part of the development of both radio and television. which is why the name is somewhat familiar. i do like to tell the story that he fundamentally got it wrong which is, as we can now see, television really should go through wires and telephone should really go through the air. [laughter] and so they essentially had it slightly reversed, but it worked for many decades, and he was a great man. >> host: richard sarnoff is co-chair of the bertelsmann corporation. thank you. >> guest: thank you.

>> a look, now, at minorities and health care disparities. we'll hear from a number of medical experts studying the

issue looking specifically at heart disease and hypertension. it features remarks by dr. loui sullivan. the u.s. commission on civil rights is the host of this event, it's about two hours. [inaudible conversations] >> okay. let's get started. i'd like to ask everyone with cell phones to put their phones on vibrate. bear with me. okay. good morning. this is chairman reynolds, and on behalf of the u.s. comig on civil rights, i welcome everyone to this briefing on health care disparities. this project is examining why despite the continued advances in health care and technology racial and ethnic minorities continue to have more disease, disability, and premature death than nonminorities.

more specifically, the commission will examine racial disparities in the rates of cardiovascular disease and the related condition of hypertension. experts will present the commissioners with results from on ongoing research and health care delivery systems access to and quality of community education, patient behavior and other aspects of health differences between population groups. the record of this briefing will be open until july 13th. public comments may be mailed to the commission. and at our address at 624 9th street northwest room 740, washington, d.c., the zip code is 20425. this morning we're pleased to welcome two panels of experts that will address this topic. on the first panel, speakers will discuss the disparity claims within the overall health care context and will also focus upon disparities and rates of cardiovascular disease and hypertension specifically, they

will evaluate potential sources of disparities and share their conclusions and views. dr. sullivan is the first president of morehouse school of medicine. in 1989 he was appointed secretary of the u.s. department of health & human services. in january of 1993, he returned to morehouse and resumed the office of president n. june of 2008 dr. sullivan accepted an appointment to the health disparities technical expert panel for the centers for medicare and medicaid services at the department of health & human services. next we welcome dr. garth graham who is the deputy assistant secretary for minority health and the office of minority health at the department of health & human services which coordinates federal health policies that addresses minority health concerns and insures that federal, state, local health

programs take into account the needs of disadvantaged, racial, and ethnic populations. dr. graham founded the boston's men's cardiovascular health project, a project designed to identify behavioral explanations for decreased diet and exercise by african-american men. then we have dr. rubens pay mys who has served as vice chancellor for academic affairs, dean of graduate studies and professor of internal medicine at the university of nebraska medical center since september of 2003. dr. payment mys was recently selected as a new member and chair for the department of health & human services office of minority health n. 2005 he collaborated with former united states surgeon general dr. david satcher to author and edit one of the first textbooks addressing inequalities in health care titled multicultural medicine and health disparities.

next we have dr. sally satel who is a psychiatrist as the oasis drug treatment clinic here in washington, d.c. she is a lecturer at yale university school of medicine and author of the health disparities myth, diagnose nosing the treatment gap. diagnosing the treatment gap. and next -- and i will need assistance pronouncing your first name. >> next we have amitabh chandra who is a professor of medicine at harvard, and he is a research fellow in bonn, germany, and the national bureau of economic research in cambridge, massachusetts. his research focuses on productivity and expenditure growth in health care, racial disparities in health care and the economics of neonatal health and cardiovascular care. then we have dr. peter bach who

is a physician at the memorial sloan kiterring cancer center. his work has focused particularly on improving the quality of care for african-american patients in medicare including cancer care. he previously served as senior adviser to the administrator of the centers for medicare and medicaid services where among other things he oversaw the agency's cancer initiatives. folks, i am excited to have you here. this is an issue that is, that we've needed to have a fully flushed-out discussion on these issues for quite some time, and i'm glad you could make it here today. the next thing we have to take care of, we have to swear you in. so, please, raise your right hand. please swear or affirm that the information you have provided is true and accurate to the best of your knowledge and belief. >> i do. >> i do. >> very good. let's get started. here are the mechanics. each speaker will have 10

minutes, and, please, try to stay within the time frame. at the end of the, at the end of the presentations we will have a q&a session, and we will start with dr. sullivan. >> thank you very much, mr. chairman and members of the commission. it's a great pleasure and genuine opportunity to be here with you today. i'm here in my role as chairman of the sullivan commission -- >> i'm sorry, mr. sullivan, one of the things that's confusing, these microphones are actually c-span microphones, but you'll find on your desk these little things right here which go to our recorder and also the audience in the back can hear, so a i apologize for that. i was confused, too, and then i realized, oh, it's the double mic day. >> thank you, commissioner yaki. as usual, you've saved the day. [laughter] >> thank you very much.

i'm here as chairman of the sullivan alliance to transform the health professions, and i want to address the issue of the health work force and its diversity and its impact on health disparities in the country. the sullivan alliance transforms profession is the a national effort to enhance the work force diversity initiatives around the country. it is organized in january of 2005 to act on the reports and recommendations first of the sullivan commission with its report missing persons, minorities in the health professions issued in september 2004 and the report from the institute of medicine committee on institutional and policy-level strategies for increasing the diversity of the health care work force. this commission from the iom produced the report in the nation's compelling interests insuring diversity in the health care work force.

this was issued in february of 2004. the strength of our health work force is central to the capacity of our health care system. the price waterhouse cooper's health research institute predicts a shortage of 24,000 physicians by the year 2020. supporting a call by the association of american medical colleges for a 30 percent increase in medical school enrollment as well as an expansion of graduate medical education positions to be achieved by the year 2015. a severe nursing shortage has been reported by the vast majority of our hospitals in our country, and the u.s. department of health & human services projects that by the year 2020 the shortage of nurses in our country will be between 400,000 and one million. the association of schools of public health estimates that by the year 2020, 250,000 more

public health workers will be needed in the nation. and finally, we have predicted 150,000 shortfall in pharmacists for the nation by the year 2010. now, this health manpower shortage is exacerbated by a maldirection both by geography and specialty because it is well documented there's a shortage of primary-care physicians and family physicians. in addition, there's a dearth of provoiders in rural and inner-city areas which have been designated as health profession shortages. as many as 35 million americans live in areas so designated. 2007 data from the u.s. census bureau indicates that one-third of the u.s. population, that is 34 percent, is today a racial or

ethnic minority. more than 50 million americans speak a language at home other than english. furthermore, the u.s. census projections show that racial and ethnic minorities will become the majority of the u.s. population by the year 2042. so in 2004 according to the commission which i chaired in its report, missing persons, we noted that only 9 percent of the nation's nurses are members of an underrepresented minority. only 6.1 percent of physicians are, represent an underrepresented minority, and 6.9 percent of psychologists are underrepresented minorities and 5 percent of dentists. now, there are a host of barriers that are impeding access to a health professions career by ethnic and racial minorities. these include the following:

poor awareness of the health profession's careers as well as poor academic preparation coming from many of our school systems that are not adequately preparing our young people. they also include financial barriers and the lack of role models and mentors for members of underrepresented minority groups. now, at this time when our supply of u.s. health professionals is not keeping pace with the growing needs of our population which is increasingly diverse racially and ethnically, today minorities account for under the age of 20, 43 percent of them are underrepresented minorities, and minority student enrollment in our nation's colleges will reach nearly 40 percent in the next few years. the dearthover minorities in the nation's health work force is a major factor contributing to health disparities. achieving greater racial and

ethnic diversity of the nation's health professionals has distinct benefits. first, minority positions are more likely to practice in medically-underserved areas and care for patients regardless of their ability to pay. a number of studies beginning in 1996 have shown this pattern. secondly, minority physicians are more likely to choose primary care practices, and minority registered nurses are more likely to be employed in nursing and to work full time. thus, improving the care of vulnerable populations. finally, a diverse health work force encourages a greater number of minorities to enroll in clinical trials designed to alleviate health disparities. in the united states, there's also evidence that the intellectual, cultural sensitivity and the professional competence of all students is enhanced by learning in an ethnically and racially-diverse

educational environment. and finally, there's evidence that a work force equipped to serve culturally and linguistically diverse individuals increases the number of visits to hospitals, to clinics or physicians' offices, results in higher utilization of care, enhasn'ts high-quality -- enhances high-quality encounters and reduces emergency room admissions. with the prospect for health reform on the nation's docket, we have the challenge and the opportunity to develop a successful model to eliminate health disparities by addressing a central issue, and that is the health care work force. the administration and the congress can lead this effort for needed changes in our health care system. such an effort must not only address the lack of health insurance or underinsurance of more than 47 million of our citizens as well as the high

cost of care, it must also focus on the current and increasing shortage and mal distribution of health professionals and the need for more racial and ethnic diversity among our nation's health professionals. all of these factors have a significant impact on access to health care, on protecting and improving the health of americans, and eliminating disparities and health status of the nation's racial and ethnic minorities. i thank you for this opportunity to present these issues to the commission, and i look forward to your questions and comments as well as your leadership and your support in these efforts to achieve our goal of eliminating disparities in health status and access to health care for all of our citizens. thank you. >> [inaudible] >> good morning, mr. chairman. it's a pleasure to present to the commission on civil rights on the causes of health care disparities, populations most affected by these disparities

and actions need today eliminate them. the mission of the office of minority health is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities. we're located in the awfts of the secretary at the department of health & human services, and we advise the secretary, deputy secretary, and the assistant secretary for health on public health policies and programs that impact racial and ethnic minorities and coordinate hhs wide efforts that address minority health issues. first, in terms of what we talk about when we say health disparities, health disparities can be defined as significant gaps or differences in the overall rate of disease incidents, prevalence, morbidity, mortality, or survival rates of the population as compared to the health status of the general population. the institute of medicine defines disparities as racial or ethnic differences in the quality of health care not caused by differences in clinical need, patient preferences or appropriateness

of intervention. the landmark institute of medicine report in 2002 served as a significant data point in terms of tracking and analyzing issues related to health disparities. overall health status in the u.s. has improved significantly as demonstrated by increases in life expect expectancies for the majority of populations. however, in spite of the many improvements in health over several decades, gaps exist by race, ethnicity, gender and other related subpopulations. these gaps may be related in part to demographic changes in the united states, but according to census data, the population of the u.s. grew by 13 percent over the last decade but has increased dramatically and diversely at an even greater rate. racial and ethnic minorities are among the fastest-growing communities across the country. they comprise 34 percent of the total u.s. population and it's projected by 2030, 40 percent of the u.s. population will be comprised of minority

populations at large. consequently, the u.s. is exappearancing greater diversity, but people are living longer, and emerging new diseases are posing challenges across the board. while it's increasing, minorities tend to die sooner from a wide variety of acute and chronic conditions. racial and ethnic minorities receive a lower quality of care across a wide range of therapeutic services. these conditions in welcome contribute to continuing racial and ethnic differences and the burden of illness and disease. for example, an estimated 15.8 million people in the united states are living with coir their artery disease, and more than 5.7 million have felt the effects of stroke which is the second leading cause of death across the board. african-americans continue to experience a higher rate of stroke, have even more severe strokes and continue to be twice as likely to die from strokes as a general population. disparities in cardiovascular disease are among the most

serious public health programs. almost 70 million americans find prehypertension are in danger of developing hypertension as associated complications. hypertension, as you well know, leads to more than half of heart attack, stroke and heart failure caused in the united states. kidney disease and heart fail yurl is nearly 40 percent greater in african-americans compared to the general population. mexican-americans also experience an even higher rate of hypertension, and we see similar numbers in the native american community. the rate of congestive heart failure in black non-hispanics between the age of 64-75 are more than twice the rate of that for white non-hispanics. in addition to heart disease disparities, african-americans are 30 percent more likely to develop cancer and 30 for percet more likely to die from cancer compared to the general populations. hispanics in the u.s. are 50 percent more likely than whites

to suffer from diabetes, and in native americans that number, as well, is twice as likely. asian-americans are much more likely to suffer from liver cancer as compare odd the general populations, so we have seen over the past many, many decades of health disparities reporting an emergence and reconfirming of data in terms of morbidity and mortality on minority populations across the board. i want to mention that one of the significant challenges we face in documenting health disparities are data gaps when we look at specific subpopulations, so we face collecting data on native american and specific asian-american and pacific eye rander subpopulations as well as some hispanic populations across the board, but from the data we have seen over the past two or three decades, we have seen a continued confirmation of the existence of health disparities in minority populations. so what is the cause of these disparities? well, it's certainly multifact

tomorrow, and i can tell you as a policymaker that i've seen the full spectrum of impact just in diagnosing specific diseases within minority communities but looking at this on the population level as well. and it is certainly related to the interplay between socioeconomic, environmental and individual factors as well as other social determinants of health. you'll hear more about these, but as we look in terms of the ideology of health disparities, it's important to realize there's definitely a multifactorial process in terms of these diseases on minorities. individual factors include things like poverty, behaviors as well as lack of health insurance or underinsurance as well as a lack of a regular source of care. other systems factor that contribute to health disparities include lack of cultural care as well as other varied system

factors that occur within the health care system. disparities in health care have significant implications for health professions, administrators, policymakers and health care consumers and present a significant challenge to the health care system. there are things that we can do both on the individual level as well as a systems level as well. individual changes include improved knowledge and awareness of disease, changes in behaviors related to smoking, exercise, nutrition, monitoring blood pressure and adhering to medical advice. systems level changes include such things as providing practice staff with greater cultural and linguistic care, improving access to care through the availability of interpreters, and making sure that we investigate strategies that improve health insurance coverage for minority populations. there are a number of current research activities as well as a number of programmatic activities that i think you'll hear more about from our panel. i want to highlight specifically as we're talking about hypertension as i alauded to the

impact -- alluded to the impact on minority populations, what we continue to see is an underdiagnosis of hypertension and cardiovas lahr disease in minority communities. i can tell you how often i have seen young african-american men who are in their late 20s or early 30s who are suffering from kidney disease that probably have been going on for years and have ravaged their bodies. so being able to adequately diagnose hypertension in its early stage is a significant factor in terms of modifying if not hopefully preventing some of this that i mentioned earlier. but there is an opportunity for us to change much of these statistics in some of the activities related to changes in welcome as dr. sullivan pointed out. community-based participatory research is a vital tool in helping to not only analyze, but hopefully address many of the dispairs we're seeing in

minority population. a research methodology that involves engaging the community at the grassroots level in terms of research agendas and then feeding back those research agendas to the community that was initially engaged in that research. i wanted to talk about some of the examples we have done in terms of cbpr type study z and highlight the roles of other agencies such as the minority center for health disparities that has done a tremendous amount of work on research. two years ago we sponsored the cities initiative, an initiative looking at stroke as well as hypertension within the black belt, that's that area along the southeast corridor of the united states where we've seen elevated rates of hypertension, ie, kidney disease and stroke, and we looked at interventions related to possibly eliminating, if not reducing those disparities. many times when people just understand in terms of the actual diagnosis they have and

realize there are certain thing they can do to take charge of their own medical care, we see communities engaging in preventive health behaviors that are not only amazing, but in fact, inspiring. we saw church members, we saw folks within the general community really take their own health into their own hands and participate in activities that subsequently led to the reduction in hypertension and some of these that we proprosed and i've alluded to earlier. the office of minority health has proposed a strategic framework for eliminating health disparities that's intended to help guide organizations and evaluation efforts of hhs as well as our partners across the country dealing with some of those individual and systemic factors related to health disparities. we also recognize that there are other components related to the

health care system that are evolving in terms of not just health care reform, but the digitalization of health care and the her generals of some things -- emergence of personal health records which provide a powerful tool for standardizing health care across the board. >> dr. graham, i can listen to you all day. >> i'm sorry. [laughter] >> so, if you don't mind, we can follow up in the q&a. >> i'm sorry. >> thank you. dr. pamies. >> thank you. first i want to thank you for holding this very important event as we can see, you've shone a very bright light on this topic of health disparities. i think it's appropriate to quote martin luther king when he said of all the forms of inequality, injustice in health care is the most shocking. my name is rubens paismies, i'm a physician and researcher who has tried to understand and find

a solution to health disparities. i think i need to discuss very briefly nine different areas that i think contributes to or explained the dilemma we now face. first, understanding the diversity. it's important to look at diversity in america. over the past 20 years the proportion of white americans has dpe creased from 83 percent in 1970 to 69 percent now in 2000. during that same period, african-americans have increased slightly from 11 to 12 percent, however, the proportion of hispanics has jumped from 5 percent to nearly 12-and-a-half percent, this makes our health care issues uniquely different from comparable nations around the world. the u.s. census bureau, in fact, had originally estimated that by the year 2050 nearly 1 in 2 americans will be a member of a racial ethnic group, however, now they indicate this could occur as early as 2037. currently we have four states who already