Remarks as prepared for delivery.
Good afternoon. Thank you to the Black Health Care Coalition of Kansas City for inviting me to be part of this event. I’m pleased to be able to join in honoring the individuals and organizations who have worked to close the gap in health care.
There are primarily two kinds of health care gaps that affect African Americans and several other ethnic minority groups. First, there are serious disparities in getting access to care. Second, there are disparities in the quality or effectiveness of care once access is gained.
As a psychologist, I am very familiar with the challenge of health care disparities when it comes to mental health. Indeed, access to mental health services is often harder to come by than medical care.
Inadequate health care is a serious burden and it falls unevenly. Poor or inadequate health care affects people’s health, but also their livelihoods, their hopes and their future plans.
I will focus on the health care disparity as it affects African Americans, but these disparities can be viewed across a whole range of factors—education, race, income, housing, air quality.
If you are poor, or a member of most ethnic minority groups, or have poor quality education, or are living in poor quality housing, or living somewhere with poor air quality, in all likelihood you will be less healthy. And, of course, combinations of these factors have an additive effect.
Last year’s National Healthcare Quality Report makes it clear that although the overall health care quality in the United States is improving, neither the disparity in access nor the gap in quality or effectiveness is closing.
So, the kind of care that’s available is better, but if you are poor and uneducated, you are no more likely to get access to that care than in the past. And if you do get access, your care is will still be of lower quality.
Let's first talk about “access to health care.”
Do you have insurance? Do you have reliable transportation to a hospital or clinic? Are there any health care facilities near you? Do you have physician or health care provider who sees your every year? Each of these questions reveals one measure of access to health care.
On 32 percent of these kinds of measures, African Americans had worse access to care than whites. For Latinos and Native Americans access is even worse. Their access was lower on more than 60 percent of measures. And the poor of all races and ethnicities trailed dramatically, with their access to care being worse than high earners on a staggering 89 percent of measures.
Now let’s look at health care quality, or effectiveness, for a moment.
The National Healthcare Quality Reports uses 140 quality measures. These measures include quality of care received for specific conditions such as cancer, diabetes, heart disease, pregnancy. They include preventive measures such as breast cancer screening. And these quality measures include treatment, for example, the likelihood of getting certain kinds of procedures if you have a heart attack or heart failure.
On quality measures, African Americans received worse care than whites in 41 percent of measures. And poor Americans, regardless of ethnicity, received worse care than high earners in 47 percent of measures. Thus poor members of ethnic minority groups have an accumulated disadvantage.
If you look at our region, Kansas and Missouri have persistent disparities in access and quality of care, meaning tens of thousands of our neighbors are living shorter, less healthy lives as a result. These aren’t just statistics. This is our community.
What’s so insidious about health care inequality is that it affects far more than the health of one person over one lifetime. These disparities are interconnected and quickly combine to create a vicious cycle, affecting generations and entire communities.
If a student has asthma because she’s growing up in poor quality housing and can’t get access to adequate health care, she’s going to miss school. That’s going to make it harder for her to learn and to eventually graduate. Her chances of education beyond high school decline. A lower paying job follows, one without health insurance, and the cycle continues for her children.
Similarly, if a child grows up in a household where healthy food isn’t available, he’s going to form habits that will follow him throughout life. Those habits will increase his chances of heart disease or diabetes. Those can cause him to miss work, increasing the chances he’ll earn less.
It definitely will increase his health care costs. And without intervention his children will likely learn those same habits, perpetuating the problem.
How do you break this cycle? How do you intervene in a lasting way—a way that is not superficial, but gets at the root causes?
Addressing these challenges takes a multi-pronged approach, and by more than just health care providers. That’s why it is so encouraging to see the broad sweep of the Black Health Care Coalition’s Advocacy Agenda. And I want to thank the Health Care Foundation of Greater Kansas City, as well as the other supporters of the Coalition, for their commitment to making real and lasting improvements in the lives of our neighbors.
What are the factors that can reduce the health care gap?
Early childhood nutrition. Helping families make good choices when it comes to nutrition and healthy lifestyles
Providing access to early childhood education. So much of a child’s life is determined in those first years, and even before birth, that the most effective efforts are often the early ones.
Intervening to address problems early. That can include identifying a developmental or learning disability so it can be addressed, or something as simple as a child needing glasses.
All of these factors can help provide the good, healthy start that will propel a child forward.
I’m particularly proud of the work being done with our community partners at Juniper Gardens in Kansas City, Kansas. We’re able to take the research being done at the university on topics such as child development and how students learn, and translate that into positive results for children and their families—giving them the knowledge and the tools to make the most of their own lives.
As we seek to bridge the gap of health inequality we must recognize that there are differences between ethnic groups. And providing equal care does not always mean doing the same thing for different people
Diseases and disorders may present themselves differently in African-Americans than in whites, for example. And certain conditions are more prevalent in one ethnic group than in another. Training health personnel to be sensitive to these differences will result in higher quality care. And if you’re able to identify and treat a condition on the first visit, rather than the fourth, that’s going to reduce costs and, most importantly, improve quality of life.
Research is also important. The ability to perceive and respond to differences in the ways that disorders are manifested across ethnic groups requires not only professionals trained to recognize these differences, but also researchers who study these areas. Researchers like Dr. Allen Greiner at the KU Medical Center, who right now is studying why outcomes are worse for African Americans who have colorectal cancer.
We have a center tackling Latino health disparities and another addressing health challenges faced by Native Americans. All of these with the goal of not just bridging, but closing the gap.
We must address the gap in income and the cost of health care. That’s one of the reasons affordable health care and affordable health insurance are so important. But if we are going to truly close the gap, we also must address one of the most significant drivers of health inequality, and that it is income and poverty.
Reducing poverty starts with giving people the knowledge and tools to be successful in the workplace and in life. Over the past decade, we have seen a systematic disinvestment in education at every level, from K-12 to college. That has to change, and we must make a commitment at every level to once again invest in our students.
Despite our current situation, I remain optimistic. You can’t witness the caring and dedication of the people here, and all throughout our community, who are giving of their time and talents to help their neighbors and not be hopeful.
I often say that the mission of the University of Kansas is to lift students and society by educating leaders, building healthy communities, and making discoveries that change the world.
Together, through organizations like the Black Health Care Coalition, we can lift up our neighbors and our communities, closing gaps and ending disparities. And if we do that—if we change enough lives—then we’ll also change the world.
Thank you for your commitment to the health and well-being of our entire community, and congratulations again to today’s honorees.