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REMARKS BY:	DONNA E. SHALALA,  SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Office of Research on Minority Health Conference, Washington, D.C.
DATE:		April 17, 2000

For a decade, the Office of Research on Minority Health has kept its promise by working with its partners at NIH to ensure that we do not remain two nations-separate and unequal in overall health. It greatly expanded the research and training portfolio on minority health at NIH. Along with the National Cancer Institute, it's working to establish partnerships between our nation's premier cancer centers and minority medical schools. And, together with the National Heart, Lung and Blood Institute, it's supporting the Jackson Heart Study-which will identify risk factors for cardiovascular disease- especially those related to high blood pressure in the African-American community. So we have much to celebrate on this tenth anniversary.

Today also happens to mark another anniversary. On this date-exactly ninety years ago-an American tradition was born when President William Howard Taft threw out the first ball to start the major league baseball season. I can't imagine any game better suited to our national character than our national past time. In baseball, no shot clock or penalty clock or game clock influences victory or defeat. Instead-regardless of the length of an inning or the number of innings in a game-each team is given an equal opportunity to win. Baseball is built on the premise of equality.

Of course, equality isn't only the hallmark of America's favorite sport-it's also the benchmark of America itself. Unfortunately, it's a benchmark that we haven't always met-especially in the area of minority health. We may have the finest health care system in the world-but too many of our citizens enjoy less years in their lives.and less health in their lives.

That's why I'm pleased to be a part of an Administration that has worked so hard to lift the shadow of health disparities that fall-not only across minority communities-but across our entire nation. As many of you know, in 1998 the President and Vice-President called on the nation to eliminate racial and health care disparities in six areas by 2010. They are: infant mortality; diabetes; cancer screening and management; heart disease; HIV/AIDS; and childhood and adult immunizations. And to make that goal a reality, we've asked Congress to commit 400 million dollars to close the gaps in health outcomes.

We've also partnered with the Congressional Black Caucus to invest 407 million dollars-over two years-to prevent and treat HIV/AIDS in African-American, Hispanic and other minority communities.

But we're certainly not stopping there. The HHS fiscal year 2001 budget includes almost five billion dollars for programs and activities to improve minority health. And it includes a request for an additional 20 million dollars to establish a new Coordination Center at NIH for research on minority health. Placed in the Office of Research on Minority Health, the Center will help develop a NIH-wide "Strategic Plan for Research on Health Disparities."

Finally-as we mark "Minority Cancer Week"-I'm pleased to say that the federal battle against cancer got a giant shot in the arm last week. The National Cancer Institute announced a new 60 million dollar program to address the greater cancer burden faced by many racial and ethnic minorities.

Thanks, in part, to seven-and-a-half years of effort.to the exciting "trans-NIH" work that's being spearheaded by the Office of Research on Minority Health.and to the leadership of all of you- I'm proud to say we've already narrowed some of the gaps. A decade ago, the gap for the most critical childhood immunizations was as wide as 26 points between white children and children of other racial and ethnic groups. Currently, 73 percent of African-American children, and 75 percent of Hispanic-American children, are fully vaccinated. But we know we can do even better. So today, I'm happy to announce that we're kicking-off "National Infant Immunization Week" with a new public service campaign that includes television and radio announcements in Spanish. The campaign urges all parents-particularly Hispanic and African-American parents-to immunize their children.

Our success in erasing the gaps in childhood immunization rates is certainly encouraging. But of course, when it comes to health disparities, we're a long way from victory-the game is far from over. I think of it as being in the seventh inning stretch. It's a time to stand up and take stock of how far we've come-but also to think about how far we must still go to win the game. We still have far to go when the Pimas of Arizona continue to have the highest rate of diabetes in the world. We still have far to go when Hispanic-Americans suffer from stomach cancer at two to three times the rates of whites. And we still have far to go when an alarming two-thirds of all new AIDS cases in 1998 were among racial and ethnic minorities-the vast majority in the African- American community.

If we really want to declare victory.if we really want to meet America's benchmark of equality for all.and if we really want to remove health disparities from the American landscape, then I believe we must meet three challenges. We must prevent disease; promote access; and increase sensitivity in the medical professions.

These challenges force us to expand our definition of what constitutes "scientific research." They place health in the overall context of economic progress, social custom, and human behavior. And they actually follow a patient through the various stages of health care.

Our first challenge is to prevent disease even before a patient visits the doctor. We know that many health problems-including heart disease, diabetes, cervical cancer and HIV-are preventable and treatable. But as our incomparable Surgeon General-Dr. David Satcher-points out, too many people haven't been helping themselves. It's not that they don't care-it's because the medical and public health communities haven't always effectively reached out to them. Joy Harjo-a poet from the Muskogee tribe-eloquently captured the importance of sitting down and communicating when she wrote: "The world begins at the kitchen table."

Improving the availability and dissemination of health information is one of the objectives of our "Healthy People 2010 Initiative." Under the leadership of Dr. Satcher, this effort is designed to achieve two overarching goals: To increase the length and quality of life for all Americans. and to eliminate health disparities in the six areas I previously mentioned by 2010. But we all need to do more to get the right information to the right people in the right way. And we also need more scientific research that explores health risk factors in minority communities-and what it takes to change unhealthy behaviors.

While we're focusing on prevention, our second challenge is to promote access. Of course, we can't wait until everyone has health insurance before tackling the problem of disparities. But once a person decides to see the doctor, we must ensure that the inability to pay doesn't keep him or her from walking through the door. More than 43 million Americans have no health insurance-and far too many of them-including 35 percent of Hispanic-Americans-are minorities. That's why we've proposed that uninsured workers ages 62 to 65-and all other Americans ages 55 to 62 who have lost their jobs and health insurance through no fault of their own-be allowed to buy into Medicare.

To help our 11 million uninsured children-including the nearly 20 percent who are African- American-we've expanded our Medicaid outreach efforts-and we've created the "State Children's Health Insurance Program"-or SCHIP. SCHIP is the largest single expansion of health insurance for children in 30 years-and it's targeted to working families who earn too much for Medicaid, but too little to afford private insurance. By last September, nearly two million children-more than the combined population of Montana, Vermont and North Dakota-were enrolled in the program. We need all of you who are working on the frontlines in our communities to help us find and enroll eligible children in both SCHIP and Medicaid.

And we need to take the next logical step. That's why the President has proposed creating a new "FamilyCare" program. Under "FamilyCare," parents of SCHIP and Medicaid eligible children would be covered by the same health plan as their children. But let me reiterate: Tackling racial and ethnic disparities can't wait until everyone is insured. We must devise new strategies.form new partnerships .and start new initiatives to end disparities-right now-while also continuing to expand health care coverage so that no one is prevented from seeing a doctor.

Of course, once a person has actually entered the doctor's office, we must ensure culturally sensitive care. That's our third, and final challenge-and it recognizes that not only is America growing more diverse.but that we will have a "minority majority" by the year 2050.

Last year, a study in The New England Journal of Medicine found that African-Americans were less likely than whites to have surgery for the early stages of lung cancer. The cause may well have been a break-down in doctor-patient communication. Somehow, the doctors weren't effectively communicating the message that surgery can save lives. Additionally, the doctor- patient relationship may have been clouded by the specter of Tuskegee-and the 400 African- American men who weren't treated for syphillis for 40 years.so the government could study the disease.

All doctors need to learn how to communicate with their patients across the divides of race, social class, education and attitudes. Medical schools must adequately train new physicians to be culturally sensitive and to understand diversity. And we all need to do more to increase the number of minority physicians-and so enhance cultural sensitivity throughout the medical profession.

Enhancing sensitivity.promoting access.preventing disease.these are the most important minority health challenges all of us face. These are challenges that government cannot meet alone. And these are challenges that cannot wait. As Dr. Martin Luther King noted, "I can walk to freedom-but only if I have a healthy body." We need each of you-and your organizations-to step up to the plate and ensure that minority health concerns are never overlooked. We need you to continue researching ways to unlock the mysteries that surround racial and ethnic health disparities. We need you to give us input and ideas. We need you to hold our feet to the fire. And we need you to help remind everyone that-when it comes to improving our health-America can never move ahead, if anyone is left behind.

Working with all of you-and with the Office of Research on Minority Health leading the way- I've no doubt that in this new millennium we'll write the final chapter on health disparities in America.I've no doubt that we'll finally achieve a level playing field for all Americans in overall health.I've no doubt that we can finally declare victory.And I've no doubt that we can keep the promise of equality for all Americans.