Homicide is the leading cause of death in black American males 15 to 44.
A black woman is 2 1/2 times as likely as a white woman to die of cervical cancer.
Those are just a few measures of the gap in health between white and black Americans. If there was any doubt about the disparity, a federal task force reported recently that nearly 60,000 "excess deaths" occur among American blacks every year. Excess deaths are defined as deaths that would not have occurred if the death rate for whites and blacks were the same.
From 1979 through 1981, the task force found, the number of black Americans who died of all causes by age 70 averaged 138,635 a year. But the toll would have been only 79,693 if the death rate had been the same as for whites. The difference -- 58,942 -- is the annual number of excess deaths in blacks.
To implement the task force's recommendations and monitor the myriad federal programs that affect minority health, Health and Human Services Secretary Margaret M. Heckler established a new Office of Minority Health. Dr. Herbert Nickens, director of the office of policy, planning and analysis in the National Institute on Aging, has been chosen as director. Six causes are responsible for more than four fifths of the excess deaths in black Americans, the HHS task force found:
*Heart disease and stroke. Cardiovascular disease remains the number one killer of all Americans, but the death rate is higher for blacks. Homicide and accidents. The homicide rate for black men 25 to 34 is nearly eight times as great as for white men of the same age. Black male Americans have a 1-in-21 lifetime chance of being murdered. At that rate, more than 12,000 black males now living in the District would die by homicide.
*Cancer. Many types of cancer have much higher death rates in blacks than in whites, including cancer of the lung (45 percent higher); esophagus (three times higher); stomach (1 1/2 times higher); and cervix (2 1/2 times higher).
*Infant mortality. Rates have declined steadily in the past 15 years, but the black rate is still double the white rate.
*Cirrhosis. The death rate from alcohol-related causes, including cirrhosis of the liver, is nearly twice as high in blacks as in whites.
*Diabetes. The disease is 33 percent more common in blacks than in whites, and 50 percent more common in black females than white females.
In releasing the report in October, Heckler said the disparity in health between minorities and other Americans "stands today as an affront to our ideals and to the genius of American medicine."
Much of the health gap -- "perhaps even most of it" -- is related "to knowledge and to life style," Heckler said. "Education is perhaps the most important single thing we can do to close the health gap."
She recommended no major new federal initiative on minority health, and the task force reportedly was told that any recommendations had to be "budget-neutral" -- not requiring additional spending.
Some community health experts are skeptical about the impact of the new Office of Minority Health on the enormous health problems of minorities. The office has a budget of $3 million.
"I don't think it can do very much," said Dr. Paul Cornely, professor emeritus of community health at Howard University College of Medicine and former president of the American Public Health Association. He called the $3 million budget "minuscule" and said appeals for "behavioral changes and education" were not enough to address underlying socioeconomic problems that harm health.
"Before we can talk about black health, we should assure the black community of the preconditions of good health -- employment, nutrition, good housing and education," Cornely said.
"A lot of blacks," he said, "were somewhat disgusted with the fact that they HHS pointed out all that excess mortality and yet they're saying there's no money and the only thing you can do is establish an office of black health to sort of monitor what is going on."
To improve the health of minorities, Congress and the Reagan administration "must be prepared to make structural changes in society," said Dr. Edith I. Jones, president of the National Medical Association, which represents black physicians. Such changes would include improvements in jobs, housing and education for black Americans, she said.
"I was critical of the report mainly because it apparently had to be budget-neutral," said Dr. Jesse Barber, chairman of neurosurgery at Howard who also heads the Coalition of Health Advocates. "It was not allowed to call for any increased expenditures.
"I was afraid that might make it health-neutral as well."
In a statement issued by the coalition, Barber praised the task force report for focusing attention on the disparity between minority and nonminority health, for consolidating health data about minorities and for highlighting homicide as a preventable health problem.
But he also criticized the report for several "serious fallacies," including the "implied assumption" that minority health problems can be resolved without additional spending and an "underemphasis on socioeconomic factors" in health.
By attributing such importance to minorities' unhealthy habits and lack of awareness of health, Barber said, the report comes close to "blaming the victim."
"I get the clear conviction that we're not looking at a health picture," said Dr. Thomas Georges, chairman of the department of community health and family practice at Howard. "We're looking at a picture that, while viewed from a health perspective, seems to be the result of social and economic and environmental conditions.
"A lot of the preventive steps that have to be taken are social and economic -- they have to do with housing and employment and just plain real-life problems of poor people who over the last few years have been getting relatively poorer."
James Speight, director of the East of the River Health Clinic in Anacostia, said the HHS report was "on target." But the key question, he said, is, "Where will it lead and will it generate any additional resources to address the problem?"