Fifth Annual National Conference on Health Disparities
December 1, 2011
Charleston, South Carolina
Thank you, Nadine, for that introduction. We’re so pleased to have Nadine leading our Office of Minority Health. She brings incredible experience as a doctor, a researcher, a leader who is well-respected within our department, and as someone who is very familiar with these issues, most recently as the main force behind our Environmental Justice Strategy. And we feel very glad to have her in this new role.
I also want to acknowledge two great health leaders in Congress, Representative Donna Christenson and Representative James Clyburn. And I want to acknowledge our conference chair, Dr. David Rivers, and all the other partners who helped make this important conference possible.
Forty-five years ago, Dr. Martin Luther King Jr. called inequality in health care the “most shocking and inhumane” form of injustice. Out of all the disparities in American society at that time – gaps in legal rights, gaps in wages, gaps in access to jobs and housing – he singled out health disparities because there is nothing more fundamental to opportunity than good health.
At the most basic level, health is freedom. It’s the freedom to go about our daily lives without experiencing pain. It’s the freedom to live long enough to achieve our goals and get to know our grand-children. It’s the freedom from constant worries about a chronic condition or accumulating health care bills.
Among people my age, there is a saying: “at least I have my health.” What they mean is that no matter what else is happening to them, being in good health gives them a basic level of control over their life. Good health alone does not guarantee opportunity. But it is hard to have real opportunity without it.
That’s why it’s so upsetting that so many of the gaps in health that Dr. King pointed to decades ago remain today. When you talk about African-American children having a higher infant mortality rate than many developing countries, or a third of young and middle-aged Latinos having no health insurance, or 60 million Americans of all races living in areas without enough primary care doctors – words like “shocking” and “inhumane” still apply.
And as you all know, the cost is not just loss of freedom and lives cut short. There’s also a steep economic price that’s paid by every American. In total, it’s estimated that racial and ethnic health disparities alone cost our economy more than $300 billion a year in lost productivity – more than the economies of Maine, West Virginia, Arkansas, and New Mexico combined.
We have a moral and economic imperative to begin narrowing these gaps in health. But when President Obama and this Administration came into office, we knew we couldn’t keep doing things the same way and expect different results. In particular, we needed to take an approach that looked beyond the care we receive when we’re sick.
We needed to look at all the factors that affect our health – from the food we eat, to the water we drink, to the air we breathe, to the homes we live in and the neighborhoods we work in, to the preventive care we receive doctor’s offices and clinics. So over the last two and a half years, we’ve done just that. We’ve looked at all of these factors and asked: what changes can we make to move us closer to an America in which every person has an equal chance to live a healthy life?
The first step we need to take is making it easier for people to live a healthy lifestyle. There are too many communities today that have no supermarkets or safe parks for kids to play in. That doesn’t mean it’s impossible to eat healthy or exercise regularly. But human nature tells us that we’re much more likely to opt for a frozen pizza at the bodega on the corner, if our other option is to take three different buses to get to the local supermarket. And kids are a lot more likely to stay inside and play video games if they’re afraid to play outside.
So what we’ve done is launch an ambitious national effort to make the healthy choice the easy and affordable choice. Through last year’s health care law, we’re supporting the best local ideas for promoting healthy lifestyles to help them become models for the rest of the country. We’re also recruiting outside partners like restaurant chains and professional sports teams through efforts like the First Lady’s Let’s Move Campaign.
And for the first time, we’ve made health a priority across the federal government. Under the new National Prevention Strategy created by the health care law, every time we make a decision that affects health – whether it’s a new environmental regulation or a school lunch policy or a transportation project – we’ll ask what it means for health and in particular health disparities.
It’s not new for our department to be doing this work. What is new are the partnerships behind this work – at the state and local level, with the private and non-profit sectors, and across the federal government with the Education Department, the Transportation Department, the Environmental Protection Agency, and others.
There is a growing understanding that our health problems start outside the hospital and that our solutions need to start there too. But it’s not enough to make sure we have more supermarkets and bike trails in our cities and towns. We also need more doctor’s offices and health centers.
We all know how important it is to have a regular source of primary care. These visits can help us catch small problems before they become big ones. They’re where we can develop a plan to manage our diabetes or high blood pressure. They’re where we get the preventive care like cancer screenings and immunizations that can sometimes save our lives.
But today, too many Americans skip this care or put it off for months because there are simply not enough primary care providers in their community. That’s especially true for minority populations. For example, about one in three Latinos and one in five African-Americans doesn’t have access to a steady source of health care. That’s simply unacceptable.
So what we’ve done is provide a historic boost to our primary care workforce. We’re expanding our national network of community health centers. We’ve tripled the size of the National Health Service Corps – a program that says to young doctors and nurses, “if you go practice in an underserved community, we’ll help repay your loans.” And we’ve put a special focus on training more minority doctors and nurses, not just to help them achieve their dreams, but also because we know they’re more likely to go back and practice in their own communities.
What this means is that more people are going to get the care that keeps them well and out of the hospital. That’s good for their health. And that’s good for our family, business, and government budgets because it’s a lot cheaper to pay for the diabetes screening at the clinic than the foot amputation at the emergency room.
But even if every American has access to the best prevention, people are still going to need health care. People are still going to get sick. There will still be car accidents. And that’s where the final piece of our agenda comes in: making sure all Americans have access to affordable, quality health coverage.
For too long, too many Americans, and especially minority Americans, have gone without the basic protection of health insurance. That’s led people to skip preventive care that could help keep them healthy. And it means that when they did need care, they often ended up in the emergency room where we all pick up the bill in the form of higher premiums. This shouldn’t happen in America.
That’s why President Obama fought so hard for a health care law that makes health insurance work better for working families, instead of big insurance companies. And at a time when a lot of misinformation continues to circulate, we need to make sure every American knows the facts about this law and what it means for them, their family, and their community.
First, it protects everyone who has health insurance with a new Patient’s Bill of Rights that ends the worst insurance company abuses like canceling your coverage when you’re sick. Second, it prohibits insurance companies from denying people coverage because of a pre-existing condition. Third, it expands Medicaid coverage. Fourth, it creates a new marketplace for those who buy their own coverage where Members of Congress will buy health insurance too.
When you add these improvements together, you get a new health insurance market where every American will have access to affordable coverage. And when you combine the insurance reforms with the prevention and workforce investments I already mentioned, the Affordable Care Act is the most powerful law for reducing health disparities since Medicare and Medicaid. And it will only make a bigger difference in the years to come.
But we know that as historic as the health care law was, it is not enough. We still have a lot of work left to do. That’s why our Department released its first-ever, department-wide Action Plan to Reduce Health Disparities earlier this year. This is not another white paper that’s going to sit on people’s bookshelves. It’s a roadmap for change based on conversations with over 2,000 doctors, nurses, teachers, business leaders, and faith leaders across the country and we’re already pushing down on the accelerator.
In October, we published new data standards that will help us get a clearer picture of health disparities. For example, we will now gather separate data on Mexican-Americans and Cuban-Americans, which could help shed light on why Mexican-Americans may be twice as likely to die from diabetes.
We’re also working to provide additional support for promotores. These community health workers are some of our most effective and trusted health messengers, especially for low-income Latinos who are hard to reach through other channels. Now, we’re building a new database that will allow us to reach and work with 15,000 promotores in the first year alone.
And we’re working to close gaps for some of the illnesses that hit minority populations the hardest. One of these is flu, for which we continue to see significant disparities in vaccinations rate. This year, as we enter National Influenza Vaccination Week, we’re making a special effort to reach out to minority communities to make sure people get a vaccine that can keep them and their families safe.
Another disease where we see enormous disparities is HIV/AIDS, for which African-Americans make up nearly half of all new infections. But this World AIDS Day, we are bringing relief to these communities thanks to a new national strategy that is finally targeting resources where they are needed most.
For any of these efforts to succeed, we’re going to need your help. Since President Obama took office, we’ve undertaken the most comprehensive federal agenda to reduce health disparities in history. But we have limited resources, and communities have different needs. If we’re going to close the gaps that Dr. King pointed to, it’s ultimately going to happen one neighborhood, one city or town, one state or territory at a time.
We have a long way to go, but we are moving in the right direction. And I look forward to continuing this work and this journey with you.