"The Alarming State of Health Disparities" by Judy Ann Bigby

Massachusetts is one of the healthiest states in the country, but—like the rest of the nation—we face unacceptable racial and ethnic disparities in health and health care.

The Department of Public Health (DPH) recently released health status indicators and data that confirm alarming disparities across the state. They exist in access to care; incidence of chronic diseases, such as asthma, diabetes, and high blood pressure; and in hospitalizations and mortality for conditions like cancer and HIV/AIDS. Throughout the United States and in all regions of Massachusetts, racial and ethnic minorities—particularly African-Americans and Latinos—have worse health outcomes than other groups.

The numbers say it all. The infant mortality rate among African-Americans is more than double that of whites, and heart disease death rates are more than 40% higher. Hispanics are almost twice as likely to die from diabetes as non-Hispanic whites. Cervical cancer risk is particularly high among Latinas, with incidence rates that are double those of white women, who are also less likely to die from the disease. And Korean-American men, for example, experience a rate of stomach cancer that is five times the rate of white men.

Although critically important, access to insurance is not the most significant contributor to these differences, so while health care reform will benefit those who were not previously insured, we must take other action steps to address disparities.

We can attribute differences in health status between various racial and ethnic groups to a complicated and diverse range of factors. Community influences like the environment; socioeconomic conditions; social stressors such as violence; the presence of social networks; and many other factors play significant roles.

Health-related problems are more severe in poorer neighborhoods. Exposure to hazards like lead, toxic waste, air pollution and pesticides are linked to a variety of ailments including asthma, birth defects and cancer. Higher levels of social stressors (as measured by crime rates) are significantly linked to higher rates of low birth weight pregnancies, teen births and age-adjusted death rates.

The Patrick Administration and, specifically, the Executive Office of Health and Human Services are committed to reducing racial and ethnic disparities in health and health care, and understand that it requires a comprehensive approach. The Health Care Quality and Cost Council (which I chair) was established to develop and coordinate the implementation of health care quality improvement goals, including reductions in racial and ethnic health disparities. The Council’s goals in this area for FY08 are to reduce disparities associated with infections, disease complication rates, readmission rates and avoidable hospitalizations, and in the screening and management of chronic illnesses. We are partnering with providers, insurers, advocates and consumers to make meaningful improvements.

Disparities in the provision of health care, whereby individuals from racial and ethnic minority populations receive lower quality care than others, must also be addressed. The Division of Health Care Finance and Policy recently began collecting race and ethnicity information for every inpatient hospital discharge from all acute care hospitals in Massachusetts. This database contains comprehensive patient-level data, including socio-economic demographics, clinical data such as diagnoses and procedures, and charge data for more than 800,000 inpatients cared for in acute care hospitals. As it grows, this database will be an invaluable in informing our future efforts to address disparities and to hold providers accountable for the care they provide.

Last month, the Office of Medicaid announced its groundbreaking Pay for Performance program, which provides incentives to reward excellence and improvement in hospital quality and reduce racial and ethnic health disparities. The program, which goes into effect on October 1, requires that providers report quality indicators by race and ethnicity. By building the data we have available in Massachusetts, we can work together to identify exactly where quality of care is unequal and develop strategies for improvement.

Our work to reduce and ultimately eliminate racial and ethnic disparities in health and health care must be far-reaching and coordinated. Policy-makers, providers, insurers, community-based organizations and consumers all play unique and critical roles in this effort. Only by working together will we truly make a difference.

Dr. Judy Ann Bigby is Secretary for Health and Human Services for Governor Deval Patrick