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Health Disparities

Health Disparities

Dr. Eliseo J. Pérez-Stable, MD

Photo Courtesy of NIMHD

Eliseo J. Pérez-Stable, MD, Director of the National Institute on Minority Health and Health Disparities (NIMHD), leads NIH's efforts to improve minority health and reduce health disparities. He recently discussed the work of NIMHD and minority health and health disparities with NIH MedlinePlus magazine.

What do you see as three of the major health challenges facing minorities in the U.S. today?

The first challenge is adequate access to high-quality health care that is based on evidence from the best research. The Affordable Care Act has made a substantial impact on decreasing insurance barriers for minorities who are uninsured or underinsured. However, the lack of diversity in the medical workforce and appropriate use of high-cost services, tests, procedures, and medications remain significant problems. Furthermore, even with expanded health care coverage, segments of the U.S. population remain uninsured, such as undocumented immigrants.

"I want to build on the rigor and quality of the science that underlies minority health and health disparities."
—Dr. Eliseo J. Pérez-Stable

The second challenge is the obesity epidemic and its causes and consequences with regard to higher rates of diabetes, heart disease, cancer, and impact on quality of life. Excess obesity and severe levels of obesity affect all racial and ethnic minority groups in the United States.

Third, early life development from before birth to school age requires special attention to emotional engagement, improved nutrition, parenting, and skill building. Scientific advances have shown that adverse experiences during early life have significant consequences in adult health.

What are the most important goals you have as NIMHD's new Director?

I want to build on the rigor and quality of the science that underlies minority health and health disparities. This will promote innovative research on these topics to advance our understanding of mechanisms leading to health disparities and to develop and test interventions that will reduce these health disparities. We plan to expand the inquiry into the mechanisms in behavior and biology that lead to disparities as well as integrate the environmental, social, and cultural factors that affect these disparities. NIMHD will also establish a more robust research program in the health care setting where disparities may be reduced or exacerbated.

Minority women have higher rates of some risk factors for heart disease.

of Hispanic women are overweight or obese
of African-American women have high blood pressure
of Native American women have been diagnosed with diabetes

—Sources: NHLBI, U.S. Department of Health and Human Services

Why should all Americans—not just minorities—understand and care about minority health and health disparities?

This is an issue of social justice. Racial and ethnic minorities and the working poor have been traditionally disadvantaged and subject to discrimination. Furthermore, the interaction of environmental, biological, and behavioral factors studied in different population groups can contribute to advancing general knowledge about specific health conditions and outcomes. Finally, demographic projections indicate that by 2040 more than 50 percent of Americans will self-identify as belonging to a minority group and this topic will, in this way, affect all Americans.

How can improvements in health care settings for minorities improve care?

People who are working in or managing in health care settings can create a welcoming environment for minority populations by acknowledging the value of differences and diversity. For example, they can provide professional interpreters and appropriate signage and forms for persons who do not speak English and create a culture of respect for all persons no matter how different each of us is.

If a person of color walks into a clinic and the only people that look like him or her are custodians and maybe the front desk staff, this creates additional barriers that institutions need to recognize and actively address. There is much to be gained in providing universal quality care to all and treating all individuals with respect in our human interactions.

What should Latinos, African Americans, and other U.S. minorities understand about the need for more of them to participate in clinical research trials for a variety of diseases?

There is a saying that if one is at the table, it is not likely that one will be on the menu. We need to overcome historical mistrust, institutional barriers, and individual factors and be at the table.

The inclusion of all minorities in clinical research, both therapeutic trials and observational studies, is an issue of social justice and of advancing knowledge. Without the inclusion of minorities in therapeutic trials, we will not really know whether a treatment applies in a similar way to these groups. In the era of precision medicine, there may be genetic differences that track my individual ancestry that will determine response to a specific drug, greater susceptibility to a certain disease and possibly better outcomes for a common condition. Minority participation in studies will help us advance knowledge about health and disease, about what works for whom and how, and in this way reduce existing health disparities.

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Spring 2016 Issue: Volume 11 Number 1 Page 4-5