CDC News Conference Transcript

A Closer Look at Racial/Ethnic Health Disparities
Focusing on Heart Disease and HIV/AIDS

February 6, 2004

DR. GERBERDING: Good afternoon.

We really welcome you to this overview of health disparities and we appreciate all the media who have come out to participate in this event. Our nation has a road map for protecting people's health that gets updated every 10 years and that's a road map called Healthy People 2010.

The road map has really only two goals. One is to protect people's health so that they can live the longest possible healthy life and the other is to eliminate health disparities. It's a great pleasure for me to be here today and to participate in this panel of people who are especially knowledgeable and who are hoping to reach out and provide a perspective on some of the most important categories of health disparities that we as a nation face.

CDC is extremely committed to addressing health disparities. We have many programs throughout our agency that are taking on these issues in very visible ways, and I personally am also very committed to health disparities.

We have wanted to make this a much bigger focus for our entire agency and one of the things that we've done is to establish one of our senior staff meetings every month, where we gather the leaders of the entire agency together, we assemble them in the auditorium in an open meeting that anyone can participate in, and we go center by center, highlighting one particular program a month that is addressing health disparities in a direct way and identifying what lessons can we learn from that and how can we utilize those lessons to improve our programs across the board.

This has already proven to be successful and has illuminated some of the areas where we've had successes and also, unfortunately, some of the areas where we have a lot more work to do.

So we are committed and it is in that spirit that we're very pleased to take the next step forward in our communications strategy to do a much better job of reaching out to the media that specifically serve minority populations and others that are affected by health disparities.

I'm very pleased also today to be standing here in a red dress, because you know that today is National Wear A Red Dress Day, a time for Americans to appreciate the millions of people whose lives are lost every year, particularly the millions of women whose lives are lost every year because of cardiovascular disease.

Cardiovascular disease is an area where there are prominent health disparities. There's a gender disparity in that women are less often diagnosed with heart disease when they have it and their treatment is sometimes less aggressive as a consequence.

In addition, they have a high mortality rate from cardiovascular disease, and in addition there are racial and ethnic disparities in cardiovascular disease.

For example, African-American women, as you'll hear, have a much higher rate of disease and a higher morality rate.

So I'm very honored to participate in the National Wear A Red Dress Day, to commemorate not only the importance of the illness and our awareness of it but also as a symbol of my own personal commitment to addressing those disparities.

CDC has taken some giant steps forward in its communication program in the last couple of years, building on some of the lessons that we've learned form the anthrax attacks as well as coming to grips with the new normal of the world in which we live, that world of globalization and connectivity and speed, and clearly a major focus of communications has to be the media.

We have been very appreciative of the interest that the media has shown in many of the emerging health issues at CDC but one of the challenges that we have is engaging people's interest in chronic health problems like cardiovascular disease, or in the diseases that don't loom large on the list of emerging infections, like SARS and influenza.

So your participation today in this outreach is a very important step forward for us.

We intend to do a much better job working with special media to provide messages that specifically target your audiences and really take advantage of the fact and respect the fact that you are there at the grassroots level really delivering information to your constituents in the way that has the most meaning for them.

We, as a government agency, can't always translate information in the most effective strategy and we're very grateful for your interest in this issue and particularly the role that you will play in helping us do a better job in reaching all of the people in our country.

So I really appreciate your being here and I look forward to learning from the comments of the other panelists. Thank you.

MS. HUNTER: Thank you, Dr. Gerberding.

My name is Karen Hunter with CDC’s division of media relations and I am going to be moderating this telebriefing today.

We're going to begin now with our panel of speakers, and following each speaker's remarks we'll open it up for questions about that particular topic.

At the conclusion of the briefing we'll open it up for questions to any of our three speakers.

Our first speaker today is Dr. Walter Williams, associate director of CDC's Office of Minority Health.

Dr. Williams will be presenting an overview of health disparities among various minority groups in the United States.

Dr. Williams.

DR. WILLIAMS: Thank you very much, good afternoon and welcome.

The setting today in the United States is one of longstanding health disparities among the leading causes of disease and death and this is despite notable progress in the overall health of the nation.

There continues to be disparities among blacks, Latinos, American Indian, Alaska natives, native Hawaiians and other Pacific islanders.

This is not a new issue. Health disparities in health status and access were first described by the university-trained African-American physician in 1859, when he asserted that the poor health status that existed among African-Americans compared to Caucasians at the time reflected social and environmental conditions related to racism and not related to genetic difference as was proposed then.

After 1950, there'd been considerable gains in health status that have been documented in the United States among racial and ethnic minority groups.

However, racial disparities in health have changed little since then. In fact in many health areas, the statistics that we've provided you show that the gap has actually widened for some health indicators.

Now CDC is working vigorously to eliminate racial and ethnic disparities in the six health status areas that have been identified by the Department of Health and Human Services for priority action.

We worked through our model, our planner model of public health research, and carrying out that public health research in a number of our CDC programs.

CDC applied our public health research model in designing and carrying out racial and ethnic approaches to community health project, Reach 2010, which many of you I'm sure are familiar with.

The CDC model for public health research involves identifying risk and protective factors associated with illness, disability, injury and death, designing responses, public health policies and intervention, evaluating the effectiveness and applicability of those interventions in communications and then disseminating those interventions widely in other affected populations.

As you know, Reach 2010 supports community coalitions in designing, implementing and evaluating community partnered and community-driven strategies to eliminate health disparities.

The demonstration component is identifying, as we speak today, innovative prevention and service delivery interventions to reduce disparities in health among the target groups.

The demonstrations hopefully will set the stage for sustainable effective programs in the communities where these projects are currently being implemented.

Currently there are 37 Reach 2010 projects nationally serving the key racial and ethnic populations, and some of the promising strategies that are being employed in Reach 2010 and other CDC programs include these that I'll mention to you today.

With regard to HIV/AIDS projects are improving recognition of risk, detection of infection, referral to follow-up care, and assurance of proper treatment through culturally appropriate programs.

Cancer, in a broad way, we try to help individuals to modify their lifestyles, to reduce individual risk for cancer, and that means reducing tobacco use, improving diet and nutrition and improving early detection, treatment and follow-up for the various cancers.

Women, as we know, can reduce their risk of dying from cervical cancer by receiving regular PAP tests, effective treatment and follow-up.

With regard to diabetes, we're trying to help individuals to increase healthy diet and modest physical activity, maintain effective treatment and increase efforts on diabetes self- management.

There are a number of very active community projects that have intensive outreach and education programs that target those specific things.

Cardiovascular disease and stroke, Mr. Mensah, a panelist today, will talk in more detail about that, but our efforts in general promote reduction of risk factors important for cardiovascular disease, stroke morbidity, and these include controlling high blood pressure, high cholesterol, cessation of tobacco use, decrease in excessive body weight, and obviously increase in physical activity.

Adult immunization is another important area. Every year, thousands of Americans die from influenza and pneumococcal infections which are infinitely preventable through current vaccine technology.

CDC now is promoting effective provider-based interventions, increasing community demand, enhancing access to services through special projects that are being implemented and encouraging vaccinated-related efforts in nonmedical settings.

Infant mortality is another important index of how well we are improving the health of Americans. We're working hard with health care experts and communities to avoid unintended pregnancies and prevent pre-term deliveries, assure healthy births, and maintain infant health in general. We're trying to educate communities and providers about the behaviors and conditions that actually affect birth outcomes, such as smoking, substance abuse, poor nutrition, expanding information on SIDS awareness through campaigns, and also trying to increase access to prenatal care.

One of the keys to our success will be promoting health through what we consider to be effective communication channels that serve the communities that we're trying to reach, and that involves our communicating with you. We realize that if we're going to be successful in this campaign we must have effective communication, must get the message out consistently and effectively to all of the communities that we're trying to target.

Thank you.

MODERATOR: Thank you, Dr. Williams. Do we have any reporters in the room that have a question for Dr. Williams?

[No response.]

MODERATOR: How about on the phone?

[No response.]

MODERATOR: Then we will move on to our next speaker. As I said at the beginning of this briefing, you will have an opportunity to ask questions of all three speakers at the conclusion. So if something occurs to you between now and then, you'll certainly have another opportunity.

Our next speaker is Dr. George Mensah, and I'm going to spell his last name for those of you who are on the phone. It's M-e-n-s-a-h. Dr. Mensah is Chief of the Cardiovascular Disease Branch at CDC's National Center for Chronic Disease Prevention and Health Promotion. As most of you know, February is American Heart Month, and Dr. Mensah is here to talk about heart disease among African-Americans.

Dr. Mensah.

DR. MENSAH: Thank you very much. I really would like to express a very sincere appreciation for the time you've taken to help us celebrate Heart Month, and in particular the work of our partners, the American Heart Association, but also at the federal sister agency, the National Heart, Lung and Blood Institute.

As Dr. Gerberding mentioned, and also mentioned by Dr. Williams, heart disease is really very, very important, and it's very, very important in the African-American community. I would just mention about six or seven key facts that for us really summarize the importance of this condition.

Heart disease remains the leading cause of death in African-American women. In fact, this year heart disease will kill more women than men, and if you look at the history, since 1900 heart disease has been the leading killer every year, year after year with the exception of 1918 when the influenza epidemic killed more people. It is a major clinical and a major public health burden. It's also the leading cause of death in African-American men, and a large number of African-American men will die prematurely from heart disease this year. The unfortunate thing is most of these deaths are preventable. We have very tremendous and very compelling science as to what to do to prevent this.

But death is really not even only the major problem. If you look at disabilities, heart disease is the leading cause of premature, permanent disability in the labor force. For young African-American men and women in the workforce, heart disease is the major cause of disability. These are very important conditions that really must be addressed.

If you look at disparities that were mentioned already, heart disease, together with stroke, when considered as cardiovascular diseases, account for the largest portion of the difference in the life expectancy between black women and white women and black men and white men. In fact, cardiovascular diseases alone account for about a third of all the years of difference in the life expectancy in African-Americans and whites. And any steps that are taken to address heart disease really helps us in accounting or in helping to eliminate these disparities.

What's very disturbing though, that the major risk factors that we've spent a tremendous amount of research effort in identifying, their trends are really not improving in terms of obesity, in terms of high blood pressure, in terms of diabetes, in terms of--if you look at most of the major risk factors that we know we can effectively address, we really are not doing as well as we ought to, and that's why it's really important to pay attention to these.

The good news is that these risk factors can be prevented in the first place, and in persons who already have these risk factors, for example, African American women with high blood pressure, there are safe and effective medications that can get the blood pressure controlled, and in fact in a proportion of persons they may not even need to take medications, that lifestyle changes can effectively reduce blood pressure.

We're working very hard, in cooperation with all the states, and in particular in about 33 states that receive funding from us, to address the prevention and control of heart disease and stroke, and we have two overarching goals, importantly, increasing the years of healthy life as Dr. Gerberding mentioned, but also eliminating disparities.

So we're really very pleased that you've taken the time to help us make sure the message gets out, that heart disease is a leading killer, is a leading cause of disability, is a major cause of disparities, and we need to seriously address. Thank you.

MODERATOR: Thank you, Dr. Mensah.

So we have any questions in the room for Dr. Mensah.

Any questions on the phone?

If not, we’ll move on to our next speaker, and again, you will have a chance to ask questions of all three speakers at the end of the briefing.

Our final speaker this afternoon is Dr. Hazel Dean who is the associate director of Health Disparities at CDC's National Center for HIV, STD, and TB Prevention, and Dr. Dean is here to talk about the impact of HIV and AIDS on the black community.

Dr. Dean.

DR. DEAN: Good afternoon.

I'd like to thank you for being here with us today. You are helping us put out the message on various diseases that impact racial and ethnic minorities in a very disproportionate manner.

Tomorrow marks the fourth annual National Black HIV/AIDS Awareness Day, a national effort to mobilize African Americans to get educated, get tested, and get more involved in the fight against HIV.

The need to take action could not be more urgent.

Today, more African Americans are living with and dying of AIDS than members of any other racial or ethnic group in the United States.

In 2002, the most recent year for which national statistics are available, African Americans accounted for 54 percent of all new HIV diagnoses.

That year, the rate of AIDS diagnosis among African Americans was more than 10 times the rate among whites.

In 2002, African American women accounted for 64 percent of new HIV diagnoses. The AIDS diagnosis rate for African American women was 23 times higher than the rate among white women.

That same year, African American men accounted for 41 percent of new HIV diagnosis among men.

The AIDS diagnosis rate among African American men was nearly nine times higher than the rate for white men.

A recent study of men aged 23 to 29 years shows that 32 percent of African American men who have sex with men were found to be infected with HIV, compared with 14 percent of Latinos and 7 percent of white men.

91 percent of these HIV-infected black men in the study did not know they were infected.

Chances are that African Americans, more than whites or Latinos, know someone, a relative, a neighbor, or a family friend who has died of AIDS. Maybe that's because AIDS is the leading cause of death for African American women age 25 to 44, and for African American men age 25 to 54.

From 1998 to 2002, the estimated number of AIDS diagnoses decreased 12 percent among whites but actually increased slightly, 2.5 percent among African Americans.

During the same time period, estimated AIDS deaths dropped 27 percent among whites but only 6 percent among blacks.

For African Americans, certain factors further fuel and complicate the struggle against HIV. Nearly one in four African Americans live in poverty and rates of sexually-transmitted diseases are as much as 24 times higher for African Americans than for whites.

While numbers like these might seem all too familiar, they are not acceptable.

National Black HIV/AIDS Awareness Day reminds us that we have the power to strike back.

Prevention, including testing, remain key elements for curtailing the spread of HIV among African Americans and getting tested is the essentially first step in turning the tide.

Early testing means that people who are HIV positive can take advantage of treatment to stay healthy longer and can take steps to protect their partners from infection.

Unfortunately, African Americans are more likely than whites to get tested late in the course of HIV infection, while life-extending antiretroviral treatments may no longer be as effective, and after they may have unknowingly transferred HIV to someone else.

Deciding to get tested can be emotionally challenging but a new type of test can make it easier.

This rapid HIV test can provide preliminary results in 20 minutes, eliminating the long anxiety-filled process and time associated with older tests.

Finding a local testing center is only as easy as going to www.hivtest.org, or calling CDC's national AIDS hotline as 1-800-3428.

People who have negative test results can take steps to stay healthy and uninfected. Those who learn they're HIV positive might have hope too; also have hope.

Many community networks provide the support, care and services they need to stay healthy.

New data tells us that people who receive their HIV diagnosis early may be able to live for many years after diagnosis, perhaps a normal life span, but only if they get the right medical care. A faster HIV test is just one part of the solution.

To overcome barriers to HIV testing among African-Americans we need to work towards ending the stigma associated with AIDS. That means more than having compassion for people with the disease. It means speaking out on their behalf and talking about AIDS with your family and friends.

The CDC is acting aggressively to stop the spread of HIV among African-Americans by working with local partners to implement and sustain prevention for those at risk. We're also working with health care providers to ensure that they counsel, test and treat patients who are at risk for HIV, and incorporate prevention interventions into the care for those who are HIV position.

As Director of the National Center for HIV, STD and TB Prevention's new Office of Health Disparities, I'm committed to addressing inequities in public health. With HIV and AIDS, there's not a moment to lose.

MODERATOR: Thank you, Dr. Dean.

And now we'll take a call from the phone for Dr. Dean.

OPERATOR: Mr. Adam Lynch, from the Mississippi Link Newspaper, your line is now open.

QUESTION: How are you doing? This is a question that could go to Dr. Mensah or anyone could probably answer this one for me. A number of minorities have problems with getting health insurance or just paying for preventive medicine. A lot of people don't want to spend that money to look for polyps when they could use that on a bill.

Aside from just adopting a system of socialism, how can we go about dealing with this?

DR. MENSAH: Your question is a very important one. I don't think I can adequately answer except to reinforce what you said. We can continue to give advice to people to take medicines for their blood pressure and to do all the right things, but if they're not insured and they're not in the system, they definitely don't benefit from it.

And so having some mechanism of addressing the uninsured population is going to be very crucial. It's just as important as having other policies that would enable people to do the right thing, even something as simple as telling people to eat the right foods. If they live in the part of the neighborhood that doesn't have access to fresh fruits and vegetables, they're just not going to be able to do that. The same as talking about high blood pressure and the importance of exercise. Even though it doesn't involve money or it doesn't involve insurance, if they live in a neighborhood that doesn't have safety, it would not make sense to go out and walk.

So I think as we talk about the science and do our best to translate the science into practice, we also have to address the policies that would make it easier for patients to follow the instructions that we give.

MODERATOR: That was Dr. Mensah, by the way, who answered your question.

Do we have another call on the phone, another question from a caller on the phone?

OPERATOR: Mr. Todd York from Indians.com, your line is now open.

QUESTION: Hi. This question is to the third speaker. I missed her name because I was leaving my name on the question line. And so I have a question for you about both HIV and other STDs. Has the CDC noticed any sort of I guess HIV or STD clusters in either--with American Indians, whether they're in reservations or even urban populations here within the past couple years?

DR. DEAN: No, I don't believe that we have any reports of clusters in Native American populations, either in urban areas or in reservation areas.

MODERATOR: Do we have a question from the room? Yes?

QUESTION: Stan Washington, Atlanta Voice Newspaper. This is for Dr. Williams. How do I phrase this question? Are African-Americans the sickest group in America? I mean, based on what I've been hearing in terms of the statistics compared to Caucasians, not really having been compared to other minority groups, but it just sounds like with all the heart disease, the AIDS rates going up an diabetes, et cetera, et cetera. I mean is the overall health of African-Americans really that bad?

DR. WILLIAMS: The quick and dirty answer to your question would be to say yes, but it really varies with respect to the specific health indicator that one might look at. I'll give you some examples.

For example, life expectancy, probably one of our most fundamental measures of health, shows a disparity on average for blacks living nearly seven or more years less than whites or other groups. Infant mortality rates are more than twice as high for African-Americans, but SIDS deaths among American Indian and Alaska natives are also three to four times the rate for white Americans. So there's an example of another race ethnic group that actually has a higher rate than African Americans.

If you look at something like cervical cancer, Vietnamese women, for example, suffer from cervical cancer at nearly five times the rate than white women, and that's much higher than the rate that occurs in African-American women. But African-American men, however, suffer from prostate cancer at nearly twice the rates for whites, but Hispanics also have a higher rate of a type of cancer, stomach cancer, where their rates for stomach cancer are two to three times higher than other race ethnic groups.

So when you asked that question you really--if you look at overall health indices, in general African-Americans overall may find themselves worse off in general, but if you start looking at very specific health status indicators, it varies by race and ethnic group as I've described to you.

QUESTION: What areas do you see African-Americans making improvements in terms of health? Are there any areas at all?

DR. WILLIAMS: Yes. In general during the past decade there has been steady improvement in the health status indicators. For example, for breast cancer screening right now the rate for mammography among African-American women receiving mammography is about equal that of whites. However, there still is a discrepancy in rates of death from breast cancer, and that often African-American women present late in the stage of cancer, and because of late diagnosis they have worse outcomes as far as treatment, and are more likely to die.

There have been steady improvements in the rates of lung cancer in all race ethnic groups, although some groups have improved at a faster rate, and therefore the gap, for example, between white men and African-American men remains fairly large, although there have been steady declines in the rates of lung cancer in all groups in the--there are many other examples that are similar. In general, a declining trend overall, but still maintain a fairly substantial gap between African-Americans, some other groups, compared to a referring(?) group, usually that is white American.

MODERATOR: Thank you. And we'll take a call from the phone now.

OPERATOR: Mr. Adam Lynch from the Mississippi Link Newspaper, your line is now open.

QUESTION: This is Socrates Garrett with Mississippi Link. This call is for Dr. Walter Williams. I'd like to know if he's done any research to see if the health disparity exists between African-Americans and whites with the same social-economic basis? Many times in our community, I don't believe we get the same quality in care, in health care when we are able to afford it. I believe there is an element in our society that says we're not entitled to the same health care on those bases. Have you done any research to see if this theory holds any merit?

DR. WILLIAMS: In general the single most important contributor to premature mortality, excessive rates of illness, is socioeconomic status, is poverty. And when studies have been conducted that actually, as we say, control for SES -- that is you look at the socioeconomic status in various strata and you compare people who fall in the same group. When you control for SES many of the, quote, disparities that exist between African-Americans and other groups actually disappear. However, some remain. When you look at very specific health indicators, what often is the case is that poor people in general do very, very badly compared to people who have better means or what I would call the benefits of the society.

But within the poor group, African-Americans are more likely to do less well, and often it's because of what are considered to be non-economic factors, that is, what's often talked about and what was cited in the recent March 2002 report from the Institute of Medicine. They talked about stereotyping, discrimination and other things that actually occur within the health care system itself, such as there's various differential access to preventive and treatment services by race and ethnicity. African-Americans in general are less likely to receive state-of-the-art procedures, particularly those that are considered physician referral procedures such as sophisticated cardiovascular procedures, orthopedic procedures. There's a long laundry list.

And this has to do with the practice of medicine in the United States. It's not related to SES because we're talking about folk who are directly in the system.

So the short answer to your question is, yes, SES is a very important contributor to disparities, but it doesn't answer the entire question. There is this overlay of physician practice patterns and other things that influence access to preventive and treatment services in the United States.

MODERATOR: Thank you, Dr. Williams.

Do we have any questions from the room?

[No response.]

MODERATOR: In that case I'll tell you that--I'm sorry, we do have a question from the room. Okay.

QUESTION: I don't want to hog all the questions, but I will.

MODERATOR: That's okay.

QUESTION: Stan Washington again, Atlanta Voice. Dr. Dean, you talked about receiving the right treatment for HIV/AIDS early on. Basically is there--I mean the costs for this. I mean we're talking about economic, you know, the socioeconomics of African Americans, been talking about poverty and how it affects the whole thing.

But when you're looking at getting the treatment early, I mean, how does one pay for that? How is that taken care of?

How can you go get the right treatment if you are in poverty?

DR. DEAN: There are funds available through the AIDS Drug Assistance Program as well as Ryan White Care Dollars.

A person would be tested and then with the help of the state and local health departments, then they would be routed into the system to receive care through those dollars.

QUESTION: Question for Dr. Williams.

The state health agencies, how important are they in this whole treatment of dealing with these ills?

I was listening to an interview this morning and it had mentioned a state and they were talking about HIV. I think it might have been in Alabama. I'm not sure. I don't know. Alabama may get upset at me; anything.

But it mentioned how they didn't know what to do when HIV had started spreading within the black community and the poverty, and just kind a ignored it, they didn't really know what to do with it and it became an epidemic.

So how important are these state health agencies in terms of combatting these problems that we're talking about here?

I heard mentioned working with 33 state agencies. Well, we've got 50 states, so where are the other, you know, agencies in that? I think that's my last question. I'll let you all go.

DR. WILLIAMS: State health agencies are extremely important in our battle against all of the health status areas of importance in Healthy People 2010.

The Federal Government, CDC, HERSA, NIH, all of the federal agencies and the Department of Health and Human Services have very intensive funding streams to support health agency programs.

Dr. Mensah referenced the cardiovascular program. It is not a comprehensive program in every state although CDC actually has comprehensive prevention programs in other areas, in all of the states, large cities, the territories and other areas.

For example, our STD service delivery programs, our immunization program, cancer prevention, cervical cancer and screening programs, are examples of programs that are fully funded in all 50 states.

Another important thing too that the state governments play a role in is access to care for those who are considered indigent, who actually meet the definition for Medicaid eligibility. The state definitions for eligibility determine whether many individuals actually can access, at the lowest level of the socioeconomic tree, access medical care.

In the state of Georgia right now, the state legislature's actually debating a proposal from our governor on a new definition for Medicaid eligibility that could affect access to care for thousands of Georgians, as an example.

But what the Department of Health and Human Services has done, particularly for vulnerable children, is to try to increase funds through the state health, children's health insurance program, or SCHIP [?] it's called, by increasing funding for that program that's allowed children who generally are Medicaid-eligible, many more children who generally Medicaid-eligible to actually be enrolled in that program, and actually receive basic preventive and treatment services.

Short answer, yes, state governments, state health agencies are extremely important in our battle against health disparities and in general to improve the health status of all Americans.

MODERATOR: Thank you very much. I want to let all of you know that a companion press kit is up on the Web site.

You can go to www.cdc.gov, click on the press room and it'll be the first item under featured links.

Later this afternoon, we will have a transcript of this telebriefing and of course reporters needing additional information, as always, can contact CDC's main press office at [404] 639-3286.

We'd like to thank all of our speakers for joining us today and thanks to all of you for coming to this briefing.

Thank you.

Listen to the telebriefing

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