By Grace Austin
In the United States, the health disparities between whites and minorities, including African Americans, Native Americans, Asian Americans, and Latinos, are well-known. Higher incidences of chronic diseases, mortality rates, and other health factors and outcomes are documented among these minority groups. Over the years, minority health has become an increasingly vital concern for the nation, due to the long-term implications for both minorities and society, from the economic (less productivity by terminally ill people and money spent on health issues) to the societal (less time to participate in social and political life).
“Minority health is truly an important national public health issue. Despite the progress our nation has made in technology and medicine, health disparities in racial and ethnic minorities have persisted in our country. The importance of addressing health disparities is to achieve health equity for all Americans in our country,” says Deputy Assistant Director for Minority Health J. Nadine Gracia.
Many throughout the country are working to change the odds for minorities. One person that is making a difference is Cleveland Clinic’s Men’s Minority Health Center Founder and Director Dr. Charles Modlin.
For Modlin, minority health has been an important issue for some time.
“After I finished my formal medical education, I was able to step back and take a broader view of the medical landscape. That’s when I really became aware of the healthcare disparity crisis. It’s also when I started thinking about what we can do at the Cleveland Clinic, as an organization, to have a positive impact on reducing healthcare disparities,” says Modlin.
Initially founded in 1921 by four doctors, the Cleveland Clinic is consistently rated as one of the top five hospitals in the United States. A pioneer in group medical practice, the Cleveland Clinic holds the distinction of being the top-rated hospital in the country for cardiac care, according to U.S. News and World Report.
Modlin, a urologist and kidney transplant surgeon, began his position at the renowned hospital in 1993. His experiences with treating prostate cancer and performing kidney transplantations that often stem from hypertension and diabetes (which acutely affect African Americans and other minority populations) led to his idea and involvement with the Health Center.
Modlin’s role at the Health Center is varied, but involves both direct patient care and engagement of minority patients in preventative care. He sees growing health issues among minority populations and health inequities as a profound crisis that inadvertently affects and will continue to affect everyone.
“If you look at changing demographics in America, 30 percent or more of the population is considered minority. By the year 2050, it is projected the minority population will become the majority population. If you look at the higher incidence of disease and lower life spans of minorities, if we have an ever increasing percentage of the population that is minority, with poorer health outcomes, that’s going to transfer to decreased productivity for the entire nation. That is, only if we don’t collectively as healthcare providers solve or reduce these healthcare disparities,” says Modlin.
The statistics are astounding. The cancer incidence rate among African Americans is 10 percent higher than in whites. Adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes. American Indian/Alaskan Natives are 70 percent more likely to be obese than whites. And racial and ethnic minorities accounted for almost 71 percent of new cases of HIV in 2010.
The roots of the problems draw back to social, economic, and environmental conditions. These are complex, but comprise: individual lifestyle factors, social and community networks, and general socioeconomic, cultural, and environmental conditions. Such environmental conditions include housing, unemployment, education, and healthcare services. Modlin sees the foremost sources of health disparities as access to quality healthcare and a general fear and mistrust of healthcare practitioners.
“I think one of the most obvious causes is lack of access to quality healthcare, often due to impoverishment,” says Modlin. “But it goes beyond lack of access. There are a number of patients that actually have access to health insurance, but choose not to [use them] because they don’t think it’s important or out of fear. I think there are patient and healthcare system factors, too. There are unhealthy behaviors, but there are also biological causes that play in, and these can all be combined with environmental factors as well.”
Solving health inequities is a complicated issue, but one that is achievable. Many have seen solutions in better social policies. Targeting public health workers is one of the goals of NACCHO, the National Association of County & City Health Officials, which has created an online course, Roots of Health Inequity, targeted at the public health workforce. The Virginia Department of Health, Office of Minority Health and Health Equity counts town hall meetings; “supporting local health districts in conducting screenings and community forums; and providing resources consisting of community action toolkits, event flyers, press releases, and fact sheets to agency partners, major stakeholders and community-based organizations” as strategies they are using to “advance health equity.”
The Office of Minority Health is taking a multi-faceted approach to solving the minority health disparity crisis. One of the main aspects is the Affordable Care Act, signed into law in 2010. “This is one of the most important pieces of legislation to help us reduce disparities. It will help us provide better access to care, while also helping to make health insurance more affordable, as well as helping to end the worst insurance company abuses. Preventive services, like blood pressure screenings, those are now provided with no cost, as cost is often a barrier to minority populations,” says Gracia. They are also investing in community health centers, over $11 billion within the next five years, that are often the “safety nets” for underserved communities.
The Cleveland Clinic, for itself, is working to get out the message and provide an example to other health institutions. “Over the past decade, we have studied the reasons [for health disparities]. With the Minority Men’s Health Center, we have deliberately tried to identify each of these barriers and create a program designed to eliminate that particular barrier,” says Modlin. The Health Center regularly visits churches and other community organizations to raise awareness of preventative health. To address lack of access, the Cleveland Clinic maintains a charity assistance program that actively enrolls needy patients. To increase cultural competency, the hospital requires all clinicians to take cultural competency training in-house and online. And to address biological issues, the Cleveland Clinic encourages minorities to participate in clinical research studies.
The issue of health disparities has engaged nearly every kind of organization, big and small, grassroots and super PACs, academia and the private sector. To Gracia, the government cannot solve the crisis alone. She points to partnerships and a multi-sector approach to end health disparities. And for Modlin, all of these organizations are welcome in the debate, as long as they help provide solutions.
“Solving this healthcare crisis is not going to be accomplished by any one physician or healthcare institution. It is going to take the whole nation to embrace this and get behind this,” says Modlin. “Anything we can do to show to others how innovation can better engage these populations, and promote access, health literacy, cultural competency, all of these things collectively are important.”
This needs to go all the way up to the White House, and people need to be aware that this is a crisis that is only going to worsen if we don’t come up with some solutions.”