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Disease Burden & Risk
Factors
Healthy People 2010,
the Nation's prevention agenda, is
designed to achieve two overarching goals: 1) Increase quality and years
of healthy life; 2) Eliminate health disparities. The second goal of
Healthy People 2010, to eliminate health disparities, includes
differences that occur by gender, race or ethnicity, education or income,
disability, geographic location, or sexual orientation.
Compelling evidence
indicate that race and ethnicity correlate with persistent, and often
increasing, health disparities among U.S. populations in all these
categories and demands national attention. Because
racial and ethnic minority groups
are expected to comprise an increasingly larger proportion of the U.S.
population in coming years, the future health of America will be greatly
influenced by our success in improving the health of these groups. Despite
great improvements in the overall health of the nation, Americans who are
members of racial and ethnic minority groups, including blacks or African Americans,
American Indians and Alaska Natives, Asian Americans, Hispanics or Latinos, and
Other Pacific Islanders, are more likely than whites to have poor health
and to die prematurely. These disparities are believed to be the
results of the complex interaction among genetic variations, environmental
factors, and specific health behaviors.
Culturally appropriate, community-driven programs are critical for
eliminating racial and ethnic disparities in health. For these programs to
be effective, prevention research is needed to identify the causes of
health disparities and the best means of delivering preventive and
clinical services. Establishing these programs will also require new and
innovative partnerships among federal, state, local, and tribal
governments and communities.
The Department of
Health and Human Services (HHS) has selected six focus areas in which
racial and ethnic minorities experience serious disparities in health
access and outcomes:
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Cancer
Screening and Management
African American women are more than twice as likely to die of
cervical cancer than are white women and are more
likely to die of breast cancer
than are women of any other racial or ethnic group.1 |
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Cardiovascular
Disease (CVD)
Heart disease and stroke are the leading causes of death for all
racial and ethnic groups in the United States. In
2000, rates of
death from diseases of the heart were 29 percent higher among African
American adults than among white adults, and death rates from stroke
were 40 percent higher.1 |
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Diabetes
In 2000, American Indians and Alaska Natives were 2.6 times more
likely to have diagnosed diabetes compared with non-Hispanic Whites,
African Americans were 2.0 times more likely, and Hispanics were 1.9 times
more likely.2 |
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HIV
Infection/AIDS
Although African Americans and Hispanics represented only 26
percent of the U.S. population in 2001, they accounted for 66 percent of
adult AIDS cases3 and 82 percent of pediatric AIDS cases reported in the
first half of that year.4 |
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Immunizations
In 2001, Hispanics and African Americans aged 65 and older were
less likely than Non-Hispanic Whites to report having received influenza
and pneumococcal vaccines.5 |
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Infant
Mortality
African American, American Indian, and Puerto Rican infants have
higher death rates than white infants. In 2000, the black-to-white ratio
in infant mortality was 2.5 (up from 2.4 in 1998). This widening disparity
between black and white infants is a trend that has persisted over the
last two decades.6 |
These six health areas were selected for emphasis because
they reflect areas of disparity that are known to affect multiple racial and
ethnic minority groups at all life stages. The representative near-term goals
within these six areas are drawn from Healthy People 2000, the Nation's
prevention agenda: targets for reducing disparities have been developed in
consultation with representatives from target communities and experts in public
health. Reliable national data is also available to track our progress on these
near-term goals in a timely fashion. The leadership and resource of the
Department will be committed to achieving significant reductions in these
disparities by the year 2010. These disparities occur for a variety of reasons,
including unequal access to health care, discriminations, and language and
cultural barriers. In addition, the following diseases and
conditions disproportionately impact racial and ethnic minorities:
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Mental Health
American Indians and Alaska Natives appear to
suffer disproportionately from depression and substance abuse. Minorities have less access to, and
availability of, mental health services. Minorities are less likely
to receive needed mental health services. Minorities in treatment
often receive a poorer quality of mental health care. Minorities are
underrepresented in mental health research.7 |
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Hepatitis
In 2002, 50 percent of those infected with Hepatitis B were Asian
Americans and Pacific Islanders.8
Black teenagers and young adults become infected with Hepatitis B
three to four times more often than those who are white.9
One recent study has found that black people have a higher
incidence of Hepatitis C infection than white people.10 |
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Syphilis
Some fundamental societal problems, such as poverty,
inadequate access to health care, and lack of education are
associated with disproportionately high levels of syphilis in
certain populations. Cases of primary and secondary syphilis in 1999
had the following race or ethnicity distribution: African Americans
75 percent, whites 16
percent, Hispanics eight percent,
and others one percent. Syphilis reflects one of
the most glaring examples of racial disparity in health status, with
the rate for African Americans nearly 30 times the rate for whites.11 |
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Tuberculosis (TB)
Of all the TB cases
reported from 1991-2001, almost 80 percent
were in racial and ethnic minorities. Asian Americans and Pacific
Islanders accounted for 22 percent of those cases, even though they
made up less than four percent of the U.S. population.12 |
Sources:
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1
National Center for Health Statistics (NCHS), Health, United
States, 2002,
Table 30. |
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2
National
Center for Chronic Disease Prevention and Health Promotion (NCCDPHP),
2000. |
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3
NCHS, Health, United States, 2002,
Table 54. |
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4
NCHS, Health, United States, 2002,
Table 55. |
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5
Morbidity
and Mortality Weekly
Report (MMWR), 2002, p.1020. |
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6
National
Center for Health Statistics (NCHS), 2002. |
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7
Mental
Health: A Report of the Surgeon General, 1999. |
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8
Department of Health and Human Services. |
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9
Marwick C, Mitka M (1999). Debate revived on hepatitis B
vaccine value. JAMA, 282(1): 15–17. |
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10
Committee on Infectious Diseases, American Academy of
Pediatrics (2000). Hepatitis C. In LK
Pickering et al., eds., 2000 Red Book: Report of the Committee on
Infectious Diseases, 25th ed., pp. 302–306. Elk Grove, IL: American
Academy of Pediatrics. |
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11
National Center for HIV, STD, and TB Prevention
(NCHSTP) Division of Sexually
Transmitted Diseases. |
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12
NCHSTP Division of TB Elimination. |
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