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 di

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

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 betw

we will examine hypertension. experts will present information regarding health care delivery systems, community education, patient behavior, and other aspects of health differences between population groups. public comments may be mailed to the commission. this morning we are pleased to welcome to panels of experts that will address this topic. on the first panel, speakers will discuss the disparity of claims within the overall health care context. they will evaluate potential sources of disparities, discuss research approaches taken and steady their project share their conclusions on views. dr. sullivan is a founding member of morehouse medicine. in 1989 he was appointed secretary of the u.s. department of health and human services. in january 1993 he returned to more house and resumed the office of president. in june 2008 dr. sullivan accepted appointment to the house disparities' technical expert panel for the centers for medicare and medicaid services at the department of health and human services. next, we w

hypertension in african-american lead to 80% stroke mortality rate, 50% rates of disease and 32% higher rates of renaturl disease. when we initially look at these datas we thought access to care was the suspected reason, however, even in veterans hospitals where access is not as much of an issue, major health disparities continue to exist. studies have shown that physicians are less likely to refer african-american african-american forbes cardiac catheterizations. and current theories on cardiovascular disparities is racial discrimination in treatment, genetics, environment and demographics. there are new theories emerging about the health disparities. first there is epigenetics or changes in the dna by consistent exposures from diet to stress that can be passed from one generation to next. it underscores the cumulative effect of poor socioeconomic conditions, discrimination and inequality of education of opportunities. the second theory is the owl static load which the body experienced biological changes in response to stress, cortical tropic a releasing home which is found to be highe

one was held accountable and people are still dying as a consequence primarily due to pulmonary hypertension. you were at the fda at the time of this fall out and i would like to hear what you have to say. >> very eloquently said. a lot of different points. on the first point, on the loneliness, and why -- one of the things that triggers, understand with food food is a very powerful stimulant. it is a reward and how we use the word reward, the great telemental psychologist defines reword as something that will change how you feel. so because food is why your into the real board pathways, the learning and motivational circuits it can change how we feel such a powerful stimulus and there is no doubt that million sophos, i think the vast majority are using food to self medicaid because when you are in this cycle what happens it to a? of the thoughts of wanting and this will taste good captures your attention and occupies working memory and when that happens in essence to regulate emotional level. and when you use it like that that is part -- that's because you're stimulating this reward pathway

hypertension is a component of both of those. >> 75% of the cost. of course, you have to look at the end-stage costs when we haven't managed it, which we discussed yesterday ad nauseam. >> that's why we keep saying we've got to shift this to prevention. those are preventible. we've got to get new structures out there. >> i've said all day, all of us want to do -- we all want to get the dollars to prevent it. the difference is we really disagree on how you do it. in my next amendment will be, i disagree that building bike paths is the way to get there. >> i'll withdraw the amendment in the hopes i can work with senator harkin's staff. >> pull that together if you will will. we've reached an agreement on senator burr's agreement number three. it's becleared on both sides. this involves the state law, parental consent, notification laws anz the like. i want to thank senator hagan for her involvement on that and others. we combined the two and senator harkin as well. i'll ask unanimous consent that burr amendment number 3 as modified be agreed to. all t

why is adult hypertension still rising when we know what the cause is? why do we still have this tremendous rise in metabolic syndrome which is abdominal girth enlargement, which is the manifestation for future disease? we're not going about this scientifically. we're going about this saying, hope it hits something. so the point of the amendment is to call us back and say let's look at what we're doing. if we're going to fund these, then let's change this up, tom. let's make you common demonstrate that you have an effective program so we're not just throwing money because we have a program today. i agree with tom that sometimes certain good programs get shortchanged because they -- people don't perceive prevention as a viable list on the priorities so it doesn't net get the money and putting out acute fire like you have said several times is the one that gets it. but let's look at -- let's slow down here and let's -- if we're going to spend $8 billion, let's do it in a way that we actually get something for our grand kpids. '. >> we're disagreeing how we

what's the decrease in incidence in hypertension and diabetes? >> that's where we got -- >> you're making it based on something that you have no idea what the answerses are. you're just saying we've got a good program out there. they've sfwoent.2. we think's working. now we're going to throw $8 billion at it. >> we didn't spend the 2.2. >> we spent $40,000 and they did. >> right. >> you have no date are at that to show you've accomplished anything in prevention, lowering the chronic disease or lettering the cost of health care. so we're making assumptions without any of the data to know that we're making an assumption we're going to spend $8 billion a year assuming, taking grand rap rapids, which a fairly well to do community, and have the same results in the rest of the country. there's no scientific rationale to that at all. >> a report from the trust for america's health entitled "prevention for a healthier america investments in disease prevention yields significant savings and stronger communities" concluded that an investment in proven comm

prevention, including the quality of ambulatory care, which can check the progression of diabetes, hypertension, or chronic disease, and through this, incidences of stroke and heart attack. at the very end of the causal chain is the world of disparities. the quality of medical care matters much more than the disparity in the quality. in the 6.5 year life expectancy gap and the 4.5 racial gap for women, which are larger when one accounts for the conditions, they are unlikely to be affected on the focus -- with the focus. the preoccupation with trina disparities is an end game, and it simply misses the fact that many minority patients simply find themselves confronting the end game sooner than everyone else. thank you. >> thank you. doctor? >> thank you for the invitation to -- whoops -- to address you today. is this better? thank you, chairman reynolds and co-chairman. my name is sally satel, and i work at a methadone clinic in northeast washington, d.c., and i wanted to give you an overview today of the contours of the health despair to debate. now, what do i mean by debate? there is certainly