Press Release

New CDC report identifies state-by-state gaps in health risk factors for racial and ethnic groups

CDC's first state-by-state look at risks for chronic diseases and injury for the five major racial and ethnic groups identifies wide disparities, even among members of the same racial and ethnic group living in different states. The report confirms earlier reports that most racial and ethnic groups, including African-Americans and Hispanics, have more health-risk behaviors, and utilize preventive services less often.

"For the first time, states will be able to identify health gaps between racial and ethnic groups and also compare their overall state experience with that of other states," said CDC Director Jeffrey P. Koplan, MD, MPH. "Most of the risk behaviors associated with chronic diseases and injury can be changed through more effective state and local public health programs, more encouragement from health practitioners for their patients to reduce harmful behaviors and adopt healthier ones, more counseling on preventive measures from public and private health care facilities and insurers, and more convenient ways to access preventive services. States can use these new data to develop and evaluate programs to reduce the health risks of all racial and ethnic groups."

Since February 1998, the Department of Health and Human Services has led a Clinton Administration initiative to eliminate racial and ethnic health disparities in six key areas of health by the year 2010: infant mortality, diabetes, cardiovascular disease, HIV/AIDS, cancer, and adult and childhood immunization. President Clinton has asked Congress for $400 million over five years to fund a variety of prevention, education and outreach activities to address these disparities in communities throughout the country.

Identifying and tracking health gaps between racial and ethnic groups and state by state are important in part because of predictions that the minority population in the U.S. is predicted to increase. In 1970, people in racial and ethnic minority groups accounted for 16% of the U.S. population. By 1998, that proportion was 27%. By 2050, racial and ethnic minorities will account for nearly half of the U.S. population.

Besides collecting data about racial and ethnic health disparities, CDC is working to prevent and reduce them through the Racial and Ethnic Approaches to Community Health (REACH 2010) program, part of the President's racial disparities initiative. In September 1999, CDC awarded $9.4 million to community coalitions in 32 states to address the six priority areas in the initiative.

Examples of the gaps in health risk behaviors and use of preventive screening between the races and ethnic groups include:

• Blacks, Hispanics, and American Indians or Alaska Natives were more likely than whites or Asians and Pacific Islanders to report fair or poor health status and obesity. Obesity can contribute to coronary heart disease, stroke and diabetes.

• Hispanic women were less likely to have had a recent mammogram and clinical breast exam at the recommended time interval than black women or white women. Percentages for black and white women were very similar. Mammography is the best available method to detect breast cancer in its earliest, most treatable stage.
  
• Among all groups, American Indians or Alaska Natives were most likely to report cigarette smoking. Smoking can cause chronic lung disease, lung cancer, coronary heart disease, and stroke and is also associated with increased infant mortality.
  
• More than a quarter of Asians and Pacific Islanders reported no leisure-time physical activity. Regular physical activity substantially reduces the risk of coronary heart disease, colon cancer, and high blood pressure and may reduce the risk of diabetes.

More research is needed to understand differences by state in risk factors for the same racial and ethnic groups. It should be noted that racial and ethnic categories are made up of people from different parts of the world and different cultures; widely varying socioeconomic status and education levels likely account for some of the differences.

The report notes that improvements in risk factors that lead to chronic diseases and injury can be achieved by all racial and ethnic groups. In the early 1980s, use of mammography was low among women, particularly black women, but the number of women who received timely screening for breast cancer doubled between 1987 and 1992, and the gap between whites and gaps almost disappeared.

"I'm extremely hopeful that the release of these data will serve as a springboard for new studies that get closer to the true causes of racial and ethnic differences in health," said Walter W. Williams, M.D., M.P.H., CDC's associate director for Minority Health.

Examples of state-by-state variation from the report, "State-Specific Prevalence of Selected Health Behaviors, by Race and Ethnicity_Behavioral Risk Factor Surveillance System, 1997," include

• 7.9% of Hispanics in Georgia reported not being able to see a doctor because of cost compared to 30.1% of Hispanics in Arizona
  
• 13.0% of American Indians or Alaska Natives in California were obese compared with 32.3% of that population in Washington State
  
• 17.8% of blacks in Minnesota reported no leisure-time physical activity in the last 30 days compared with 54.6% of blacks living in Kansas
  
• 14.3% of whites in the District of Columbia reported high blood cholesterol compared with 35.2% of whites living in Illinois
  
• 9.4% of Asians or Pacific Islanders in Oregon reported not always wearing a safety belt while driving or riding in a car compared with 27.4% in Minnesota

A cross-section of HHS agencies are conducting activities to address disparities: an internal workgroup has been organized in each of the six health areas that are the focus of the health disparities initiative; a Spanish-language campaign to encourage more Hispanic families to get their children immunized was unveiled last year; more than 250 grants have been awarded to Native American communities for programs to prevent diabetes, and $156 million was targeted last year to improve HIV/AIDS prevention and treatment in minority communities; and HHS is asking Congress for $20 million in fiscal year 2001 to establish a coordinated center for health disparities research within the Office of the Director at the National Institutes of Health. The department has also opened a web site devoted exclusively to racial and ethnic health disparities, at http://www.raceandhealth.hhs.gov.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES