day. >> thank you very much. i am here as chairman of the soul of an alliance, to transform the health professions -- chairman of the sullivan alliance. the sullivan alliance to transform america's health professions is a national effort to enhance through the hell worst force diversity initiatives around the country. -- the help work force. . .

central to the capacity of our health-care system. the pricewaterhousecoopers system predicts a shortage of 24,000 positions by the year 2020, supporting a call by the association of american medical colleges for a 30% increase in mosul school enrollment -- in medical school in enrollment. this is to be achieved by the year 2015. -- in medical school enrollment. and nursing school shortage has been reported by a vast amount of hospitals in our country, and the u.s. department of health and human services predicts that by the year 2020, the shortage of nurses in our country will be between 400,000 and 1 million. there is an estimate that by the

year 2020, 250,000 more public health workers will be needed in the nation. and finally, we have predicted a shortfall of 150,000 in pharmacists for the nation by the year 2010. now, this health manpower shortage is exasperated by a maalot distribution of physicians, both by geography and by a specialty -- a mal distribution. there is a shortage of primary- care physicians and family physicians. in addition, there is a dearth of health providers in rural and city areas whichever and designated by the public health service as shortage areas -- which have been designated as shortage areas. many live in areas that have been so designated. in 2007, the data from the a census bureau indicates that one-third of the u.s. population, that is 34%, 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 projection shows that racial and ethnic minorities will become the majority of u.s. population by the year 2042. so in 2004, according to the commission, which i chaired in this report, we noted that only 9% of the nation's nurses are members of an underrepresented minority. only 6.1% are physicians -- are an underrepresented minority, and 6.9% a psychologist are underwriters and minorities and 5% of dentists. now, there are a host of barriers that are impeach and access to a health professional career by ethnic and racial

priorities. -- minorities. these include the following. port awareness of the health position careers as well as poor academic preparation coming from many of our school systems that are not adequately preparing our young people. the also include financial barriers and the lack of role models and mentors for members of underrepresented minority groups. at this time, when our supply of u.s. health professionals is not keeping pace with the growing needs of our health population, which is increasingly diverse ethnically and racially, today, minorities account for americans under the age of 2043% of them are underrepresented minorities. -- under the age of 20, 43 percent of them are underrepresented minorities. the dearth of minorities in the nation's health workforces is a major fat contributed to help disparities.

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

racially diverse education and permit -- environment. then serving culturally and linguistically culturally diverse individuals increases the number of initial visits to hospitals, to clinics, or physicians' offices. it results in higher utilization of care, enhances high-quality counters, lowers medical errors, and reduces emergency room admissions. with the prospects for health reform on the nation's stock it, we have the challenge and the opportunity to develop a successful model to eliminate health disparities, by addressing the central issue, and that is the health care work force. the administration and 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 maldistribution of forces and the need for greater diversity. all of these factors have is an advocate impact on access to healthcare, of protecting and improving the health of americans, and eliminating disparities in the health status of the nation's racial and ethnic minorities. i think you for this opportunity to present these opportunity -- to present these facts. i appreciate your comments as well as your leadership and support in these efforts. to achieve our goal of eliminating disparities in health status and access to healthcare for all of our citizens. thank you.

>> thank you for letting me to address this civil-rights council. this is to improve the health of several through the developmental policies and programs that would help eliminate health disparities. we are located in the office of secretary within the office of health and science within the department of health and human services, and we advise the secretary, the assistant secretary, and others on programs that impact ethnic and racial minorities including 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 and differences in the overall rate of these incidences prevalent, morbidity, or survival rates in the population as compared to the health status of the general population. the institute of medicine defines this crisis as racial or ethnic and the equality --

clinical the patient preferences are in need. -- are needed. there is a report in 2002 that served as a significant datapoint in terms of tracking and analyzing issues related to health disparities. the overall health status in the u.s. has improved significantly as demonstrated by an increase in life expectancy for the majority of the population. however, despite many improvements in health over several decades, significant gaps still exist. these gaps may be related in part to demographic changes in the united states, but according to the 2000 census data, the population of the u.s. grew by 13% over the last decade but has increased dramatically in diversity at a greater rate. ethnic and racial minorities are fast-growing in this country, comprising 34% of the total u.s. population, and is projected that by 2030, 40% of the u.s. population will be comprised of

minority populations at large. consequently, the u.s. is not on experiencing greater diversity, but they are experiencing greater cost with health care, and diseases are presented challenges across the board. while this is increasing, minorities tend to die sooner for many acute and chronic conditions. racial and ethnic minorities receive a lower quality of care across a wide range of diagnostic and therapeutic services. these conditions in health care can be to continuing differences in the burden of illness and disease. for example, an estimated 15.8 million people in the united states are living with coronary artery disease, but 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 risk of stroke, have even more severe strokes, and continue to be more than twice as likely to die of stroke as the general population this is among the

serious public health problems. 70 million americans fall into the newly listed risk categories of pre-hypertension or are in danger of developing hypertension. hypertension, as you well know, leads to half of all heart attacks, strokes, and part failures in the united states. this is a major risk factor for coronary artery disease, kidney disease, and heart failure, and it is 40% greater in african- americans compared to the general population. mexican-americans, also experienced an even higher rate of hypertension, and we seek similar numbers in the african- american community. black non-hispanic between certain ages are more than twice that for white non-hispanic. african-americans are 30% more likely to develop cancer and 30% more likely to die from cancer compared to the general population's. hispanics in the u.s. are 50% and more likely than whites to

suffer from diabetes and incidences of diabetes, and with native americans, that number come as welcome is twice that. they are much more likely to suffer from hepatitis b and liver cancer, as compared to the general population, so we have seen over the past many, many decades of health disparities and the emergence and we confirming of data in terms of the impact of disease prevalent, morbidity, and mortality on minority populations across the board. i want to mention that one of the significant challenges that we face in documented health disparities are data gaps when we look at specific populations, so we face the challenges in collecting data on native american and specific pacific islanders and the populations as well as some specific hispanic populations across the board, but from the data that we have seen and have seen over the past two or three decades, we have seen a continued confirmation in the existence of health disparities in minority populations.

what is the cause of these disparities? it is certainly multi factorial. there is the need -- disease diagnosis and diagnosing specific diseases with the minority communities, but looking at this and the population, as well, it is related to socio-economic and environmental come individual, and personal factors, as well as other social determinants of health. you will hear more from this panel, but as we look in terms of the etymology, it is important to recognize that this is definitely a multi-factorial process, for the disease processes in minority communities. individual risks include poverty, low help the literacy, behavior, as well as lack of insurance or underinsurance as well as a lack of a regular source of care. there are other health disparities, which includes a lack of many issues, including

other areas system factors which occur within the health-care system. disparities and health care have significant implications for health professionals, administrators, policymakers, and health care consumers and present a significant challenge to the health care system. there are things we can do with individual efforts. individual changes include improved knowledge and awareness of disease, changes in behavior is related to smoking, exercise, nutrition, monitoring blood pressure, and adhering to medical advice. systemic changes include such things as providing practice for greater access of the requested an appropriate care, improving access to care through the availability of the interpreters, and making sure that we investigate strategies that improve health insurance for minority populations. there are a number of current research activities as well as a number of program activities related to disparities which i think you'll hear more about from our panel.

specifically talking about hypertension, as i talked about this with minority communities, while we continue to see is under diagnosis of all hypertension and cardiac -- i cannot tell you how often i have seen young, african-american men who are in their late 20s or early '30's who are suffering from kidney disease and other types of problems that probably have been going on for years and whichever ravished their bodies -- in their late twenties or early thirties who are suffering from kidney disease and other jets the problems that probably have been going on for years and which have ravished their bodies. -- ravaged their bodies. there are activities related to changes in health care, as dr. sullivan pointed out. community-based participatory research is a vital tool in helping us to not on the analyze the hopefully address many of

the disparities that we're seeing in minority populations. community-based participatory research involves engage in the community at the grassroots level in terms of research agenda and then feeding back those research agendas to the communities that were initially engaged in that research. i want to talk a little bit about some of the examples we have and highlight the role of other institutes, or other agencies, such as the national center for minority health disparities, which has done tremendous work with community- based chetry research. we sponsored a city's initiative as an initiative looking at stroke as well as hypertension along the southeast corridor of the united states, where we have seen elevated rates of hypertension and kidney disease and stroke, and we look at interventions related to eliminating or reducing those disparities. one of the things we have found is the power of awareness. many times, when people

understand the actual diagnosis that they have and realize that there are certain things that they can do to take charge of their own medical care, we see communities engaging in preventive health that are not on the amazing but, in fact, inspiring. we saw a church members and folks in the general community taking their health into their own hands and participating in activities that subsequently led to the reduction in hypertension and at some of the things the we proposed from hypertension, i.e. kidney failure and stroke, and some of the things that i alluded to earlier -- some of the things that we proposed from hypertension. the strategic framework is intended to guide organizations and courteney the systematic planning implementation and evaluation efforts of hhs of minority health as well as partners across the country, dealing with some of the individual and systemic factors related to health disparities.

we also recognize that there are other components related to the health-care system, in terms of not just health-care reform, but the digitalization of health care and the emergence of electronic health records and personal health records, which provide a powerful tool for standardizing. >> i could listen to you all day. >> i am sorry. >> if you do not mind, we can follow that up. thank you. doctor? >> members of the commission, distinguished panel, other guests. we want to shine a very bright light on this issue of health disparities. before i begin, i think it is important to quote dr. martin luther king when he said that in justice and health care is the most shocking and inhumane of disparities. there is someone at the university of nebraska, where i am.

i even tried to understand the solutions to the growing problem of health disparities. i think to really better understand the issue, i need to discuss very briefly nine different areas that i think contribute to or explain the dilemma that we now face. first, understand the diversity it is important to look at diversity in america. over the past 20 years, the proportion of whites has decreased to 69% now in 2003 and during that same period, the proportion of african americans has increased slightly from 11% to 12%. hispanics have got up to it 12%. the country is becoming increasingly more divorce, making their health care issues uniquely different from other comparable nations around the world. the u.s. census bureau had initially said that by the 2050, 1/2 americans would be a member of a racial and ethnic group -- the country is becoming increasingly more diverse.

there are some areas, like washington, d.c., which already have minority majorities. only 2% of registered nurses, at 3% of psychologists, and similarly, african-americans constitute 12 percent of the population, but 9% of registered nurses, and only 4% dentists. in the last few years, it has actually dropped in several key areas was slightly increasing in some other areas. in total, underrepresented minorities comprise less than 8% of the nation's physician work force and only 4% of the medical school faculty, while almost 20% of those come from black colleges that have medical schools. i believe having proportional representation is important for a variety of reasons, not only for patient care but also for showing under minority --

underrepresented minorities that they, too, can enter the health- care field. as has been mentioned, the landmark institute of medicine report on equal treatment, particularly the increasing need for diversity, they drew four conclusions. first, underrepresented minority health care professionals are more likely to show up in it urban and disadvantaged areas. second, patients are more likely to seek care from positions of their own race or ethnicity and report being more satisfied -- to seek care from physicians of their own race or ethnicity. third, the seawall models. fourth, minorities are more likely to participate in research studies when the research is conducted by a health-care provider of the same ethnic group. consequently, underrepresented health care professionals are also likely to of research interests where minorities are effective, thereby helping to solve the mysteries, because

this disproportionately affects and could have a poor outcome on minorities, because these researchers often see first hand the effects of these diseases affecting the committees and their families, and they become interested in learning more about those diseases and the outcome. clinical research studies are vital in understanding why certain racial and ethnic groups are affected differently by treatment. that is why i think it is sensible for us to continue to collect racheal data so we can better understand disease outcomes. mortality, morbidity incidents, the system is said to be very good if you're healthy. unfortunate, this is not the case for many individuals. -- unfortunately, this is not the case for many individuals. racial and ethnic minorities experience greater mortality and morbidity. african-americans have a laugh -- life expectancy of 66 years, when white men will live to an average of 74. compared to an american indian, they will live in their mid

=fifties. -- they will live into their mid fifties. major health and technology could dances and the past 60 years, despite that, 1.6% higher than whites is the african- american race, and that is the same as it was in the 1950's. examining the prevalence of certain diseases and conditions and racial and ethnic minorities gives further evidence of health disparities. african-americans have the highest mortality from hiv/aids, stroke, cancer, and hypertension green in fact, if you look at hiv/aids rates, more than 80% of women who have diagnosed -- and hypertension. in fact, if you look at the hiv/aids raids, more than 80

percent of women who have been diagnosed with an -- hiv/aids rates. hypertension and african- american leads to a a% higher stroke mortality rate, 32% higher rates of renal disease than the general population -- leads to an 80% higher stroke mortality. compare that to 30% of whites. when we initially looked at the data, we thought that access to care was the suspected reason. however, even at veterans hospitals, where access is not such an issue, studies have shown that positions are less likely to have african- americans going through invasive cardiac procedures and other problems. there is racial discrimination in treatment, genetics, in varmint, and demographics. there are no theory -- new theories emerging kreme first,

with genetics, -- there are new theories in genetics. something can be passed on from one generation to the next. this underscores the cumulative effect, discrimination, and inequality of education. the second theory, it states that the body experiences biological changes in response to stress. specifically, some things are found to be higher with those who have experienced long periods of stress, meaning that years of feeling on the court experiencing discrimination can negatively impact health. recent research has shown that your prescription drugs prescriptions are being filled. maintaining healthy blood pressures or other cardiovascular situations, in order to being able to afford these, it results in high blood pressure, an increase in stress,

hypertension, and a number of other dangerous conditions. in a near future, -- the disproportionate burden of health disparities has been well documented. there are several ka-ching factors,ñw social economic, racism, limited access, and the quality of service being provided. there are also a patient and provider behavioral factors. -- there are several key factors. despite increasing care, the difference between the different minority groups to whites are some of the in the getting worse or remaining stagnant. this also means having substandard housing, few opportunities for high -- housing, limited access to health care. this includes anything from air quality, water quality, contaminants, as well as other

pollutants, which tend to be more prevalent in these socio- economic committees which are low, and often live in more segregated areas where there is higher poverty and more drug and alcohol abuse. mixing -- missing in these areas is greenspace and access to health care. african-americans tend to live in segregated neighborhoods, even when you factor in income level. in fact, some major urban areas in the united states are segregated as they were back before the civil rights era and the apartheid era of south africa. kids inherit a lifetime of poverty, and lack of educational opportunity, and typically a lifetime of poor health.

just a few words about the educational inequality. low-income areas have less filling trophic abilities to support education. as a result, racial and ethnic people have your wall models, they tend to lower their goals to low pay and send assassins occupations. for many minority children, many expectations for them are set so low that they never reach their full potential. half of african-american children and 40% of hispanic children have a swap out rate of close to 50% and compared them only 11% for children. >> dr. pamies, thank you very much, and we will continue during the q&a. >> doctor? >> i am a professor at harvard

university's kennedy school of government and a fellow with the dartmouth institute for health policy. thank you for inviting me to the commission to share my thoughts on how to improve healthcare for minority patients. we're all aware of the stubborn persistence of racial disparities in treatment over time even when patients are fully insured. many believe that the clinical encounter is the most pernicious source of these disparities. my main point this morning is that we are unlikely to make great strides in improving minority health by channelling action on this panel. the importance of the clinical and counter is dominated by other shortcomings, such as the lack of access to high-quality providers, which are far more injurious to minority health. this comes primarily from the clinical encounter, with a provider treating to be a patients, one white and one black, differences in the critical encounter may occur because there is explicit discrimination where a provider consciously withhold about legal care from