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Health disparity
Friday, Sept. 30, 2005, 10:15 to 10:45 a.m.

(Note: Speech delivered at a conference on health disparity issues among communities of color.)

Governor Gregoire; Senator Franklin; ladies and gentleman:

It is an honor to speak with you today on the issue of public health disparities.

I would first like to thank the organizations that made this event possible:

• The Commission on Asian Pacific American Affairs
• The Commission on African American affairs
• The Commission on Hispanic American Affairs
• The Governor's Office of Indian Affairs
• The State Department of Health
• The Department of Social and Health Services
• The State Board of Health
• The Washington Health Foundation, and
• The HumanLinks Foundation

This has truly been a collaborative effort among a diverse group of constituents. I think this sets a positive tone and precedent for a healthy and spirited discussion.

As many of you may know, reforming and improving our health care system is an issue that is close to my heart. I believe that in the richest and most powerful country in the world, we ought to be able to provide basic health care to all of our citizens.

It is vitally important that we lessen the impact and burden of illness on all people in our communities, regardless of race, gender, or religion. Our discussions today are critically important to rectifying the injustices that many people face in our current health care system. Today's sessions have a greater purpose than mere discussions and networking opportunities—Today's conference signifies an increased and necessary call for action among our region's top health professionals.

Benjamin Disraeli, the great 19th century British prime minister, once said, "The health of the people is really the foundation upon which all their happiness and all their powers as a state depend." I worry sometimes that we have forgotten that insight in modern day America. Well, I can tell you that I have not forgotten. I believe that our communities are only as strong as its people. And if people are not getting the adequate health care they need, particularly underserved communities, our foundation—as Disraeli said—is truly in jeopardy.

Public health is directly connected to poverty, income, education, and, community. We can't look at health care in a silo and assume it is only a luxury for the well off. Health care needs to be provided to all people of all color. We are morally responsible for improving the disparities in health care because a healthy society is the foundation on which we build our schools, our neighborhoods, and our economy. Health care is not a privilege—it is a right.

I know we have a long road to travel in achieving equality in health status. I know that everyone here knows this. And I am hopeful that perhaps more people than ever are finally waking up to this reality.

As Hurricane Katrina has laid bare on the evening news, there is a wide socio-economic gap that plagues our cities. The public health disparities are glaringly apparent. A survey released by the Kaiser Foundation a few weeks ago on the evacuees in Houston shelters examined the significant health challenges that will complicate relief and recovery efforts in the months to come. The most alarming findings were:

• 52% of the evacuees reported having no health insurance coverage at the time of the hurricane.
• Of those with coverage, 34% came from Medicaid and 16% through Medicare,
• And 41% of evacuees reported chronic health conditions such as heart disease, hypertension, diabetes and asthma

These are shameful numbers. They are shocking numbers. They are an indication of how far we still need to go to build a just and equitable society in America.

There is another factor here that we must not shy away from: it is clearly evident that most of the Katrina evacuees were people of color. The events of Hurricane Katrina were a tragedy, but it is a greater tragedy if we do not come together as a community to solve major social injustices like this.

The US Census Bureau reports the number of uninsured people in our country has increased by 800,000. This translates into 45.8 million Americans. And among the uninsured; Blacks, Latinos, and certain Asian/Pacific Islander groups make up the majority.

As most of you know, the uninsured are less likely to receive preventative care, have regular checkups, get treatment for mental illness, and be admitted to the hospital for treatment on pre-existing conditions like heart disease or diabetes.

Although we are the wealthiest country in the world, and 13% of our GDP is spent on health-related expenditures, there are still startling disparities in the well-being of our citizens.

Locally, King County has one of the largest metropolitan health departments in the country. And based on per capita income, we are one of the wealthiest counties in the state. Fortune has smiled on us here — or on most of us, at least. Because, unfortunately, roughly 15% of adults in King County are uninsured and 4% of our children go without health insurance. That is unacceptable to me. And like Hurricane Katrina evacuees, the largest percentage of our uninsured communities is among communities of color. We must do better at serving these populations, and I know that we can.

The most pressing health disparity concerns for King County include:

• Diabetes rates which are significantly higher among African American, Latino, and American Indian compared to whites.
• Infant mortality which is 2.5 times higher in African Americans and 1.5 times higher in native Americans compared to whites
• Lower screening rates for breast and cervical health among ethnic minorities, especially Latina women, African Americans, and Asian Americans

And these are just a few examples of the far-too-many disparities in our community. We can clearly see that access to care is disproportionate despite our tremendous advancements in health care. We see growing numbers of minority groups unable to access even the most basic health care services.

And even when care is readily available, the quality of care for communities of color still suffers. According to the Institute of Medicine, African-Americans nationally are less likely to:

• receive diagnostic testing or adequate pain medications;
• have early stage diagnoses of cancer and preventative asthma control measures;
• or be placed on a kidney transplant waiting list

And other minority communities are likely to experience similarly unequal access to health services.

It is obvious that King County is not immune to these injustices. For all the strides we have made as a country in recent years, discrimination very much remains a powerful factor in the determination of health outcomes for minority communities.

For many people, it is too easy to become accustomed to these disparities, and assign them to factors beyond our control. It is easier to accept them as realities not likely to improve in our lifetime because of political inertia or indifference. This would be the wrong way to think, and I refuse to think that way. Our goal must be to find solutions, not excuses.

The right way to think is that we can correct health care disparities. I speak, in particular, to the many of you here today in the health care profession. We have the opportunity to revisit and reform these social injustices. We can implement thoughtful, strategic, and continuous actions to bridge this gap — through policy, implementation and execution.

In King County, we have already begun that process. We have taken many steps to combat this problem. And we are working in collaboration with the State and Federal Government on further actions and solutions.

Together, we are working hard to end discrimination in public health care settings and to have open access to quality health care for all people. We are working to decrease the disproportionate impact of diabetes, asthma, cancer, and obesity in communities of color.

And our responses have been internal and external in scope.

Internally, our public health department has formed a Diversity Management Committee. This committee is comprised of our public health department which is linked to City and County agencies and communities. The committee focuses on promoting cultural competency, policy changes, social justice and undoing Institutional Racism.

Externally, we have a few examples. The REACH coalition is a major program funded by the Center for Disease and Control. It is run locally by our Public Health Department, in collaboration with community organizations. Their mission is to reduce diabetes in minority communities. There are already close to 700 participants in this program with African-American, Asian-American, and Latino representation. REACH's goals will help create opportunities for diabetes education and self-care through community and individual support.

The Steps-to-Health program is a federally-funded program led by community partners and our King County Department of Public Health. The Steps program has the task of reducing health disparities from chronic illnesses like diabetes, obesity, and asthma. Steps has been instrumental in developing ways to fight these deadly illnesses. I love this program, because it deploys a multi-pronged strategy that coordinates actions at the individual, family, clinical, school, and community levels.

Finally, The King County Asthma forum is a local asthma coalition convened by Public Health and the American Lung Association of Washington. They've established a network of individuals and agencies to communicate about, collaborate on, and coordinate projects that improve and support asthma prevention. As I am sure you know, asthma is a major health ailment plaguing minority communities.

Now I'm sure there are many people at this event that are currently contributing to these initiatives. To all of you, I would like to recognize and thank you for your hard work and dedication. Your efforts have a tremendous positive impact on our disadvantaged communities and also have a lasting impact on the community-at-large.

These chronic disease prevention initiatives are model programs due to their ability to serve diverse populations in a culturally-competent manner. And because of this, they are directly addressing health disparities. But, we need these kinds of practices and strategies to become the norm for the entire county and state.

We understand the problem and we have identified many of the proven strategies that will assist us in solving them. But it is up to us to make sure we implement these strategies.

So we have more work to do. We can always do better. And we will do better.

We can look at our own practices in our daily work and re-examine how our efforts contribute to healthy communities for everyone.

We can take action in our personal and professional lives. Through generosity of time and money, we must make an effort to eliminate health disparities. We need to educate our children in the pursuit of social justice and engage them in our current actions. The decisions and actions we make today will dictate whether we succeed in reducing the disparities of tomorrow.

Can we close the gap or will we see more communities of color suffer needlessly under the disproportionate burden of disease?

Will we strive to protect the health and well-being of all children, regardless of color or class? Will we secure their right to a healthy life?

Will we have one standard for healthy communities or will we continue along with the same faulty standards?

This is the challenge I pose to you all.

Thomas Edison once said, "If we did the things we are capable of, we would astound ourselves."

I love that sentiment. So I say to you today, let us astound ourselves. Let's work for a better tomorrow for everyone in our amazing and diverse community.

Thank you and enjoy the rest of the conference.

Updated: Nov. 28, 2005

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