David Satcher


Both the life expectancy and the overall health of Americans have improved greatly over the last century, but not all Americans are benefiting equally from advances in health prevention and technology. There is compelling evidence that race and ethnicity correlate with persistent health disparities in the burden of illness and death. For example, compared with their white counterparts, black babies are twice as likely to die during their first year of life, and American Indian babies are 1.5 times as likely. The rate of diabetes among Native Americans is three to five times higher than the rest of the American population, and among Hispanics it is twice as high as in the majority population. Although constituting only 11% of the total population in 1996, Hispanics accounted for 20% of new tuberculosis cases. Also, women of Vietnamese origin suffer from cervical cancer at nearly five times the rate for white women. Current information about the biologic and genetic characteristics of these populations does not solely explain these health disparities. These disparities result from complex interactions among genetic variations, environmental factors, specific health behaviors, and differences in health care access and quality. While the diversity of the American population may be one of our nation's greatest assets, it also represents a range of health improvement challenges-challenges that must be addressed by individuals, communities, and the nation. The demographic changes that are anticipated during the next decade magnify the importance of addressing disparities in health status; groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population. Therefore, the future health of America depends substantially on our success in improving the health of racial and ethnic minorities. A national focus on disparities in health status is also particularly important as major changes unfold in how health care is delivered and financed. In a February 1998 radio address, then-President Clinton committed the nation to an ambitious goal by the year 2010: to eliminate the disparities experienced by racial and ethnic minority populations in six health-related areas, including cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, immunization rates, and infant mortality. 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. Clinton's goal parallels the focus of Healthy People 2010-the nation's health objectives for the twenty-first century-which Donna Shalala, former Secretary of the Department of Health and Human Services (DHHS), and I released inJanuary 2000. Achieving this vision will require a major national commitment to identify and address the underlying causes of higher disease and disability levels in racial and ethnic minority communities. These causes include poverty, lack of access to quality health services, environmental hazards in homes and neighborhoods, and the scarcity of effective prevention programs tailored to the needs of specific communities. The effort will require improved collection and use of standardized data to correctly identify all high-risk populations, and to monitor the effectiveness of health interventions targeting these groups. Research dedicated to a better understanding of the relationships between health status, race, ethnicity, and socioeconomic background will help us acquire new ways to eliminate disparities and to apply our existing knowledge.