Reflections, Revisions, Renewals

It is customary at the end of each year to pause and celebrate achievements, ponder lessons learned, and renew commitments to do more, even better. Having marked our accomplishments, we look to the new year with anticipation and new aspirations. As we begin 2013, I want to reflect briefly on progress in the national agenda to improve minority health and reduce health disparities, share some shifts in our thinking, and greet the new year invigorated and ready for the opportunities and challenges ahead.

Since the publication of the 1985 Secretary’s Task Force Report on Black and Minority Health, the federal government has revised and renewed our efforts to reduce health disparities through the National Partnership for Action (NPA); the National Prevention Strategy; Healthy People 2020; and provisions in the Patient Protection and Affordable Care Act, to name a few. Along with increasing access to quality health care, these national initiatives represent a strategic revision in the national agenda to shift our attention from “excess deaths” highlighted in the 1985 report to the social and physical environments – broadly understood, that help shape health outcomes.

Last year, CDC’s Office of Minority Health and Health Equity established five priority goals, one of which is to “reframe eliminating health disparities as achievable.” In this reframing, we are exploring ways to modify and expand how health disparities have historically been documented, explained, and addressed. In the field of public health, minority health is principally examined through the lens of epidemiology – the study of the distribution and determinants of health-related states or events in specified populations. In the case of minority health, this study is primarily applied to the prevention and control of health problems. Descriptive epidemiological studies are sometimes reported as point-in-time snapshots and others reflect trends over time. What could be more fully described in reports of these studies are the historical events and social conditions that contextualize health outcomes.

For example, health disparities between African Americans and whites in the U.S. are well documented back to the 15th and 16th century slave trade of Africans in the U.S. and North America; continuing through different historical landmarks of the antebellum period of slavery in the South; the post-Civil War and Reconstruction eras; post-Reconstruction and the span of “Jim Crow,” and persisting through the Civil Rights era; and more recent “Black liberation” and “Black Power” movements of the late 1960’s and early 1970’s. [Source: Byrd, WM and Clayton, LA. An American Health Dilemma. (2000)]. Revisiting the history of minority populations in the U.S. and how these events impact health are important in our reflections, revisions, and renewals as we plan for the future.

Nationally and at CDC, there has been considerable progress over the past several years in attending to the social determinants of health. With this attention comes the necessity to work with data outside of the public health and health care domains (e.g., education, employment, social services); to champion innovative and rigorous surveillance and evaluation methods that capture the impact on health of programs addressing social determinants, regardless of the sector (e.g., health, housing, justice) in which programs reside; and to increase awareness within the larger population of the relationship between health outcomes and a host of social factors.

Moving forward, we will focus as much on reporting solutions as we do in describing the problem. We will work with partners to catalyze a dual strategy that mobilizes both affected community members and the institutions and sectors that shape opportunities for health. We will refine our understanding of minority health as distinct from conventional descriptions of the burden of disease experienced by minority communities.

As social norms are changing toward healthy living, we must be sensitive to those who feel guilt and frustration when they are not meeting the new cultural expectations such as maintaining an ideal body weight or prescribed exercise regimen. There are small successes such as having a blood pressure check or eating more fruits and vegetables we can and should celebrate. In the new year, we will consider how the language we use to talk about minority health may motivate or discourage people from caring for their own personal health.

As we begin the New Year, it is worth reiterating that health disparities are a societal issue and not just the burden of selected populations. In the years ahead, we must identify ways to quantify and communicate to all of our society the benefits to everyone in eliminating preventable health disparities and achieving health equity.

What are your reflections, revisions, and renewals to help eliminate health disparities in 2013?