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Federal Health Survey Finds Racial Gaps

Study: Disparities between whites and minorities narrow but persist in many cases, researchers report.


WASHINGTON — Despite a narrowing of the gap between the health of whites and minority groups, "substantial" differences persist, according to a federal study released Thursday.

Since 1990, Americans overall have grown healthier, said the report released by the Centers for Disease Control and Prevention, which tracked health matters ranging from prenatal care to suicide rates from 1990 to 1998.

But minorities, in many cases, did not keep pace with the improvements enjoyed by white Americans.

A related study also released Thursday showed that death rates for lung, colon, rectal, breast and prostate cancers decreased during the 1990s, but gains were not shared equally among racial groups or between men and women.

The overall declines in cancer death rates were attributed to fewer smokers, earlier detection, improved nutrition and more effective treatments.

Researchers said they believed that if those factors could be improved for all groups, "more than half of cancer deaths could be prevented and most racial and ethnic disparities in cancer death rates could be eliminated."

Gaps between the races when it comes to disease and death have long concerned public health officials, many of whom believe access to quality health care plays a large role in the disparities. And after a dip in uninsured Americans during the boom years of the late 1990s, rising unemployment and a reduction in employee benefits have recently boosted the number of Americans without health coverage.

Federal health officials had set ambitious goals to improve Americans' health and greatly reduce the disparities between racial groups during the 1990s under an initiative called "Healthy People 2000."

Thursday's report card showed mixed results.

The study found that all but one of 17 "health indicators" had improved from 1990 to 1998. Only the overall percentage of low-weight babies climbed during that period--from 7% to 7.6%--despite special efforts to target Latino and black women for improvement, the study said.

In nearly every category, minority groups continued to show higher rates of disease and death, a fact that "shows how far we still have to go" to "eliminate disparities in health among all population groups by 2010," said Health and Human Services Secretary Tommy G. Thompson.

To cite just a few of the differences: Non-Latino black Americans were eight times more likely than whites to contract tuberculosis and 10 times more likely to be the victim of a homicide. That's even after the tuberculosis rate for blacks dropped 50% and the homicide rate 34% during the reporting period.

Top federal health officials, however, noted that large gains were made in areas where specific communities had been singled out for care. For example, federal programs aimed at reducing the rate of syphilis in black and Latino communities helped contribute to cutting the rate of the disease in those communities by nearly 90%.

Dr. Jeffrey P. Koplan, director of the Atlanta-based CDC, called the reduction "a clear lesson for public health" that such efforts should be "targeted and tailored to the needs of specific groups."

But even where dramatic strides had been made, syphilis still occurs dramatically more often in some minority populations. Blacks, for instance, remain 34 times more likely to contract syphilis than whites. Latinos are three times more likely to get the disease.

Minorities also made far less progress in some areas where white Americans reported significant gains. For instance, while the death rate for breast cancer in white women dropped 19% over the course of the study, the death rate for black women dropped 4%.

Prenatal care is another area where stark differences remain.

While 12% of white women in 1998 received no prenatal care during the first three months of pregnancy--down from 16.7% in 1990--pregnant minority women were far less likely to see a doctor early on.

Although the figures represent significant reductions from the early years of the study, nearly 27% of black women, nearly 26% of Latino women and more than 30% of American Indians or Alaska natives still got no prenatal care for the first three months of pregnancy.

The study showed about 17% of Asian women did not receive care in the first trimester, down from nearly 25% in 1990.

And in a few areas--notably motor vehicle crash deaths, work-related injuries and deaths, and suicide rates--the gap between rates reported by whites and minorities increased by more than 10%.

Outgoing Surgeon General David Satcher said that in "many ways," the study is good news for the health of all Americans.

"But," he said, "our work isn't done until all infants have the same chance to thrive, all mothers have equal access to prenatal care and all Americans are equally protected from cancer, heart disease and stroke."

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