Reducing Health Disparities:
How Far Have We Come?

The annual Healthy People Consortium Meeting celebrated the partner-ship's 10 years of success in working on the Healthy People 2000 initiative. The Consortium's 10th birthday is but one marker of the Department of Health and Human Services' (DHHS') commitment to achieve the Nation's health objectives by utilizing the expertise and skills of States and national membership organizations. It is clear, noted Dr. Claude Earl Fox, Acting Administrator of the Health Resources and Services Agency and chair of the Healthy People Steering Committee, in his opening remarks, that Healthy People represents a partnership that sees results.

Dr. Robert Windom, former Assistant Secretary for Health, brought greetings from the Secretary's Council on Disease Prevention and Health Promotion Objectives for 2010. The Secretary's Council, which is com-posed of four former Assistant Secretaries for Health and the Operating Division Heads of DHHS, met in April 1997. Dr. Windom noted that the potential exists for reaching 50 percent of the year 2000 objectives. He encouraged healthy competition among geographic areas for achieving Healthy People objectives and greater accomplishments through the 2010 initiative.

Dr. Fox reviewed the first year of Healthy People 2010 development, which began when focus groups of Consortium members identified what had worked well with Healthy People 2000, what should be preserved, and what should be recast for 2010. Their comments laid the foundation for the Secretary's Council work and played an integral role in shaping the pro-posed framework, which was released for public comment in September 1997. DHHS has begun work on sentinel indicators, which will be used to increase the visibility of Healthy People objectives to the general public.

With funding from Robert Wood Johnson, Partnership for Prevention is convening a Business Advisory Council that will include large and small, minority-owned, and women-run firms from across the country. The purpose of this Council is to make Healthy People a useful and valuable tool for employers to use in both worksite and community health pro-motion.

Dr. Marcia Bayne Smith, the key-note speaker, examined health disparities among racial and ethnic minorities, people with low income, women, and people with disabilities. She acknowledged that race is an issue but emphasized that poverty is a better measure of health status. She encouraged a closer look at disease prevention and health promotion strategies, particularly community-level approaches that focus on behavior change.

Dr. Clay Simpson, Deputy Assistant Secretary for Minority Health in the Office of Public Health and Science, explained the presidential race initiative and its goal of creating a more united America. Dr. Simpson then chaired a panel that highlighted racial and ethnic disparities:

• Dr. Grace Wang, Health Officer of the Seattle-King County Health Department, dispelled the myth that all Asians in America are highly educated with better health outcomes than the total population. In fact, the illiteracy rate of Asians is two times that of the total U.S. population; illiteracy increases the likelihood of low utilization of health services. Asians and Pacific Islander immigrants are most at risk for poor outcomes.
• Lia Margolis, Executive Director and Chief Executive Officer of Lia Margolis and Associates, showed the differences in poverty rates between Puerto Ricans (41 percent), Mexicans (28 percent), Cubans (17 percent), and whites (11 percent). She stated that since the 1980s the number of uninsured Latinos has increased dramatically. Latinos have the highest rate of uninsured among new immigrants as well as among workers. Since Proposition 187 passed, many immigrants in California now have no health insurance to access preventive care.
• Dr. Bailus Walker, Associate Director and Professor of Environ-mental and Occupational Medicine at Howard University Cancer Center, challenged participants to think of the major factors that will affect the health of minorities by the year 2010. He cited a blurring of barriers between what is social, biological, medical, and genetic. He also challenged participants to develop community programs that can be targeted to particular racial and ethnic groups.
• Theda McPheron, Director of Cherokee Associates, detailed the inequities and racism that Native Americans face. She described the problems facing Native Americans not living on reservations or on reservations where they are not "registered" when they attempt to access services.

Dr. Clement Bezold, President of the Institute for Alternative Futures, set the stage for developing objectives for the year 2010. He challenged the audience to set audacious goals for Healthy People 2010 objectives. He also examined potential factors that could influence the public's health, including technological advances, the Human Genome Project, and demo-graphic shifts.

In the afternoon, the 260 participants broke into workgroups by Healthy People 2000 priority area to discuss and comment on the proposed framework for Healthy People 2010. Each group examined the vision, goals, enabling goals, and placement of the focus areas. They were then asked to comment on objectives that should be deleted, modified, or added to the current list of objectives in each priority area. A report from each group is posted on the Healthy People

2010 homepage at: http://www.health.gov/healthypeople.

The meeting concluded with a reception highlighting "Operation Clean Hands," a national hand-washing campaign developed in a public-private partnership between the American Society for Microbiology and the Pharmaceutical Division of Bayer.

The next Healthy People Consortium meeting is set for November 13, 1998, in Washington, DC.

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