Panelists Discuss Reducing Inequalities in Health Outcomes in United States
Three experts discussed "Reducing US Health Disparities: The Role of Healthy People 2010, New Genetic Technologies, Health Care, and Social Policy" to a packed Snyder Auditorium on February 8. The discussion was the latest installment in the Future of Public Health Millennial Symposium Series, hosted by Dean Barry Bloom. Timothy Johnson, medical editor at ABC News and an HSPH alumnus, moderated.
First on the agenda was the implications of Healthy People 2010, a publication from the US Department of Health and Human Services released every 10 years that outlines health goals for Americans. For the first time since the series started, Healthy People 2010 addressed health disparities, an important step in acknowledging the problems of health inequities. But, as Johnson asked the panel, what difference can the document really make?
Nancy Adler, professor of medical psychology at the University of California at San Francisco, commented that the document was useful but also schizophrenic. The first part addresses broad health indicators while the second part tackles very specific diseases and their interventions. The disease-specific focus is too narrow, she said, although it does bolster understanding of the disease pathways. Instead, she would like to create a matrix of diseases with underlying factors such as socioeconomic status that would prove more useful to researchers than simply knowing if someone died of a particular disease.
Healthy People 2010 has prompted research, added Harold Freeman, president and CEO of North General Hospital, particularly of health disparities. But research and its delivery are extraordinarily disconnected in the United States, he said. As long as the disadvantaged are removed from the application of scientific findings, there will be no way the goals of Healthy People 2010 can be implemented, he said.
Freeman threaded this theme into his discussion of the health care system and reducing disparities. He said it's not the health care system itself that is the most important thing--it's addressing inequalities. Disease occurs under human circumstances such as housing conditions and educational opportunities, he said. Providing all Americans with comparable access to such opportunities in addition to health care may reduce the uneven burden of disease.
The third panelist, Thomas Boyce, professor of epidemiology and child development at the University of California at Berkeley, echoed Freeman's comments.
"Health care is an isolated human service in society," he said. Medicine and health care need to become part of the social fabric of a community, he said.
As an example, Boyce described a thriving elementary school in San Diego, California where children receive health care and play in after-school programs in addition to learning their ABCs. Parents, kids, and community leaders meet once a week on school grounds to share dinner and discuss the school's programs. They have made the school a personal project.
The speakers concluded their discussion by addressing genetics and health disparities. "The new genomics has the potential for benevolence and malevolence," said Boyce.
He explained that genetic technologies may advance understanding of social epidemiology, allowing health programs to be customized for groups of people. And yet there is an undisputed potential for abuse of genetic information.
As an example, Boyce described a possible scenario in which drugs may be designed to target specific genes involved in diseases. Such drugs will most likely come with expensive pricetags and therefore may only be practically available to more affluent people, augmenting existing disparities.
Freeman picked up the theme by observing that cutting-edge technologies tend to increase disparities between those who can and cannot afford the technologies' benefits. He asked what race really means in today's society. It has no biological meaning, he said. Genetic technologies have revealed only a .01 percent difference in DNA among humans, meaning that any two individuals share nearly 100 percent of their DNA whether or not they are blood relatives. But perception of race persists, said Freeman.
"Americans see each other through the lens of race," he said.
He urged that resources be spread more evenly among people, connecting health care to social justice, and described a finding that illustrates the unevenness of health care in America as clearly as a line drawn on a map.
The line extends along the Appalachian Trail from Maine to the south. People living along this line tend to be poor, and women along this route die at much higher rates than the national average from cervical cancer, a treatable disease if detected early enough by a ubiquitous and cheap Pap smear.
"Women should not die from this disease," said Freeman.
The panel concluded by calling visiting health disparities expert Michael
Marmot to the front of the auditorium. Fresh from Logan Airport, Marmot
described his work with health inequalities in England.
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Human Genome Project Leader to Speak at Next Future of Public Health Symposium J. Craig Venter, president and chief scientific officer of Celera Genomics, the company that has spearheaded efforts to sequence the human genome in addition to government efforts, will be a panelist at the next Future of Public Health Symposium on Thursday, March 15 from 3:30 p.m. to 5:30 p.m. in Snyder Auditorium. The topic will be, "Genomics: A Population Perspective." Other speakers will be Gerald Keusch, director of the Fogarty International Center at the National Institutes of Health, and Richard Lewontin, Alexander Agassiz Professor of Zoology at Harvard University. Dean Barry Bloom will host. |
