WHO KNOWS
A brief interview with David Satcher, MD, Ph.D., Senior Visiting Fellow at the Henry J. Kaiser Family Foundation and former U. S. Surgeon General.
In regard to the elimination of racial and ethnic disparities in terms of health care access, of what accomplishments as Surgeon General are you most proud?
After we completed our report on oral health, pointing out the great disparities in access to oral health care that disproportionately affect African Americans and Hispanics, several states throughout the country have increased their Medicaid reimbursement to try to increase access. Congress is looking at the same thing.
The CDC now has funded 46 communities to develop models for improving or working to eliminate disparities in health care and access. Each community is different. For example, one community might be looking at infant mortality and therefore, it would be concerned about access to prenatal care. Flint, Michigan, is an example of that. A project in east Los Angeles is looking at diabetes in Hispanics. One of the real issues with diabetes is how early it's diagnosed; also important is how well people get treated-how tightly their blood sugar is controlled. So, access is really critical for preventing the complications of diabetes-blindness in many cases, end stage renal disease, and, sometimes, a need for lower limb amputation.
I'm really pleased with the actions that have been taken in both the public and the private sectors to work toward eliminating disparities. Several foundations have made elimination of disparities their priority project. The Robert W. Johnson Foundation, Kellogg, Commonwealth and others are funding programs.
What do you think that state legislatures can do to be more active in decreasing disparities?
First, I think that state legislators ought to become informed about disparities in their particular state and about what the major issues are in relation to those disparities. If you are in a state such as Minnesota or Oklahoma where you have more American Indians than many other states, you ought to be concerned with those disparities that especially affect native Americans. You should go beyond that and ask the question, "What are the barriers to American Indians getting access to quality health care?"
Sometimes you're going to find that the barriers are financial; and other times you're going to find that they are cultural. Hispanics often complain about people not speaking Spanish, and we need to get more people on the health care team that do that. We also need to look at the issue of culture because different cultures between providers and patients also can inhibit access to care. The bottom line is that state legislators are in a position to become informed about disparities and to fund programs that are geared to eliminating disparities, especially in the area of access.
One good example is Medicaid reimbursement. If you look at the state of Georgia, I think it was a legislator who himself was a dentist, Dr. Jackson, who educated his colleagues and got them to support significantly increasing the reimbursement for Medicaid for dental healthcare and therefore providing access to many more children.
Do you think that, in this time of state budget crises, states can do anything to reduce disparities without increasing spending?
I think that everything starts with education-[legislators] educating themselves and then educating their constituents about disparities. Just by educating people, you can go a long way toward improving access. All the barriers to access are not in the system; some of them are in the people. Not just cultural-some people aren't informed. Some people aren't inspired. Some people aren't trusting of the health system. So there are a lot of things that you can do to mobilize people to improve their own health.
I think that one of the major weaknesses of the health system in this country-and one that disproportionately affects minorities-is a lack of emphasis on health promotion and disease prevention. We need to put more emphasis on that. We need to put out more resources. The first step is educating people about the importance of regular physical activity, eating at least five servings of fruits and vegetables per day, responsible sexual behavior, avoiding toxins like tobacco, and so forth.
We spend $120 billion a year in this country to treat the consequences of obesity. If we were to embark upon programs to get people to be more physically active and to eat right, in time-and it's not going to be right away-we are going to see the results of that in terms of reduced costs. Perhaps the most important thing, however, is not the reduced costs, but the fact that it is one way of eliminating unnecessary pain and suffering.
Are there any parting words or wisdom that you would like to impart to state legislators?
Access to health care is a very important issue, but beyond access is the quality of care that people receive once they have access. Someone needs to be paying attention to that. Someone needs to be paying attention to lifestyles in the community. Someone needs to be working with the schools and the communities to make sure that there are places for people to be physically active. It really pays off in the long run.
Someone ought to be concerned about environmental quality and the reason that so many of our children are getting asthma. Why is asthma increasing, especially in the inner city? Someone needs to be working to support research in other things. There is no excuse for children being exposed to high lead levels in the home or in the community. So someone ought to be paying attention to that. We need research in all those areas and programs. I hope that we will take a balanced approach to eliminating disparities in health. If so, we can be successful.
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