Data monitoring is also important for civil rights enforcement. It is important to improve data collection for Health IT. We need to have standardized health IT, and particularly broaden health IT in outpatient settings to monitor the circumstances under which quality or inequality of health care occurs. So while we need to encourage responsibility for one's own care, when it comes to monitoring health care and equity of health care, health IT is important.
Structural problems such as residential segregation cause disparities in health and health care access. People of color concentrated in residential communities of lower economic status, with resource barriers and constraints that make it difficult to provide the same quality of care you will find in higher socioeconomic communities. This makes it difficult to access quality health care for people of color, so while we rebuild and renovate communities, the system has not considered the way in which this often excludes major communities from accessing health care.
If you look at the number of uninsured, non-Medicaid eligible people living with HIV has steadily grown, funding for the Ryan White CARE Act has barely increased over the last six years. As a result, states are creating waiting lists or imposing other cost containment measures for access to medical care and the AIDS Drug Assistance Program, which serves as a lifeline for people living with HIV. In the new administration, we need to reconsider excluding Ryan White from the overal treatment picuture and it must be fully funded. Communities of color affected by HIV also have an urgent stake in broader health care reform efforts; universal access to health care is a human right which recognition in U.S. law is long overdue.
Yes, I see your point, but note that I spoke of behavioral determinants before diets. Those determinants actually also include environmental determinants which predispose some communities more than others. There is a lot that needs to be done but the diet is and will always remain a large part of our dilemma. I was raised in Europe and the Caribbean, where we do eat but not to just stuff ourselves. While in the US, I have never seen another place with such huge portions that two people can really eat. On top of that we do not teach our children to eat to be satisfied, we teach them to get stuffed and that is not necessarily good for our digestive system. Many doctors will tell you that eating smaller portions on a regular basis may actually be more beneficial and more nutritious than eating two or three huge portions and get so stuffed that you cannot move.
I also believe that we have created an environment where our children cannot enjoy the outdoors as much as the indoors with a Wii game infront of the television. Although the game does require a bit of physical activity, I cannot imagine that regular physical activity can be replaced by a game played on TV. Socializing is cut out and causes people to become more self directed. For young children this is not healthy, just my opinion. Why create games that no longer require youth to socialize and thereby cut out the influence a healthy social environment? We have a lot of work to do but I still contend that diet is an important part of our reason for this epidemic. People do not need sugar to be physically active.
Let's not forget that there is more to health than healthcare. We need to move beyond the conversation of medical care and affordability and personal responsibility and access and coverage. All of these are important but these are not sufficient. Citizens also need to think of living and working conditions and homes and communities and opportunities and resources to broadly address the problems of inequalities we see in communities across the country. Racial and ethnic differences in health outcomes exist and they are not being addressed but they are real. a Simple card will not erase those differences. The MacArthur Network on Socioeconomic Status issued an important report on facts on socioeconomic status and what you can do to improve health.The Unnatural Causes Series is another source for community leaders and can use to provide resources to address health, not simply access to care. Healthy communities are about more than just health care and each policy that affects health is a health policy, which means that we have a wide range of stakeholders to work with, not just the health care industry.
The Yonkers housing intervention also showed that improving neighborhood quality led to improved health. There are also studies from outside the United States that showed the same thing. There is also evidence that reducing poverty, improving living standards, enhancing income with no health intervention leads to improved health. A study done, very carefully done experimental design in the 1970s showed that providing mothers additional income led to improved birth weights for their children. A natural experiment found that providing American Indian households additional income led to improved outcomes for their children.The New Hope experiment in Milwaukee, Wisconsin also found that by providing additional income to households helping them to improve their living standards led to improvement in both educational and health outcomes. The Conditional Cash Transfer program from Latin America also document that providing low-income communities and households additional income leads to improved health for income. So we have evidence.
There is good research now from the Movement Opportunity Program, for example, that randomized families that found that improving neighborhood quality with no intervention in health led to improved health. The Yonkers housing intervention also showed that improving neighborhood quality led to improved health. There are also studies from outside the United States that showed the same thing. We also have evidence that reducing poverty, improving living standards, enhancing income with no health intervention leads to improved health. A study done, very carefully done experimental design in the 1970s showed that providing mothers additional income led to improved birth weights for their children. A natural experiment found that providing American Indian households additional income led to improved outcomes for their children.
Recently D. A. Garcia and D. Williams published a paper in which they looked at the impact of segregation on poor kids in the United States. They asked a simple question. What percentage of Black and minority kids live in worst conditions than the worst of White kids? To decide the quintile of White kids that did worst in residential conditions, found in all metro areas studied, 76-percent of African American kids and 69-percent of Latino kids were doing worst than the worst-off White kids in the United States. These levels were even higher in highly segregated metropolitan areas. So Transition Team, what can we do about segregated areas, about equality of poor life in areas?
At the NIH Summit on Health Disparities, Dr. Wiliams actually discussed the fact that geography is a huge predictor of opportunity in American society and a huge predictor of health outcomes. A closer look at Indian reservations and by looking at the high levels of residential segregation in the United States, you will see that in 2000, most of America’s major cities were only slightly less segregated than South Africa was on the legally mandated apartheid in 1991. Environmental segregation matters. David Cutler and his colleagues showed that if we could eliminate the effect of segregation in the United States, you would completely wipe out racial, namely Black/White differences in income, in education, and unemployment, and reduce Black/White differences in single motherhoods by two-thirds, all of that driven by residential segregation. William Julius Wilson and Robert Sampson concluded that the worst urban context in which Whites reside in the 171 largest cities in the United States is considerably better than the average context of Black communities.
We have to also address the disparities currently existing between socioeconomically diverse groups further fueled by racial and ethnic differences, something very few have addressed here if at all. Dr. Wiliams at Harvard University spoke very eloquent when he stated that investments in early childhood programs have decisive benefits for the wellbeing, the educational performance, the educational success of children as well as for their health. There’s growing body of evidence that shows that the brain circuits in fetal and early childhood periods are affected by exposure to stress. When infants are exposed to toxic stress, there’s damage to the brain architecture that makes them incapable of functioning, of learning well, of achieving the socioeconomic status that will put them on a path of good health. So when a child can’t read in grade one, it’s not that child just has behavioral problems but his/her brain has been damaged by the toxic stress that he has faced. We can do more to reduce the stress that children face.