savings especially when you to have very real worry is given the current budget climate in the state political dynamics. the legislators and the public understand the india that you're not taking money away but more for your money and using its more efficiently to services to more people and delivering services and a better way. and when you are fighting budget cuts to personalize and set of talking about to prevent a very sympathetic cases. this isn't going to harm the random number on the page, this is going to harm maria and her family and here is their story. and is much people to identify. >> those are summaries terrific in out make one other observation doing a lot of stuff. i wouldn't underestimate the power of the positions, when we and other states have a white

today and they come with their white lab coats, be either uniquely good and having impact of legislators but here is the trouble, it can be hard with being paid for an hour. it is very hard. you have you're own tough times we take a day or two off to go to the state capital and that is hard to do with other responsibilities but what has been done in other states where it had the legislators say it was pretty powerful, there was a hundred or a thousand physicians so again you are here, you're sitting all day with no windows. so i know you folks have made that commitment but i just want to end it with my thoughts once

in a generation window, this is a unique time when there is an enormous amount at stake in a separate to do is two have done and do more and get more people involved because i was opposed and i did a lot of work and i never presume to that i thought it was a bad plan and i feel comfortable. i didn't presume it was going to be 16 years before the opening and and i learned my lessons and so as i said because the elected officials don't like getting stomped on some things and work in health care to work this ad time that so if that happens again and is the outcome of this is not going to get back to the next year. it will drop an old job until we have the next combination of how an economy and large parts of the majority is that we have

said we can go back in time, it is a once in a generation window and it is open now and whatever happens sets the tone for arguably the next generation. >> i think that is inappropriate note to end on, if there are some people in the audience loved somewhat depressed where pessimistic by this i have a large supply of anti-depressant with made. [laughter] >> the other thing i want to say is you're so cynical and i tell people americans can be ill informed but they're not stupid. we're in a powerful system that works in a country that works in change is possible and our president's personal story in my lifetime i was raised in the '60s. it is his being elected in is a powerful proof of this country can accomplish. i never and i haven't in this

for a long time, i get less cynical about this country and capacity for positive change. [applause] >> thank you all for listening and we will move on to the next panel. thank you, panelists. [applause] >> coming up tomorrow

we will hear from a number of medical experts studying the issue specifically hard disease and hypertension. the u.s. commission on civil rights hosts this event, it is little over three hours. >> does everyone have their mikes? what's can started, the speakers on the second panel will discuss specifics issues with cardiovascular health and the following experts will participate in the second panel. dr. william lewis is on national

committee for the american heart association's get with the guidelines program, associate prof. of medicine and shays western university and chief of clinical cardiology at metro health medical center and ice we haven't dr. herman taylor in 1998 arrived in jackson mississippi to new in jackson study, the largest base that a have that undertaking involving african-americans, the study both sought to answer questions about cramer's to a disease then the black community and provided historically black colleges experience in large scale epidemiological research. dr. taylor is a founder of hard to hard to in nonprofit organization that provides cardiac services for children from the developing world. then we will hear from dr. barbara howard, the senior scientist and former president of a red star is a two and holds

faculty appointments in the berman even bredesen and a permanent biochemistry at howard university and his past year of the american heart association on attrition, physical activity my pastor of the nutrition committee of the american heart association and past chairman of the nutrition studies section of the national institutes of health. her major sea -- major research is in cramer's, a disease in relation to diabetes and is the risk of that group and her current research projects include strong heart study, multi center study of cardiovascular disease and its risk practice of american indians and a study of the genetics of coronary artery disease and alaskan eskimos. and then finally we have serving as co-director of the quality improvement collaborative, expecting success excellence and

cardiac care. research professor and director of the center for health care quality and the health policy at the george washington university school of public health and health services. at this time we will swear you in. please swear or affirm the information that you have provided and will provide is true and accurate to the best of your knowledge and belief. let's get started. everyone will be limited to 10 minutes more or less and we will say what the q&a for the and so let's start with time to louis. >> on behalf of the american heart association and the moist and 22 million volunteers and supporters i want to express my appreciation for the average today to address the commission on civil rights and share information to reduce health disparities involving health

disease and stroke. improving health care quality and high praise for the american heart association peridot given the fragmentation and health care system on average americans receive the care, and about half the time. however, racial and ethnic minorities and women generally receive lower quality treatment. compared to their counterparts. all patience but especially patience of color and women need higher-quality care. and our short time together outlook is much discussion on the american heart association's innovative quality improvement program, get with the guidelines -- that are published by the american association and i as a result of critical analysis of studies on team is proven to be beneficial with patience. adherence to these improves patient outcomes. unfortunately the chairman of cramer's to a disease is

complicated and achievement will must be it a team effort and a patient with heart failure as many as 15 class when stevenson or tests and this care must be organizing coordinated. in 2000 and the american heart association launched the program that currently focuses quality improvement for a free conditions, our failure and stroke. and it has multiple care provided to patients and health providers adhere to guidelines for treating and preventing these conditions. providers obviously remain free to customize the care provided by the evidence base recommendations for these diseases reflect noncontroversial aspects of care that are supported by a wealth of scientific evidence. and the components of the program include the following first, and web based management tool that permits a real time

and input data regarding each patient. second, in clinical decision support function which provides and ensures that all consider the recommended aspects of care for each patient among these are reminders if you will. free, real-time benchmarking function that allows individual hospitals to compare their statistics with a variety of performance measures against large databases providing statistical averages for in writing a brighter types. in some cases merely providing accurate to physicians promotes improvement in appearance. educational materials are provided for our patients and care givers. it has targeted education materials for individuals from a variety of cultural backgrounds written in a variety of languages. tools are often provided to help

writers communicate with community-based providers regarding their patients' care and any recommendations for follow-up. this improves the transition from the hospital to the outpatient meeting. in this program also functions as a robust clinical registry that permits further incentive evaluation of the effectiveness and the progress made in improving care including analysis of the quality of care and clinical outcomes on the basis of race and gender. and taken in combination of these elements form of program shown this as a scientific study to improve and aerospace guidelines and reduce disparities among various subgroups and in particular i will highlight for observations from the clinical data in the program. first get with the guidelines has demonstrated a substantial narrowing the ratio at bank the space provided with hospitals

and upon hospital discharge for patients with coronary artery disease, heart failure and strawberry, in fact, the clinical outcomes for minority patients in hospitals participating in the get with the guidelines program are envious a call for black and hispanic programs to comparison of their counterparts in the 20,000 patients heart failure model demonstrated that african american receive equitable care compared to their white patients. additionally in hospital mortality was lower for african-american patients. additional preliminary analysis of over 230,000 patients in the module demonstrated that adherence to balance improved in both women and older patients and allows light disparities exist between men forces women and older forces and their patients and baseline analysis

these gaps narrowed over time. yet with the guidelines has enhanced the transparency of issues devolving disparities, at the microscopic level these help individual who hospitals of justice in around here on a case by case basis. at the macroscopic level the registry is now providing a rich source of data that highlights ongoing needs to address disparities and care. this data on health care disparities with corner are disease is being reported in the new american heart association 2009 statistical update and published. before we can eliminate these health care disparities we must first measure and highlight them. it has permitted this study of health care is paris involving additional intervention's beyond the core performance measures

captured in this registry. for example, this registry has been used to study and identify significant disparities and the use of cardiac devices such as recent position therapy and implantable defibrillators. instead of 34,000 patients admitted to 228 hospitals between 2005 and 2007 using the get with the guidelines heart failure program the use of cardiac we synchronization analyzed. one of the major findings was that the crt use aires by age, race, hospital size and geographic location. it was less, compared with my patients in this is particularly concerned because african-american patients have a higher incidence of non ischemic cardiomyopathy which has been shown to be a stone greater rates of response to this crt therapy. additionally african-american patients are more likely to

develop advanced symptomatic heart failure and have a higher rate of free hospitalization fourth, participation in the get with the guidelines program has been embraced in the u.s. and is valued the significant benefits of participating and currently there are 1,007 and 25 hospitals using the programs and the largest number of these hospitals 1300 participate in the program were a 1,000 participate in coronary heart failure programs and this is about a third of all in the u.s.. participating hospitals are a diverse group of large academic community and rural and urban hospitals located in every state. in summary, and the american heart association we believe that each person in the u.s. to the owners receive high-quality care regardless of race, ethnicity, gender or other

factors anna clinical guidelines will help insure all patients receiving proper care. the use of continuous improvement that included support such as that and get with the guidelines, how to chance light practice guidelines and to the consistent use the patient's bedside and minimize condition bias that can lead to disparities. as has been devastated the program is a powerful tool to improve patient care at the bedside use in the registry function we're able to bring greater transparency to health care disparities' in cardiovascular disease and stroke with meaningful scientific evidence from high publications using the registry data and as we extend our quality it exists to use quality as a gender blind race and

ethnicity strategy aimed to produce tremendous gap between groups of patients and optimize outcomes and i thank you for inviting me to present to the commission and entertain the questions you have indymac thank you, dr. taylor. >> thank you for the invitation to be here today. i think on behalf of jackson state university who are the home for the jackson her study. i do have slides, they will illustrate points but if you can't turn iran and look at them and i think the text will cover of my points adequately. since larger derange of the topic health disparities is covered by several speakers and i will restrict my remarks to research principally for the checks in her study and some reasonable implications of that

research. as has been said, is the largest single site longitudinal study of cardiovascular health undertaken thus far and sponsored by the national institutes of health. it is you need to examine cycle social, metabolic and senate influence on carter resco disease and also they will to compare our data with a suitably designed studies and other groups and should be remembered the representation is a work in progress so much of what i say will describe results, and also doesn't treat its participants, it is a longitudinal study. to tell you what i will be telling you the main point will be the following. early results from our strutted dramatically confirm the high risk for disease among americans in the u.s. but to 08 in jackson mississippi and then the specific instance of hypertension increased level of

awareness committeemen and control of hypertension have been achieved within the community. the improvement in treatment and control is encouraging however because of the much higher occurrence of other risks compared to other groups in the u.s. the disparities in hypertension related wearability and mortality will persist and for ever is to prevent hypertension and the other risk factors are critical to strategy to eliminate disparities in cardiovascular health. we recently compared the rates of obesity but of all african-american jackson are steady but the study, a long running steady in the white american population. we were twice as likely to be obese. severe obesity with a bmi less

than 35 was almost three times as high but they all black study. the data shown for younger people with the older group, it is interesting to note and this was a complex line but i will tell you what it says in particular increased with each increase in bmi which is basically been adjusted for how tall you are in both jackson and framingham and it is of interest among normal way participants the percentage of hypertension was a three 1/2 times higher in jackson than in whites and framingham and the ratio of diabetes was six times higher in blacks of normal weight. the metabolic syndrome is a cluster of risks that is getting

increased attention and these risk factors increase the risk of diabetes in america and cardiac arrest the disease. diagnose when three or more diabolic this orders occurs simultaneously. our analyses demonstrate that extraordinarily high metabolic syndrome problems exists among our cohort and among those nearly half of the women and over a third maine hung metabolic syndrome and the national average about 25%. these traits suggest continued pitcher differences in diabetes. notably with the prevalence of metabolic systems inevitably declines with higher household income and educational attainment. attention is likely this a most treatable and controllable risk

factor however controlling hypertension and to define operationally as reducing blood pressure to 140 over 90 is a problem particularly african-americans and are reports of a widening disparities and the success of hypertension control between blacks and whites. the control rates are much less than desirable from african-americans and this is seen as the figure in the text. nationwide wall 70 percent of whites who are treated for hypertension and gone could control only about half of african-americans do. and data from the jackson hard study on the slide demonstrate and that are interesting to contrast of the national data. the percentage of african-americans who have hypertension who are under control in our study is exactly the same as the national average

which is 70%. therefore national data show a persistent gap in control rates. however, the tax in her study carries the hopeful message to that under some circumstances equal rates are possible for blacks and whites. but is attaining equally good hypertension control rates between the races and have to eliminate disparities in these diseases and death. between these two groups. despite favorable control rates in jackson, high levels of cramer's, a disease and death persist among blacks. the latest surveillance data are discussing. the incidence of heart attacks showed a 65% higher rates and among black women there was a threefold increase in the number of heart attacks during that.

this data is from the most recent survey. stroke rates for blacks were more than doubled for whites. these data are occurring in a city which has a jackson hard study as a reflection of what is going on where as control rates are actually as good as the national average. the disparity persists and these data suggest among other things that major gaps can remain between the groups despite the end of active treatment of a most important cause of disease. one of the messages of data was that good health care alone will not resolve health disparities. health care most often happens when something goes wrong or high-risk situation manifest itself whether it is an elevation in cholesterol or

catastrophic attack. the most often discussed focusing on care for establish disease and this is critically important. however, what i am emphasizing here is the need to focus on understanding and addressing more abstain issues. we need to answer the question why do blacks have hypertension, diabetes and obesity that set the stage for a disparity. when we asked these questions and applied the preventive interventions we will have a greater chance of eliminating disparities and improved quality and availability for our care where it is necessary but not sufficient to raise interest to the general population. who must address fundamental causes. in short a much more aggressive approach unclear attention to prevention must be required if there is to be as is called for

in healthy people 2010. much of the expertise in these fields lies in the nutrition, behavior and psychology and social epidemiology and some of that was covered in this morning's panel. and then all internet address these issues but just to review of issues surrounding the food supply characteristics to the amount of calories they take in directly tied into health status. salt intake, dependence on fast food and regarding eating outside the home. physical activities in the neighborhood and to what extent the encouraging optimal levels of physical activity. and finally the burden of persistent discrimination in a

personal institutional or environmental. in conclusion the bottom line i believe is an honor to eliminate disparities and hypertension death and disease we must provide equitable chairman across socioeconomic clients and must decrease the number of african-americans that become hypertensive and the first place. if we are to reduce ruminate disparities in general we must reduce the number of persons to develop the risk factors discussed at the beginning of this presentation. our research strong suggests that a more two-pronged approach is imperative and one inquisition of awareness and utilization of care and investment and research to further define the basis of high-risk sector levels among and the minorities and use of prevention efforts that kobe on health care institutions into this is i know. these are critical to resolving

that of mattel's despair days, it cannot be achieved without balance attention to risk prevention and treatment. >> dr. howard. >> thank you mr. chairman and members of the commission, i am honored to be invited here to talk to about the projects that time been able to be involved with in american indian community is. i hope that one of going to tell you a sense of light on the issue that you are confronting the and perhaps strategy is to begin to deal with its one. we started 22 years ago with a project called the strong heart study that was funded by the national heart, lung and blood institute and we have been working from all of this time under some basic tenets that i think you're relevant here. one is we have worked in full partnership with the communities beceiving input that all levels