While opponents of the historic health care law continue to try to derail the policy in federal courts, the Obama administration is moving ahead with its implementation. This week the National Prevention Council of the Office of the Surgeon General in the U.S. Department of Health and Human Services (HHS) released its National Prevention Strategy, a comprehensive roadmap to promote and secure the nation’s health and wellness. The report focuses on four critical areas: Health and Safe Community Environments, Clinical and Community Preventive Services, Elimination of Health Disparities and Empowered People. Driving the strategy is the goal of increasing the number of Americans who are healthy at every stage of life. For Black Americans, the strategy raises important considerations as Blacks’ high health costs are driven by disproportionate incidence of chronic illnesses that are driving health care disparities.
The National Prevention Strategy was released just days before the National Institute for Health Care Management (NIHCM) released a data brief, Understanding U.S. Health Care Spending. One of the key and most alarming statistics cited in the NIHCM brief is that 5 percent of the nation’s population is responsible for almost 50 percent of health care spending. One of the key drivers of health care costs is rates for chronic diseases, some of which – obesity, diabetes, asthma, hypertension – are prevalent in the Black community. The brief notes that the nation spent $2.5 trillion on health care in 2009, an amount equal to $8,086 per person, the highest total in our nation’s history. Of the latter per-person spend; approximately 84 percent ($6,800) went to personal health care services and products. Chronic conditions are driving up health care costs, and the NIHCM brief points to data that indicate people with at least one chronic illness are two to four times more likely to have spending among the ranks of the top 5 percent in the nation.
The National Prevention Strategy addresses the lack of accurate information that is culturally and linguistically appropriate, and easily understood. The dearth of information for easy public consumption contributes to the lack of attention to health care needs, the treatment of illnesses and consequently the incidence of negative health outcomes. The document makes clear that “providing services and information in ways that match patients’ culture, language and health literacy skills also can improve patients’ trust, facilitate adoption of health behaviors, and increase future use of health services.” The report also notes the connection between education, employment and health, and how discrimination and unfair treatment in the workplace can increase “blood pressure, heart rate and stress, as well as undermine self-esteem and self-efficacy.”
The National Prevention Strategy is candid about the differences in health outcomes across subgroups of the population, noting that 14% of African-American adults are in fair or poor health. It raises several key facts, including:
Low-income and minority neighborhoods are less likely to have access to recreational facilities and full- service grocery stores and more likely to have higher concentrations of retail outlets for tobacco, alcohol and fast foods.
Low-income and minority populations are at increased risks of being exposed to pollution. As a result, they face higher risks for poor health outcomes, such as asthma.
Coronary heart disease and stroke account for the largest proportion of inequality in life expectancy between whites and Blacks, despite the existence of low-cost, highly effective preventive treatment.
To address these conditions, the National Prevention Strategy suggests a greater focus on communities at greatest risk and a focus on community-based approaches that are driven through collaboration between community leaders, group members, and organizations. In addition, the report recommends an increase in the capacity of health care workers to identify and address disparities, suggesting a mobilization of forces – education, labor, public safety and more - across communities in partnership with health care workers. The National Prevention Strategy calls for support for research to identify strategies to eliminate health disparities and standardizing the collection of data on health care disparities.
The National Prevention Strategy calls for a number of action steps to reduce the nation’s health care disparities, including the support of cross-sector activities to increase access to education, jobs, economic opportunity and improvements in quality of life; such as access to safe neighborhoods and grocery stores. In addition, the report calls for a realignment of resources to meet the needs of communities that experience health disparities, and the development of community-based interventions to improve health outcomes. Significant in the plan’s focus on solutions is the call for partnerships between a wide-range of groups, including businesses and employers, health care systems, educational institutions, community and faith-based groups, and individuals and families; an acknowledgement that a holistic approach must be pursued if the health of communities of color is to improve.