A Closer Look at the 'Health Gap' for Minorities

A wide range of diseases takes a far greater toll on minority groups. The result? Shorter lives laced with more chronic illness for many racial and ethnic groups.

Data from the Centers for Disease Control and Prevention (CDC) paint a dim picture:

• The heart disease death rate is 29 percent higher for African Americans than whites.

• African Americans, American Indians and Latinos are at least twice as likely as whites to have diabetes.

• African Americans are 23 percent more likely than whites to die from all types of cancer.

• Hispanic women are 2.5 times more likely than white women to have cervical cancer.

• African American men born now can expect to die six years younger than white friends.

• Racial and ethnic minorities make up 70 percent of new cases of HIV and AIDS.

Because of this "health gap," government agencies, non-profit groups and other experts urge minorities to take care of their health. Seeing a doctor, getting health screenings, knowing the family history and making wise diet and exercise choices and decisions regarding smoking, alcohol use, sexual behavior, drug use and other behaviors that directly impact health are a great start.

Such steps are vital because lifestyles cause about 70 percent of illness and death, the CDC says. We eat too much, pick foods that aren't good for us, smoke, skip physical activity and avoid the doctor. This is even more true for minorities, and the reasons are complex.

"A common misperception is that disparity in health care is simple, that minorities are making poor choices," says Anne L. Schwartz, Ph.D., vice president of Grantmakers in Health, a nonprofit educational group. But a lot of minorities find their choices limited by where they live and their access to education and health care. In 2003, for instance, although 69 percent of older white adults received a flu shot, only 49 percent of older African Americans got one. Dr. Schwartz adds: "Someone might live in poverty, they don't own a car and there's no food market in the vicinity. So they eat fast food because it's available and inexpensive."

Varying impact

Minority groups' health varies. Asian Americans, for instance, don't suffer the disease rates and early deaths of other minorities.

Differing disease rates were once blamed solely on biological differences among races and ethnic groups, says Harold P. Freeman, M.D., director of the National Cancer Institute's Center to Reduce Cancer Health Disparities. "We know now that's not it."

He cites three main causes:

• Poverty: 25 percent of blacks are poor, while 10 percent of whites are poor. About 33 percent of Hispanics have no health insurance, compared with 20 percent of blacks and 10 percent of whites, he says. "Look at the areas of the country that have the greatest poverty and you'll find higher death rates [and] low access to preventive care."

• Culture: Lifestyle, behavior and the way we communicate drive death rates, Dr. Freeman says. "Black American men have a higher rate of smoking cigarettes, have a high-fat diet and die at a higher rate from cancer. But culture does not equal race. In Africa, where black men eat more fruits and vegetables and don't smoke nearly as much, cancer rates are not nearly as high." Beliefs can affect health care, too. "For many Native Americans, you can't even use the word 'cancer' because [they believe] saying the word might bring it on."

• Unequal care: An Institute of Medicine report says minorities often get unequal health care. "Studies have shown that whites are 12 percent more likely to be referred for surgery in potentially curable lung cancer than blacks," Dr. Freeman says. Blacks often miss out on life-saving kidney transplants.

Walter W. Williams, M.D., M.P.H., the CDC associate director for minority health, says we need to increase access to care, to education about risks and to preventive medicine.

"The answer lies across systems," he adds. "We need to decrease poverty, increase upward mobility, create better housing." All these steps will lead to better health care.