HEALTH DISPARITIES AMONG MINORITIES
(House of Representatives - June 04, 2003)

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[Pages H4971-H4975]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  HEALTH DISPARITIES AMONG MINORITIES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Illinois (Mr. Davis) is recognized 
for the remaining time before midnight as the designee of the minority 
leader.
  Mr. DAVIS of Illinois. Mr. Speaker, I had planned to talk about 
health care as a result of the Congressional Black Caucus' chairman, 
the gentleman from Maryland (Mr. Cummings), coming to Chicago on Sunday 
to participate in a forum dealing with health care issues that is going 
to be held at the Illinois Institute of Technology.
  But listening to much of the discussion this evening as special order 
speeches have been made talking about tax cuts and tax breaks and which 
groups got them and which groups did not, I could not help but be 
reminded of the fact that President Bush has been in office now for 
about 2 years after being selected by the Supreme Court, and has 
actually presided over one of the worst downturns in our Nation's 
history. We have lost 2.7 million jobs, as many as 500,000 in the last 
2 months alone. The only answers that I have heard the Republicans give 
is, tax cuts, tax cuts, and more tax cuts as we have gone from a 
surplus to a $350 billion deficit, the largest deficit in the history 
of this country.
  As I listen to all of the information about tax cuts and the 
inability to give certain groups a break, the top 1 percent of the tax 
cuts that we have made will receive on an average of $24,100 in 2003, 
this year. Those with incomes of more than $1 million will receive an 
average of $93,500.
  I hear people talk about what will happen for small businesses, and 
52 percent of small business owners will only get between zero and 
$500. Seventy-nine percent of the benefits will go to individuals who 
have incomes of over $100,000. Twenty-nine percent of the population 
will go or 29 percent of the breaks will go to individuals who make 
more than $1 million.
  More than two-thirds of the tax cuts will go to the top 10 percent of 
the population, and over 50 percent of the tax cuts will go to the top 
5 percent of the population. The bottom 60 percent of the taxpayers 
will only get 8.6 percent, averaging less than $100 a year for the next 
4 years. The average reduction for the richest 1 percent will be 
$103,899 for 4 years. Thirty-nine percent will go to this tiny group. 
The best off 1 percent of the population will get 52 percent of the 
benefit.
  I am not one that always pays a great deal of attention, but 
oftentimes

[[Page H4972]]

I do read them, to what newspapers have to say about these proposals 
and what we are doing. But as we talk about the need to stimulate the 
economy, I was reading the New York Times on May 9, and they indicated 
or they stated, they said, that lower-income families, of course, would 
be the quickest to spend the money to help provide some of the stimulus 
the Republicans claim is their first priority. Instead, the GOP remains 
fixated on high-income concerns. Framing the reconciliation talks is 
more than an exercise in dueling sugar plums.
  So I guess, concerning this whole business of who gets what, a friend 
of mine told me the other day that there was a quote that said the 
history of the world, my friend, is relationships between where the 
money goes, and that after everything else is talked about, look and 
see where the money goes.
  It seems to me that as we have dealt with the tax cut issue, most of 
the money continues to go to the wealthy. Most of the money continues 
to go to those who have the most.
  At any rate, our health situation is still in bad shape. I am going 
to spend the rest of my time talking a little bit about that. Our 
health care system is unacceptable for the world's most powerful and 
wealthy country. I would say that the state of health care in this 
country is one of the top critical issues facing the Nation. I do not 
believe that it can be cured by putting too much of our resources in 
one population group.
  Even as we come to an end of the war against Iraq, there will still 
be and still are individuals in need of health care. It is true that 
the state of education, the state of unemployment, and the state of 
housing are all in dire need of improvement, as well; but they all 
connect to the need to have a solid, concrete health care system that 
serves all people.
  The state of one's health sets the precedent for everything else in 
our lives. If we are not in good health, we cannot perform our jobs 
well or do well in school. If we are not in good health and do not have 
insurance, we end up with an exorbitant amount of debt that will be 
virtually impossible for anyone to pay off, if we have been sick.
  The numbers are absolutely startling. There are approximately 60 
million people without health insurance at some point during the year 
in this country. Many people believe that it is only the unemployed or 
individuals with low incomes that cannot afford health insurance.
  However, nearly 80 percent of the uninsured are individuals from 
working families who cannot afford health insurance or cannot access 
employer-provided health insurance plans. More than one out of every 
five families making $75,000 a year or more has at least one member 
without health insurance.

                              {time}  2320

  In Chicago, those making between $25,000 and $75,000 or 34 percent 
have at least one family member without health insurance, as do 41 
percent of families making up to $25,000. In Illinois, almost 10 
percent of those with at least a bachelor's degree and 20 percent of 
full time workers are uninsured. America needs to realize that the face 
of the uninsured has changed. The level of education or salary will not 
automatically guarantee an individual insurance anymore.
  The health crisis is not only due to the number of uninsured in our 
Nation. There are millions more than the estimated 60 million uninsured 
at some point that have less comprehensive insurance than what they 
actually need, and, therefore, are under-insured. They are the families 
working for small firms or family-owned businesses that are being hit 
the hardest by the current state of the economy, forcing the employers 
to cut back and have the employee pay higher premiums. There are senior 
citizens on Medicare that are being denied care by physicians who can 
no longer afford to care for them. These are the components of a 
failing health care system. With State and the Federal Government 
slashing Medicaid, the safety net we once depended on is instead not a 
net at all.
  Currently in Congress there are numerous resolutions that would help 
mend our Nation's health care crisis as a whole. The proposed solutions 
range from a refundable tax credit, to purchasing private insurance, to 
Congress enacting health care for every American, to amending the 
United States Constitution. There are also resolutions to help to 
resolve a single issue plaguing the health system, whether it is the 
cost of prescription drugs, the reimbursement amounts for a mammogram 
under Medicare, or a new formula for FMAP.
  Although minor changes in health care may be easier for a Member to 
get passed, it allows many Americans to remain stuck, still unable to 
afford expensive health insurance. I believe that Congress must act 
sooner rather than later and reform our health care system as a whole.
  One of my American Medical Student Associate fellows, Amanda 
Muellenberg, once explained the problem of fixing Medicare piece by 
piece with an old Dutch story. She said there was once a young boy 
walking down the road and realized that the town's dike had a hole in 
it. To save the town, the young boy put his thumb in the hole to stop 
the leaking. Soon another crack and a hole appeared and then another 
and another. It was not long until the young boy ran out of fingers to 
clog the holes, and still with all his efforts, he could not stop the 
dike from leaking. Instead of clogging each new hole in our health care 
system, we need to rebuild it.
  The Kaiser Family Foundation found that uninsured Americans cost 
Federal, State, and local governments about $35 billion in 2001. Much 
of that money went to treating individuals who had become seriously ill 
due to a lack of medical attention. I believe this amount that is spent 
on helping the uninsured ill could be better used to give screenings 
and preventative care, leaving less of a financial burden on taxpayers 
and hospitals for admissions.
  President Bush made the commitment to America to leave no child 
behind in education. Instead, we need to ensure that no American is 
left behind in preventative care, access to medical treatment, and 
affordable insurance. The way to accomplish this and the only real way 
is through enactment of a national health plan, where everyone is in 
and nobody is out. And as much of a problem that we have across the 
board with health care and health insurance, when it comes to some 
population groups, especially when it comes to minorities, nowhere are 
the divisions of race, ethnicity, and culture more sharply drawn than 
in the health of the people in the United States.
  Despite recent progress in overall national health, there are 
continuing disparities in the incidents of illness and death among 
African-Americans, Latino/Hispanic-Americans, Native Americans, Asian-
Americans, Alaskan Natives and Pacific Islanders as compared with the 
U.S. population as a whole. We can point to 6 areas in particular: One, 
cancer; two, cardiovascular disease; three, infant mortality; four, 
diabetes; five, HIV/AIDS; and six, child and adult immunizations, 
aggressively.
  Cancer, for example, research shows in general that people of diverse 
racial, ethnic, and cultural heritage are less likely to get regular 
medical check-ups, receive immunizations, and be routinely tested for 
cancer when compared with the majority of the U.S. population. Cancer 
deaths are disproportionately high among Latino/Hispanic-Americans and 
African-Americans. Vietnamese women are 5 times more likely to have 
cervical cancer and Chinese-Americans are 5 times more likely to have 
liver cancer.
  Cardiovascular disease. Disparities exist in the prevalence of risk 
factors for cardiovascular disease, coronary heart disease and stroke. 
Racial and ethnic groups have higher rates of hypertension, tend to 
develop hypertension at an earlier age, and are less likely to undergo 
treatment to control their high blood pressure.
  Mexican-American men and women have elevated blood pressure rates. 
Obesity continues to be higher for African-American and Mexican-
American women. Only 50 percent of Native American, 44 percent of 
Asian-Americans, and 38 percent of Mexican-Americans have had their 
cholesterol checked within the past 2 years. Coronary heart disease 
mortality is higher for African-Americans. Stroke is the only leading 
cause of death for which mortality is higher for Asian-American males.

[[Page H4973]]

  We look at infant mortality, current studies document that despite 
advances, African-American and Native American babies still die at a 
rate that is 2 to 3 times higher than the rate for white Americans. 
Infant mortality is really a measure that health professionals use to 
measure quality of life. If infant mortality is high, it usually means 
that the quality of life is low. If infant mortality is low, it usually 
means that the quality of life is high.
  Statistics revealed that among Native Americans and Alaskan Natives, 
the incidents of Sudden Infant Death Syndrome, SIDS, is more than 3 to 
4 times the rate for white American babies. And while the overall 
infant mortality rate has declined, the gap between black and white 
infant mortality rates has widened.

                              {time}  2330

  Diabetes, studies indicate that diabetes is the 7th leading cause of 
death in the United States. Approximately 16 million people in the U.S. 
have diabetes. African Americans are 1.7 times more likely. Latino 
Hispanic Americans are 2.0 times more likely. The Alaskan natives and 
Native Americans are 2.8 times more likely to have diabetes than 
whites. The Pima tribe of Arizona has the highest known prevalence of 
diabetes of any population in the world. Native Americans and African 
Americans have higher rates of diabetes-related complications such as 
kidney disease and amputation as compared to the total population.
  HIV/AIDS, recent data from prevalence surveys and from HIV/AIDS cases 
surveillance continue to reflect the disproportionate impact of the 
epidemic on racially, ethnic and linguistically diverse population 
groups, especially women, youth and children.
  The African Americans and Hispanic Latino group accounted for 47 and 
20 percent respectively of persons diagnosed with AIDS in 1997. Among 
African Americans, 56 percent of new HIV infection and AIDS cases are a 
result of intravenous drug usage. For Hispanic Latino groups, 20 
percent of new HIV infections and AIDS cases results from intravenous 
drug use. Seventy-five percent of HIV/AIDS cases reported among women 
and children occur among diverse racial and ethnic groups.
  Six, child and adult immunizations. Statistics from the President's 
Initiative on Race reveal that for the most critical childhood 
vaccines, vaccination levels for preschool children of all racial and 
ethnic groups are about the same. However, immunization levels for 
racial and ethnic groups are lower.
  School age children and elder adults of diverse racial and ethnic 
backgrounds continue to lag when compared to the overall vaccination 
rates for the U.S. general population. While 79 percent of white 
preschoolers are fully immunized by 2 years of age, only 74 percent of 
African American and 71 percent of Hispanic Latino children, including 
preschoolers and school age children, are fully vaccinated against 
childhood diseases.
  Annually, approximately 45,000 adults die of infections related to 
influenza, pneumonia infections and hepatitis B, despite the 
availability of preventive vaccine. Among the elderly, there is a 
disproportionate amount of vaccine preventable diseases in racial, 
ethnic and underserved populations.
  Although the reasons for these disturbing gaps are not well 
understood, it appears that disproportionate poverty, discrimination in 
the delivery of health services and the failure of health care 
organizations and programs to provide culturally competent health care 
to diverse racial, ethnic and cultural populations are all contributing 
factors.
  For people under 65, blacks and Hispanics have a higher percentage of 
being uninsured than whites; 12.7 percent of non-Hispanic whites are 
uninsured; 22.8 percent of blacks are uninsured; and 24 percent of 
Hispanics are uninsured.
  Minorities face greater difficulty in communicating with physicians. 
Hispanics are more than twice as likely as whites, 33 percent versus 16 
percent, to cite one or more communication problems, such as 
understanding the doctor, not feeling the doctor listens to them or 
that they had questions for the doctor but did not get asked. Twenty-
seven percent of Asian Americans and 23 percent of blacks cite that 
they also have communication problems.
  Minorities, of course, are more likely to be without a regular 
doctor. Hispanics are twice as likely to not have a regular doctor than 
whites, 41 percent versus 19 percent. Thirty-one percent of Asian 
Americans and 28 percent of blacks are without a regular doctor.
  Compared with the rates for whites, coronary heart disease mortality 
was 40 percent more for Asian Americans but 40 percent higher for 
blacks in 1995. Stroke is the leading cause of death for which 
mortality is higher for Asian American males than for white males.
  Racial and ethnic minorities have higher rates of hypertension, tend 
to develop hypertension at an earlier age, are less likely to undergo 
treatment to control their blood pressure. From 1988 to 1994, 35 
percent of black males 20 to 74 had hypertension compared to 25 percent 
of all men.
  Among adult women, the age-adjusted prevalence of overweight 
continues to be higher for black women, 53 percent, and Mexican 
American women, 52 percent, than for white women. Only 50 percent of 
American Indians, native Alaskans, 44 percent of Asian Americans and 38 
percent of Mexican Americans have had their cholesterol checked in the 
last 2 years.
  According to the 2001 Surgeon General's Report on Mental Health, the 
prevalence of mental disorders is believed to be higher among African 
Americans than whites, and African Americans are less likely to be 
treated for mental problems such as depression or anxiety.
  Infant death rates among blacks, American Indians and Alaskan natives 
and Hispanics in 1995 and 1996 were all above the national average of 
7.2 deaths to 1,000 births. The black infant death rate is 14.2 deaths 
per 1,000 births. This is nearly two-and-a-half times that of white 
infants, 6 deaths, 1,000 births. Puerto Ricans have a rate of 8.9 
deaths, 1,000 births, and overall, American Indians have a rate of 9 
deaths to 1,000 live births.
  HIV/AIDS is the sixth leading cause of death for African American 
males and the 10th leading cause of death for African American females. 
In 2000, 47 percent of all cases reported in the United States were 
among African Americans. The rate of new AIDS cases among African 
Americans was almost 10 times higher than among whites.
  Cancer is the second leading cause of death in the United States, 
accounting for more than 544,000 deaths each year. For men and women 
combined, blacks have a cancer death rate about 35 percent higher than 
that for whites, 171.6 versus 127 per 100,000. The death rate for 
cancer for black men is about 50 percent higher than that for white 
men, 226.8 versus 151.8 per 100,000. The prostate cancer mortality rate 
for black men is more than twice of that of white men, 55.5 versus 23.8 
per 100,000. The death rate for lung cancer is about 27 percent higher 
for blacks than for whites, 49.9 versus 39.3.

                              {time}  2340

  Incident rates for lung cancer in black men is about 50 percent 
higher than in white men, 110.7 versus 72.6 per 100,000. Native 
Hawaiian men have also elevated rates of lung cancer compared with 
white men. Alaskan native men and women suffer disproportionately 
higher rates of cancer of the colon and rectum than do whites. 
Vietnamese women in the United States have a cervical cancer rate five 
times that of white women, 47.3 versus 8.7 per 100,000. Hispanic women 
also suffer elevated rates of cervical cancer. Black women have the 
highest death rate from cervical cancer. Stomach cancer mortality is 
substantially higher among Pacific Islanders, including Native 
Hawaiians, than other populations.
  We mention these numbers because America, our country tis of thee, 
has a goal to create equal justice, equal opportunity, equal service. 
The idea that out of many can be one, and one not just in concept but 
also one in reality. And to make real these ideas, there is obviously a 
need for special programs and special activities, in addition to 
changing the way we provide treatment in some instances.
  There is a need to increase the numbers of minorities in medical 
schools, in nursing schools, and to train more professionals. There is 
the need to put more ambulatory care programs in places where there are 
none. There is a need to increase accessibility. Of course we know that 
poverty plays a tremendous role. There is a need for

[[Page H4974]]

more education, more assistance for individuals to take control of 
their own health.
  And that is why the Congressional Black Caucus has made health one of 
its top priority issues. That is why we are pleased that our chairman, 
the gentleman from Maryland (Mr. Cummings), will in fact be in Chicago 
on one of his stops as he and other members of the caucus go across the 
country trying to help raise the issue, trying to help people to 
understand what they can themselves do, and also continuing to suggest 
to America that we have to put our resources where our conversations 
are; that we have to make available quality comprehensive health care 
to all people in this great country without regard to their ability to 
pay.
  So, Mr. Speaker, as I come to the close of my special order, I want 
to thank you for your indulgence. I want to thank the American people 
for watching and listening. And I hope that we can indeed let America 
be America again, the land that never has been and yet must be. The 
America that we all continue to dream about. The America that we all 
continue to hope for. The America that can ultimately crown its good 
with brotherhood from sea to shining sea. And the America that can have 
quality comprehensive health care for you and quality comprehensive 
health care for me.
  Ms. LEE. Mr. Speaker, today members of the Congressional Black Caucus 
rise to expose the truth about minority health disparities in our 
health care system.
  Many of my colleagues will outline the ongoing racial divide when it 
come to minorities' reliance on emergency and ambulatory services, the 
issue of access to health care and how minorities are 
disproportionately uninsured. Others will talk about the leading 
illnesses and health conditions that kill more Blacks and Latinos than 
Whites because of social and economic community distrust of the health 
care system.
  However, tonight I want to bring attention to the increasing minority 
health disparities connected to environmental racism. The simple fact 
is the environment affects your health, and Blacks, Latinos and other 
people of color are suffering and dying because of toxins in the 
environment.
  Dr. Martin Luther King, Jr. laid the groundwork when he declared that 
``we will not be satisfied until justice rolls down like waters and 
righteousness like a mighty stream.'' The metaphors of nature are the 
metaphors of life, and that is fundamentally where environmental 
justice begins and ends.
  Unfortunately, the waters themselves in much of the world are 
tainted, and the toxic streams flow all too often through neighborhoods 
at the economic margins of society, particularly minority 
neighborhoods.
  Far too often, the issue of minority health and the environment is 
ignored. Now, the Administration continues to roll back all of the 
environmental protections that Democrats have fought for, minorities 
will pay the highest price of all, trapped in homes near brown fields, 
power lines and sanitation plants. Democrats must stand against the 
Administration and the deceptive conservatism that continues to sweep 
our policy debates and our nation.
  Members of the Congressional Black Caucus see the forces of 
environmental injustice playing themselves out in terms of minority 
health disparities.
  These disparities follow a cradle to grave cycle: beginning with 
infant mortality, continuing with workplace hazards and increased 
exposure to pollution, and ending with disparate access to healthcare, 
diagnoses, and medical treatment.
  We see these forces clearly in diseases that strike most deeply into 
our cities and affect children most severely.
  Asthma rates among the urban poor are reaching alarming proportions. 
Death rates from asthma, and a host of other treatable diseases, 
are significantly higher among African Americans than any other ethnic 
group.

  In my own district, asthma rates are among the highest in the 
country, and children in West Oakland are seven times more likely to be 
hospitalized for asthma than children in the rest of California.
  Over twenty-eight percent of low-income African American children 
suffer from lead poisoning, more than twice the level of exposure among 
low income white children, and far higher than among children of the 
middle class or wealthy.
  Toxins concentrate along the color lines that have historically 
divided American society. Children of color are much more likely to 
suffer from lead poisoning, resulting in devastating effects on mental 
development. We are also finding that public housing communities have 
been secretly dealing with mold for years, another place where 
minorities are disproportionately located. These are minority health 
injustices that we cannot accept.
  Environmental minority health disparities grow not only out of 
poverty, but racism. We must address the ravages of the past while we 
forge sounder policies for tomorrow. Our environment may be defined as 
our surroundings. Inner city neighborhoods that have liquor stores but 
no grocery stores speak to years of less than benign neglect and to the 
need for meaningful social and economic investment. That is a form of 
racism. Superfund sites that are under-funded; factories and plants 
that emit carcinogens under the protections of grandfather clauses; 
healthcare that is inadequate and racially biased; all demand our 
attention and financial resources. They are all forms of environmental 
racism.
  We must demand environment health justice for our communities. The 
gap between minorities and whites in health care continues to grow, but 
I stand here today in support of universal health care, more resources 
for minority health initiatives, and a re-evaluation of the national 
agenda for health and justice. We must consider the environmental 
health agenda because it affects our homes, our communities, and the 
overall health of America.
  Mr. CONYERS. Mr. Speaker, in 2002, the Institute of Medicine released 
a telling report entitled: Unequal Treatment: Confronting Racial and 
Ethnic Disparities in Health Care. The report documented many troubling 
findings which unfortunately, health experts in the underserved 
communities have been crying out about for decades. It documents the 
case that the American health care system was set up so that African 
Americans, Hispanics, and other underserved minorities would receive 
``second class back of the bus health care'' in public hospitals and 
community clinic--many of which are on the verge of economic collapse.
  Minority Americans are at least twice as likely as white Americans to 
be uninsured. More than 30 percent of Latinos and 20 percent of African 
Americans do not have health insurance--and the gap has been widening 
over the last decade. Astoundingly, minorities now account for two 
thirds of the new AIDS cases, and HIV infection is the leading cause of 
death among younger African Americans. Yet, African Americans are 41 
percent-73 percent less likely than whites to receive particular drug 
therapies.
  African American women are far less likely to receive a mammogram 
than white women and are at far greater risk of being diagnosed with 
breast cancer. Black men are also 1.5 times more likely to develop 
prostate cancer than white men, and they are three times more likely to 
die of the disease. Even more disturbing, African American children are 
plagued by asthma. They are twice as likely to be diagnosed with the 
disease and a whopping six times as likely to die from it as white 
children. Just last month the Harlem Hospital found that an incredible 
25 percent of children in central Harlem has asthma--one of the highest 
rates ever documented in an American neighborhood. Add to all the 
previously noted findings the fact that African American 
infant mortality rates are three times higher than the rate for white 
American babies, and the diagnosis for the future of the African 
American family seems not only chilling but painfully malignant.

  Under George W. Bush and the Republicans, the current health 
disparities are likely to get worse--the principle reason is that they 
are gutting health care in general and Medicaid in particular. Medicaid 
is the bedrock of health coverage for poor Americans in general and 
minorities in particular--it insures one out of five children in 
America and two thirds of all nursing home residents.
  Because of the budget crisis in the states, the Center on Budget and 
Policy Priorities has predicted that as many as 1.7 million Americans 
could lose health coverage entirely under Medicaid cut back proposals 
in the states. Amazingly, the Bush Administration is opposing efforts 
to help the States pay their Medicaid responsibilities and help keep 
poor and minority Americans insured.
  This Congress I have been dedicated to bridging the gap in health 
care disparities amongst Americans. I have introduced a bill that would 
provide universal health care for all Americans. H.R. 676, ``Medicare 
For All'' is a national health insurance bill endorsed by 4000 
physicians across the country. I also reintroduced H. Con. Res. 99, a 
resolution that commits to covering all of the uninsured by 2005. Just 
last month, the Congressional Black Caucus launched campaign to end 
racial disparities in healthcare by backing my universal healthcare 
resolution. I am also planning to introduce legislation that will bring 
Medicaid to anyone earning less than 200 percent of the poverty level. 
This will allow almost all working poor and unemployed Americans to 
have health coverage. It will also ensure that major urban hospitals 
can receive sufficient reimbursements so that they are not forced to 
shut their doors.
  In 2003, in without a doubt the most powerful and wealthy society in 
the history of the

[[Page H4975]]

world, there is absolutely no excuse for the health disparities that 
are crippling and killing off our African American and minority 
communities. I urge my colleagues today to support the efforts of the 
CBC and others who are fighting to improve the health of all Americans.
  Mr. DAVIS of Illinois. Mr. Speaker, I yield back the balance of my 
time.

                          ____________________