Health bill will iron out disparities

By David Satcher

The fractious debate over health care has obscured the promise this bold legislation has to reduce health disparities in the United States. In 2000, this country set a goal of eliminating disparities in health among different racial, ethnic and socioeconomic groups. Health care reform is needed in this country for everyone, regardless of race, but I believe it is also critical to our achieving the overarching goal of eliminating disparities in health.

A 2005 study I was involved with found that if disparities had been eliminated in the last century there would have been 83,500 fewer deaths among African-Americans in 2000 alone. This means that in the last decade of the 20th century, there would have been almost 900,000 fewer deaths among African-Americans. And 2.5 million more African-Americans, including 620,000 children, would have had health insurance if we had universal coverage.

As long as there are disparities among different ethnic and racial groups, we as a nation are not living up to our commitment to life, liberty and the pursuit of happiness for all Americans. Likewise, persons with mental disorders, regardless of race, suffer disproportionately due to discrimination in access to treatment.

So what are health disparities? They are real and measurable; they cause needless suffering; and they can be fatal, causing premature and unnecessary deaths.

Disparities show up in life expectancy rates (whites live on average five years longer than African-Americans); infant mortality rates (13.3 deaths per thousand for African-Americans and 5.7 for whites); prevalence of obesity (African-Americans have a 51 percent higher prevalence of obesity than whites); incidence of diabetes (American Indians more than twice as likely as whites) and other chronic diseases; the number of deaths from cardiovascular disease (African-Americans are 29 percent more likely to die from cardiovascular disease than whites); and cancer (prostate death rate is twice as high among African-Americans as whites and African-American women have higher mortality rates from breast cancer than any other groups).

So what will happen to health disparities under a reformed health system? Most of the uninsured will be eliminated and the underinsured will be buttressed. There will be opportunities for people to secure access to quality health care services and prevent needless pain and suffering. There will be opportunities to encourage healthy lifestyles and prevention measures that will secure a healthy future for our children — habituating them to nutritious foods and regular exercise. And there will be opportunities to eliminate the stigma attached to mental illness and improve early treatment.

Without these reforms, people will continue to delay getting needed preventative care such as screenings that can detect early prostate, colon and breast cancers and prevent early death. America will continue to have some 47 million people who are left out of the system, who are without a medical home and of necessity will use emergency rooms, thus adding to the ever-increasing yearly cost of health care. While we spend almost $2.5 trillion per year on health care, we spend less than 3 percent of our health budget on population-based prevention.

This country needs a health system that balances health promotion, disease prevention, early detection and universal access to care, including mental health care. A balanced health system that focuses more attention on prevention is both more cost-effective and more humane. Hopefully, this legislation begins to move us in that direction.

Dr. David Satcher, the director of the Satcher Health Leadership Institute at Morehouse School of Medicine, was the 16th U.S. surgeon general.