Diversity Tests Health Care in 3 Md. Counties

By Susan Levine
Washington Post Staff Writer
Saturday, December 1, 2007

The increasing diversity of three of Maryland's largest counties is exacerbating already serious health disparities within communities, according to a new report.

Those disparities are not uniform across Montgomery, Prince George's and Frederick counties, despite the jurisdictions' similarities and parallel growth in their immigrant populations. Often, the differences seem inexplicable.

African Americans in Montgomery, for example, suffer a double-digit rate of infant mortality, a rate significantly higher than that of any other group in any of the counties. The rate of hospitalization for strokes among Latinos in Frederick is more than twice that of Latinos in Prince George's. Whites with diabetes are hospitalized most frequently in Prince George's, but their death rate is two to three times as high in Montgomery.

And in keeping with state trends, Asian Americans probably have the highest cervical cancer mortality regionally, although detailed data are lacking.

Partnering Toward a Healthier Future, the report that was released this week by Adventist HealthCare's Center on Health Disparities, addresses the persistent "and in some cases deepening" gaps in the counties across racial and ethnic lines. "Without action, the existing health disparities affecting these communities will only grow more pronounced," it concludes.

The 113-page document is the first major public undertaking of the center since its creation early this year. The color-coded charts do not represent new research, but statistics from local, state and national surveys are offered in eye-opening comparisons.

"We've got to have the local and regional conversations," Ulder Tillman, Montgomery's health officer, stressed yesterday during a forum to discuss the report and its call for collaboration on culturally sensitive programs and outreach, research and data collection.

The information presented comes largely from 2000 on, a period when the white population in the counties dropped as a proportion of the total as the numbers of African Americans, Latinos and Asian Americans rose. The report addresses only the three jurisdictions because they are the primary service area for Adventist's hospitals in Takoma Park and Rockville. The center's executive director, Marcos Pesquera, wants to expand the geographic boundaries in subsequent updates to include more of suburban Maryland.

"I'm hoping this will bring a lot of people together," Pesquera said. "Can we be a catalyst to ignite change?"

Much of the counties' growing diversity is because of immigrants from Mexico, Central America, the Caribbean and Africa. Together, the report notes, the immigrants bring "new challenges" to local health care because of a lack of understanding or fear of the system as well as language difficulties.

Affluent Montgomery has more doctors and dentists per capita than Prince George's and Frederick, plus multiple hospitals and an extensive primary care coalition of community clinics for low-income and uninsured residents. Frederick, by contrast, has only one hospital, no community clinic, a single mobile health van and a long list of pregnant Latino women unable to find any prenatal care.

Though Frederick is beginning to focus on obstacles to health-care access, its health officer, Barbara Brookmyer, acknowledged how difficult progress is. "I don't see the groundswell of energy toward addressing these inequity issues," she said at yesterday's forum.

The report shows how much poorer African Americans' health remains. Their rates of prostate cancer -- and deaths from the disease -- are at least a third higher than whites' rates, regardless of jurisdiction.

The report recommends that services to racial and ethnic minorities be expanded by local health departments, state agencies and nonprofit organizations. The report says more funding and other resources are needed for screening initiatives, support services and care that target health disparities. Successful programs should be copied in neighboring jurisdictions, it added.

The report also urges more coordinated research, especially through partnerships with academic programs, at the state and local levels.

Yet it stresses that statistical information must be improved before this can happen; data should be collected by county of origin as well by race, ethnicity and language. "Without this data," the report notes, "it is difficult for healthcare providers, advocates, and policy makers to identify health disparities, and therefore impossible to evaluate methods to address them."

Prince George's Health Officer Donald Shell seconded that point yesterday. "If you can't measure it, you can't manage it," he said.

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