low birth weight that account for many of these deaths; and * AIDS - Among blacks is more than triple than that of whites: black children account for more than 50% of all children with AIDS.
BLACK ELDERLY The black American elderly community in particular, is currently the fastest growing segment of the total black American population. Between 1970 and 1980, the black American population increased by 34%. Whereas the total population of the United States increased by only 16%. Data from the United States Census Bureau indicates that as of March 1988, 2 million black Americans were over age 55, 1 million over age 65, and approximately 900 000 were over age 75. It is projected that by the year 1999, the number of black Americans over the age of 65 will increase to 3 million. Black Americans have and continue to be victims of adverse economic and social conditions, and the elderly community is particularly susceptible to problems associated with these societal ills. Economically, black Americans generally have less personal post-retirement income than their white counterparts, and are more dependent on social security benefits for the majority of their retirement income. The median income of the black American elderly is considerably less than that of the white elderly, ie, $4113 for black American men; $2825 for black American women; as compared to $7408 for white men and $3994 for white women. Geographically, approximately one fifth of the black American elderly live in rural areas as compared to a somewhat lower population than white elderly. In these rural areas, one in every two black American elderly lives in poverty. Broken down by sex, almost two-thirds or 68% of black American women are in or near poverty, as compared to 40% of white women. In urban 126
areas, one in three of every black American elderly lives in poverty, as compared to a ratio of one in nine by the elderly white community. In terms of mortality, black Americans have a lesser life expectancy than whites, a gap which continues to demonstrate the excess deaths occurring among blacks which has been well documented in the Heckler Report of 1984, and which has not been seriously addressed in any meaningful way to this date. Although black Americans who may reach the age of 70 enjoy a higher survival, they usually suffer from higher rates of poverty and illness. At this juncture, let us review the particular impact of some of the leading killers on the black elderly population.
Heart Disease The number one health problem facing the elderly population, as a whole, is heart disease. A senate special committee on aging reported that heart disease accounted for 10% of all doctor visits, 18% of short-stay hospital and bed disability days, and 45% of all deaths in 1980, a large number of the 750 000 Americans who die each year of heart disease are elderly. While heart disease remains a strong contributor to poor health and death among the elderly in the general population, and there has generally been a marked decline in death rates from this disease. This has not been true of the black American population. The decrease could be the result of the public awareness of the link between dietary fat and heart disease. A national survey recently revealed that public awareness rose from 45% in 1982 to 80% in the mid-1990's; however, the report also showed that misunderstandings remain about the terms "fat" and cholesterol. For example, only 29% of the surveyed population knew that a product characterized as "cholesterol-free" could still be high in saturated fat these factors as well as the traditional ethnic eating habits of the target population could be an explanation for the absence of a decline in the disease among black American elderly also we must remind you that one's socioeconomic status plays a significant role in determining the types and quantities of foods purchased. Many of those foods have the potential to impact negatively when eaten without regard to proper distribution of calories. Thus, there appears to be a particular need for better educational programs focused on this population, if we are to obtain equivalent advances in reversing the negative trend in the target population.
Cancer and High Blood Pressure The death rate for esophageal cancer is 10 times JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
PRESIDENT'S COLUMN
higher for black American men. We have a 25% higher incidence of cancer, with cancer of the lungs, prostrate, stomach colon and pancreas being more frequent, breast cancer is also highly prevalent in black American women. While high blood pressure affects more than 28 out of every 100 white adults, it affects more than 38 out of every 100 black Americans, and black American women over the age of 65 are more at risk than any other group in the United States.
SPECIAL PROBLEMS OF BLACK AMERICAN WOMEN Today, there are 17 million women over the age of 65, many of these women suffer from inadequate health care due to the lack of research concerning the health of older women, misunderstandings and ignorance of older women's needs, and a disproportionately high level of limited insurance coverage. While women comprise 50% of the population over 65, they make up 72% of the elderly poor. One third of older single women rely on social security benefits for at least 90% of their incomes. In 1986, it was reported that 35% of older black American women and 25% of older Hispanic women lived in poverty. Medicare pays only 33% of medical bills for single women. The Department of Health and Human Services reported that the average American woman with a life expectancy of 85 years has a 1 in 10 chance of getting breast cancer. While many older women believe that they have to worry less about getting this disease as they age, the fact is, 80% of all breast cancers occur in post-menopausal women, despite these statistics, early detection allows more options and presents a better prognosis for women diagnosed with'breast cancer. Yet a study by the American Cancer Society showed that less than 50% of physicians refer women over 40 for a mammogram. Periodic mammogram screening, however, is not a benefit covered under Medicare. It is important that older women ask their physician for a mammogram, and, if possible, get one through available community programs. The particular difficulty as relates to elderly black American women is that since a disproportionately high number of these individuals are drawn from the lower economic sector of the population, they are less likely to have competent, regular medical advice, care, and attention. The American Cancer Society also reports that there is an increase in the incidence of lung cancer among women, to the extent that it has surpassed breast cancer. Additionally, heart disease, which is mentioned earlier JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
as the number one health problem facing the elderly, is the leading cause of death among women. Previously thought to be a man's problem, statistics reveal that 350 000 of the 750 000 Americans who die each year of heart disease are women. All of these ailments continue to adversely affect elderly black American females at a greater rate than it does their white counterparts.
HEALTH PROMOTION AND DISEASE PREVENTION PRIORITIES I have had the opportunity in other forums to comment on the unusual manner in which minorities use the health care delivery system. Indigent minorities in inner cities use the hospital emergency room as the primary source of access for medical treatment. The visit to the emergency room is usually precipitated by a critical occurrence. The treatment in the emergency room could be the only medical treatment these families receive. This is sharply contrasted with the use that a substantially larger portion of non-minorities and more affluent minorities make of the emergency room; they generally use it as an urgent, temporary replacement for the care of a regular family physician, that may not be immediately available. It has been estimated that 31 million Americans alone have no form of health insurance coverage. This figure includes 11 million children and 15 million women of childbearing age. When one considers that the greatest threats to the health of minorities in this country include cancer, poor nutrition, and infant mortality, the exclusion of these groups from the benefits derived from early detection of disease and general health education is unconscionable. These figures, which include only those Americans with no health insurance, do not include the millions of Americans who are minimally and often inadequately insured. There has been a failure of specific programs to address the needs of uninsured and underinsured
minorities.
THE DISADVANTAGED MINORITY HEALTH IMPROVEMENT ACT Congressman Stokes and Senator Kennedy should be commended on their efforts in introducing legislation which begins to address several of the key health care needs of minority populations. NMA supported the disadvantaged minority health improvement act, which seeks to address the inequities in medical service delivery to that significant segment of the chronically underserved minority community. NMA is encouraged by the recognition in this act that 127
PRESIDENT'S COLUMN
health promotion of disease prevention and increased assistance to medical students are essential components of any plan to improve the health status of Americans. NMA presented testimony on Capital Hill earlier this year in support of the Disadvantaged Minority Health Improvement Act. I am pleased to report that this bill was signed into public law 101-527 by President Bush on November 6, 1990. Title I of the act authorizes $10 million for the Office of Minority Health Research and demonstration projects and an additional $10 million for the Secretary of Health and Human Services (HHS) to fund grants and contracts, is a commendable first step. These funds will allow the medical community to obtain data on the best methods to meet the unique challenges of serving underserved minority populations. Additionally, the findings of this act highlight the glaring need to increase the number of minorities in the health profession. Blacks, Hispanics, and Native Americans represent approximately 20% of the population of the nation; however, these minorities constitute only 7% of physicians, 4% of dentists, and 6% of nurses practicing in the. United States. The new law provides for increased scholarship and loans to medical students and nursing students, which are positive steps in addressing the gross under representation of minorities in the health profession, but more is needed.
LOANS AND SCHOLARSHIPS NMA has a special interest in increasing the number of minorities in the health professions. The National Medical Association, along with representatives of the American Medical Association, the Association of American Medical Colleges (AAMC), and the American Association for the Advancement of Science have formed a special task force on the black and minority applicant pool in an attempt to address the significant deficiency in the provision of health care to the minority and medically underserved populations of this country. During this past year we have begun efforts to identify and alleviate factors which will not only increase the numbers of qualified blacks and minorities in the applicant pool, but also to increase the recruitment, training and retention of minorities in medical and other health professions. The enhancement of scholarship and loan programs for the support of minority students in the health care professions is one essential measure crucially needed to enhance our efforts to increase the numbers of minorities in health care roles. Black and minority medical school graduates have been more likely to serve the medically indigent and 128
underserved populations, especially the minority populations whose disparate health status has been well documented, the AAMC medical student graduation questionnaires have indicated that this trend has and will continue. Statistics from the AAMC show that approximately 80% of black, and 90% of minority graduates are from majority medical schools. Yet, the percentage of under-represented minority enrollees in medical schools has not increased significantly since 1974. In 1988-89, the percentage of minority students enrolled at 61 of 127 medical schools was less than it was in 1983-84. Five medical schools had no minorities enrolled in their programs. While the minority population of this country, especially that of blacks and Hispanics, will be rapidly increasing during the next decades, there are not adequate efforts to increase the number of minority students interested in and qualified to pursue careers in the health professions, although they are urgently needed. A national reemphasis on and recognition of this contribution to alleviating the health care crisis for those with disparate health status is long overdue.
CONCLUSION Thank you for allowing me the opportunity to address the critical heath care issues of our nation, in particular those affecting black Americans. After presenting you with these grim and depressing statistics. You may be asking yourself why did the Congress of National Black Churches ask me to speak before you today. The reasons are many and significant. Black churches have been and continue to be the heart and soul of the black American community. Churches have been the vital lifeline in our lives, a forum for exchange of ideas, and during the civil rights movement, churches were the staging area for the war against poverty and the war for equal rights. Now our churches are needed to help fight a new war - the war for equal access to quality health care. The first step in solving any problem is to identify it, then make efforts to educate "the masses" regarding the problem, this problem is so severe it will require the combined efforts of the minority and majority communities nationwide. Government, private sector and individual involvement is vital to the success of this latest war confronting the black community. The urgency of the health care status of black Americans demands that the black churches must play the role of the town criers and educators of society. You must ring out from the pulpit to educate those regarding this JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
PRESIDENT'S COLUMN
plague on our communities. In doing so, it is essential that we start with our own community but quickly spread that word to the news media, the congress, the executive branch, and every responsible unit of government and of the institutional community.
NMA has been in the forefront in addressing many of the issues affecting black Americans in the health arena. We look forward to working with you to ensure that health care for all Americans will be improved during the decade of the 1990's.
The National AIDS Information Clearinghouse Now-one toll-free number for reference assistance and to order publications:
|
~1-800-458-5231 FAX: 1-301-738-6616 Call us. We're your centralized resource for information on HIV/AIDS programs, services, and materials. A service of the U.S. Department of Health and Human Services Putblic Health Service * Centers for Disease Control
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
129
