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Dying For Basic Care

For Blacks, Poor Health Care Access Cost 900,000 Lives

By January W. Payne
Washington Post Staff Writer
Tuesday, December 21, 2004; Page HE01

More than 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites, according to an analysis in the December issue of the American Journal of Public Health. The study estimates that technological improvements in medicine -- including better drugs, devices and procedures -- averted only 176,633 deaths during the same period.

That means "five times as many lives can be saved by correcting the disparities [in care between whites and blacks] than in developing new treatments," Steven H. Woolf, lead author and director of research at Virginia Commonwealth University's Department of Family Medicine, said in a telephone interview.


Former U.S. Surgeon General David Satcher, a report co-author, says disparities in healthcare between African Americans and whites need to be corrected. (Horace Henry)

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Health Care Gap
The Post's January W. Payne reports that 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites.

Woolf and four co-authors compiled and examined the data, which they drew from the National Center for Health Statistics.

"We were trying to say that there was something you could do in medical research to improve health outcomes," said co-author David Satcher, former U.S. Surgeon General and current director of the National Center for Primary Care at the Morehouse School of Medicine. "But if you didn't focus more on the translation of that into especially the populations that tended to be left behind . . .you were not going to get as much out of the research as you would otherwise."

Otis Brawley, medical director of the Georgia Cancer Center for Excellence and professor of hematology, oncology and epidemiology at Emory University in Atlanta, said: "It's important [to note] that this is not an argument against science. . . . This is an argument that there are therapies out there that are not new that people just don't get."

Reduced access to health care doesn't account for all the racial disparity in preventable deaths. Blacks have greater incidence of some diseases; some of this greater morbidity results from education, income level and environment as well as access to health care. The challenge, the authors said, is to deliver the same quality health care to everyone, despite these factors.

One of the Healthy People 2010 goals -- the nation's health priorities for the decade -- is to eliminate such inequities in health care. Satcher said some steps, such as the creation of the National Center on Minority Health and Health Disparities at the National Institutes of Health, have already been taken, but more needs to be done.

"Access to care is a big factor. African Americans and Hispanics are much more likely to be uninsured and underinsured and underserved" and may not seek care as often as whites, Satcher said. "So a great part of it is really focusing on how do we get prevention programs, intervention programs [and] treatment programs to people in underserved communities?"

Shiraz I. Mishra, of the University of Maryland School of Medicine's Comprehensive Center for Health Disparities, Research, Training and Outreach, agreed that more attention should be paid to addressing the causes of disparities. "Unless those issues are addressed, we will not be able to reduce disparities [between racial groups] in morbidity [illness] or mortality in the United States," he said. "Technological advances do have their place in our society; however, there are some things that are a little bit more basic."

The researchers used mortality rates, which decreased by an average of about 0.7 percent per year during the studied period, to estimate the number of deaths that were prevented by improvements in the "technology of care." For the purpose of the analysis, they gave full credit for the decline in mortality to these advances.


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