COSSA Sponsors Congressional Briefing on Health Disparities
How SES, Race and Ethnicity Effect Health Outcomes and What to Do About It: Research on Minority Health Disparities
On June 26, 2000, COSSA, the American Psychological Association, the Society for the Psychological Study of Social Issues, the National Association of Social Work, and the American Sociological Association held a joint congressional briefing, "How SES, Race and Ethnicity Effect Health Outcomes and What to Do About It: Research on Minority Health Disparities," on Capitol Hill.
Addressing a standing room only audience, social and behavioral scientists addressed the ways in which health outcomes can be improved for racial and ethnic minorities by including social and behavioral science research in federal health research initiatives. They included: Brian Smedley, study director of the Institute of Medicine's report "Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and Medically Underserved;" Norman B. Anderson, the former and first director of the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR); Hector Myers, Professor, Department of Psychology, University of California Los Angeles; David R. Williams, Professor of Sociology and a senior research scientist at the Institute for Social Research, University of Michigan, and a faculty associate in the African American Mental Health Research Center and the Center for AfroAmerican and African Studies, Michigan; and Jeanne Miranda, Associate Professor of Psychiatry, Georgetown University Medical Center and Senior Scientific Editor of the Supplement to the Surgeon General's Report on Mental Health on Culture, Race, and Ethnicity.
Smedley commented on that morning's announcement that the mapping of the human genome was completed. He noted that, "ironically, . . . we are also increasingly coming to understand that breakthroughs in medical genetics are not going to result in the overall population health improvements that have been the goal of public health for decades." The greatest improvements in the Nation's health, said Smedley, will "result from a better understanding of social and better factors that affect health."
It is "critical," he said, "to support research that will examine differences in behavioral and social factors," such as "cultural variations in health attitudes and practices; ethnically appropriate interventions to improve diet and reduce risk behaviors such as smoking; and social and environmental conditions, such as a lack of access to appropriate cancer screening and prevention information, that may contribute to disparities."
Anderson, now at Harvard, noted that the timing of the briefing was particularly auspicious, given that "there have never been greater interest and determination, both in Congress and the Administration, to take action to eliminate the health disparities that exists between minority and majority populations in this country." He expressed his belief that the NIH is moving toward an expanded view of health: that the physiology we are born with, and the social and physical environments in which live, and the choice we make about our lifestyles all interact to make us sick or keep us well. The NIH is approaching an increasing number of health conditions from a multidisciplinary perspective, which increases the odds that the multiple influences on health can be sorted out and understood, Anderson concluded.
Williams provided congressional staffers with an overview of "what we know" regarding trends and social determinants of health. Focusing his remarks mainly on the black/white differences, Williams presented data similar to those he described at the National Institutes of Health's conference "Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health" held June 27 -28 on the NIH campus. (See UPDATE, July 10, Number 13).
How do we make sense of the data? he asked. "These are not acts of God," he continued. The answer, said Williams, lies in the systematic implementation of policy, the legacy of racism (skin color is one of the mechanisms not readily recognized), residential segregation, schools, and jobs. These factors are all driving forces in determining the health status of blacks, said Williams.
Myers discussed the "Biobehavioral Contributions to Ethnic Health Disparities: The Case of Hypertension and Birth Outcomes." Myers stressed that "health and disease are products of the interaction of psychosocial, behavioral, and biological processes." The effects, he continued, may be direct via biological changes that parallel, precede, or are part of emotional reactions or behavioral patterns in response to chronic life stresses.
Using hypertension as an example, Myers expanded on the usefulness of the biobehavioral model in understanding ethnic health disparities. Hypertension, he said, results from the disregulation of blood pressure control mechanisms. He listed the risk factors for hypertension including: family history, low socioeconomic status, excess weight, African American ethnicity, older age, male, high sodium intake and low intake of calcium, potassium and magnesium, high fat diet, sedentary lifestyle, smoking, excessive alcohol consumption, and high chronic stress. Noting that most of the research has been on black/white differences, Myers said the studies suggest that hypertension has a different pathogenesis in blacks and whites. In blacks, noted Myers, high blood pressure develops earlier, is more likely to be undiagnosed and uncontrolled, has a faster disease course, and earlier mortality.
Miranda focused her presentation on the "Sociocultural Aspects of Psychotherapy: Disseminating Effective Care." She began by expressing her amazement that there are not disparities in the need for mental health care. However, she observed that there are huge disparities regarding access and use of mental health care. Miranda also highlighted new evidence that reports as minorities use mental health care, they get poorer quality care than their white counterparts. Blacks, said Miranda, have the potential to have worse outcomes. They are over-represented in homeless populations and the criminal justice system, she noted. She emphasized that it is also possible that their mental health problems lead to worse outcomes.
She noted, however, that African-American, Latino, and poor patients differ from middle class whites in their responses to therapists and to mental health settings. They are less likely to participate in care than middle class white patients, and they tend to underuse services or discontinue using services prematurely, she continued. On the other hand, African American and Latino patients respond similarly to quality care as white patients, noted Miranda.