Cancer Health Disparities Planning

This past Friday, a group of about 20 community and academic leaders met to discuss how to best address the many disparities related to cancer here in Arizona. The meeting, held at the Talking Stick Resort, included a lively discussion about the need for enhanced collaboration, advocacy and education. Dr. Tim Flood (pictured with Justin Tai, APCA Public Ally) provided profiles of cancer disparities by racial/ethnic group as a lead-in to the facilitated discussion. The Cancer Health Disparities group is a subcommittee of the Arizona Cancer Control Coalition, led by the Arizona Department of Health Services.

Doug Hirano, MPH, APCA Executive Director

White House Offers Input Opportunity for Asian Americans and Pacific Islanders

For those of us who have been advocating for the health and well being of Asian Americans and Pacific Islanders, there’s an interesting opportunity to guide the federal government’s efforts in this arena. The White House Initiative on Asian Americans and Pacific Islanders is coordinating an effort to provide comment on government plans to enhance services for AAPIs.

Each major government department has or is developing a plan to improve services to AAPIs. These draft plans are available on-line. The public has 30 days to provide comment once the initial draft plan is completed. Our area of interest is the Department of Health and Human Services, which includes key agencies such as the Centers for Disease Control and Prevention, the Office of Minority Health, the Health Resources and Services Administration and the National Institutes of Health. With concerted and strategic effort, these agencies can have a sizable impact on the health and well being of populations such as AAPIs suffering from health disparities such as hepatitis B, tuberculosis, tobacco use and diabetes. Communities have an obligation to participate, however. This is an important opportunity.

Here’s a link to the plan.

The deadline for comment is February 17th. I’ll provide a draft of our suggested comments in an upcoming blog entry.

- Doug Hirano, MPH, APCA Executive Director

CDC Releases New Health Disparities Report: What’s Missing?

The Centers for Disease Control and Prevention has issued a landmark report on health disparities – the first produced by the CDC that covers a variety of health problems. Areas addressed include environmental health, health care access, infant deaths, motor vehicle deaths, suicides, HIV infection, obesity and diabetes, among other areas. It’s required reading for those of us working to end health disparities and is a nice companion piece to the recently released Healthy People 2020 document.

Having said that, there will probably be discussion about the health areas that were not included in this health disparities report. Here’s how the CDC folks explained what was and what wasn’t included in the report:

Topics included in CHDIR 2011 were selected on the basis of one or more of the following criteria: 1) leading causes of premature death among segments of the U.S. population as defined by sex, racial/ethnicity, income or education, geography, and disability status; 2) social, demographic, and other disparities in health outcomes; 3) health outcomes for which effective and feasible interventions exist; and 4) availability of high-quality national-level data.

It can be argued that areas such as breast cancer qualify to be addressed on the basis of the aforementioned criteria. Breast cancer is clearly a major cause of premature death; demographic disparities exist (African American women have disproportionately high mortality rates), effective interventions (early screening and detection) exist, and high-quality national-level data (vital statistics) are available. Why wasn’t breast cancer addressed in this report?

For those of us focused on issues that face Asian Americans and Pacific Islanders, there is the question as to why hepatitis B was not addressed in this report. Hepatitis B among AAPIs also meets at least three (and arguably four) of the four aforementioned criteria. In a prior blog entry, I had commented on the lack of attention to hepatitis B in the Healthy People 2020 document. There would seem to be a pattern here.

Clearly, more work remains for those of us advocating for more attention to the silent epidemic of hepatitis B – particularly among AAPIs. In a future entry, I will discuss a short term opportunity to provide important input to the federal government on this topic.

-Doug Hirano, MPH, APCA Executive Director

Can We Really Eliminate Health Disparities?

For the past nine months, I’ve been meeting with some folks from other health-related organizations here in the valley. We share an interest in addressing the fact that selected groups of people systematically suffer worse health outcomes (i.e., health disparities) when compared to the general population. We are in the early stages of forming a cross-cultural institute to address the problem of health disparities here in Maricopa County. Here’s an excerpt from the draft document that we’ve been developing:

“Despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of illness and death than non-minorities. African Americans, for example, experience the highest rates of death from heart disease, cancer, stroke, and HIV/AIDS when compared to any other U.S. racial or ethnic group. American Indians disproportionately die from diabetes, liver disease, and unintentional injuries. Hispanic Americans are almost twice as likely as non-Hispanic whites to die from diabetes. In addition, some Asian-American subpopulations experience rates of stomach, liver and cervical cancers that are well above the national averages.”

This paragraph succinctly describes our collective problem related to health disparities. These disparities continue to exist 25 years after the 1985 landmark report from the U.S. Department of Health and Human Services that originally called for action on health disparities.

I personally believe that with our current science, technology and health promotion evidence base, health disparities can be eliminated. However, this is not a quick fix. Health disparities are directly associated with multiple overlapping issues, including poverty, educational attainment, the physical environment, access to health services, and personal health behaviors. Race and culture matter as well. For even when all other factors are adjusted for, people of color in this country suffer disproportionately in terms of preventable disease and death.

APCA is glad to be involved with a group of agency representatives that is willing to expend the time and resources to tackle health disparities in Maricopa County, and we thank St. Luke’s Health Initiatives for supporting our group through its TAP Program. We have a large task at hand. We believe that our cross cultural institute must advocate for social and health policies that level the playing field so that everyone – regardless of race, ethnicity, disability status or sexual identity – has an opportunity for good health. We also believe that more work is needed in the health care and public health sectors to provide culturally proficient health services.

I will continue to update this blog about our efforts. Anyone interested in this initiative should feel free to contact me for further information.

- Doug Hirano, MPH, APCA Executive Director