Perspectives in Disease Prevention and Health Promotion Report of the Secretary's Task Force on Black and Minority Health

In January 1984, the secretary of the U.S. Department of Health and Human Services (DHHS) established the Task Force on Black and Minority Health in response to the national paradox of steady improvement in overall health, with substantial inequities in the health of U.S. minorities. DHHS released its Report of the Secretary's Task Force on Black and Minority Health on October 16, 1985. The report documents the disparity in key health indicators among certain groups of the U.S. population.

A comprehensive study was carried out to investigate the long-standing disparities between the health status of U.S. blacks, Hispanics, Asian/Pacific Islanders, and Native Americans compared to that of whites. To characterize the health problems of minority Americans, the Task Force reviewed existing health status information on minority and nonminority populations available in Health, United States, 1983 and other supplementary data sources (1-10). National mortality data were analyzed for more than 40 disease categories for 1979-1981. "Excess deaths" were defined as the difference between the number of deaths observed in the minority populations and the number that would have been expected if the minority population had the same age- and sex-specific death rates as the nonminority population. This method quantified the number of deaths that would not have occurred had mortality rates for minorities equaled those of nonminorities.

For each of the major causes of death identified as priority areas, the Task Force formed a subcommittee to consider and report on the etiology; associated physiologic, cultural, and societal factors; means for improving treatment; and possible intervention strategies to prevent excess deaths in minority groups. The Task Force also developed other mortality indices (such as person-years of life lost, life expectancy, and relative risk of death by cause), as well as indices of morbidity and health status for minorities (such as prevalence rates of selected diseases, hospital admissions, physician visits, limitation of activity, and self-assessed health status). It also reviewed other factors pertaining to minority health, including demographic data, health education, health professionals, and health-care services and financing.

In discharging its responsibility, the Task Force engaged consultants from the various racial/ethnic groups and others to provide additional information and perform supplementary reviews of data. It also interacted with various private organizations and associations and commissioned research papers on some issues.

The Task Force found that 60,000 excess deaths occur each year in minority populations (Table 1). Six causes of death were identified that together account for more than 80% of the excess mortality. The ranking of these health problems according to excess deaths differs for each minority population; the problems are listed here in alphabetical order, with some examples of excess mortality rates observed in different minority groups:

Cancer. Cancer accounts for 16% of excess mortality among black males under age 70 years and 10% for black females. Cardiovascular disease and stroke. Cardiovascular diseases account for 24% of excess mortality among black males and 41% among black females. Chemical dependency, measured by deaths due to cirrhosis. Cirrhosis of the liver, which is associated with excessive use of alcohol, accounts for 13% of excess mortality among Native American males and 22% among Native American females under age 70 years. Diabetes. Diabetes accounts for 38% of excess deaths among Mexican-born Hispanic females. Homicides and accidents (unintentional injuries). Homicides account for 60% of excess mortality among Hispanics under 65 years of age. Unintentional injuries account for 44% of excess deaths among male, and 30% among female, Native Americans. Homicides and unintentional injuries account for 19% of excess mortality among black males under age 70 years and 38% for those under age 45 years. For black females, the disparities are somewhat less--6% and 14%, respectively. A substantial proportion of excess deaths due to homicide and unintentional injury may be associated with excessive use of alcohol and other drugs. Infant mortality. Of excess deaths among black females up to age 45 years, death in the first year of life accounts for 35% of that excess. The relative ratio of average age-adjusted, sex-specific mortality in minority populations, compared to that in the nonminority population, by selected cause, suggests the relative importance of specific health problems within each group (Table 2).

One of the Task Force's major concerns was the quality of available data, especially on Hispanics (Tables 1 and 2). For example, for the Hispanic population, separate mortality data are only available on those who are foreign-born. Mortality data for the Asian-American population reflect predominantly the longer established subpopulations of Chinese, Japanese, and Filipino ancestry much more than recent immigrants.

The Task Force made eight main recommendations to the Secretary, each of which was followed by several specific suggestions:

1. Implement an outreach campaign, specifically designed for minority populations, to disseminate targeted health information, educational materials, and program strategies.

2. Increase patient education by developing materials and programs responsive to minority needs and by improving provider awareness of minority cultural and language needs.

3. Improve the access, delivery, and financing of health services to minority populations through increased efficiency and acceptability.

4. Develop strategies to improve the availability and accessibility of health professionals to minority communities through communication and coordination with nonfederal entities.

5. Promote and improve communication and coordination among federal agencies in administering existing programs for improving the health status and availability of health professionals to minorities.

6. Provide technical assistance and encourage efforts by local and community agencies to meet minority-health needs.

7. Improve the quality, availability, and use of health data pertaining to minority populations.

8. Adopt and support research to investigate factors affecting minority health, including risk-factor identification, education interventions, and prevention and treatment services.

Reported by Office of the Director, CDC.

Editorial Note

Editorial Note: The Report of the Secretary's Task Force on Black and Minority Health represents a significant step in the process of establishing a consensus on the major health problems affecting minority Americans. The first volume of the 10-volume Task Force Report summarizes the data on minority-health problems and recommendations to address the disparities between minority and nonminority populations. Subsequent volumes will contain a more complete discussion of selected topics prepared by the subcommittees.

Recommendations were intended to emphasize the following principles: (1) incorporate minority health initiatives into existing DHHS programs to address health conditions amenable to immediate improvement; (2) press for greater public and private involvement in a common effort to eliminate the health disparity; (3) resolve unanswered questions through a concerted program of research and data collection; and (4) seek new strategies to minimize health inequities between minorities and nonminorities. The recommendations propose activities for a coordinated effort by which DHHS may redirect some of its resources to address the demonstrated disparity in health status between minority and nonminority populations. In addition to expertise and experience in the areas studied, the senior scientists and officials from DHHS selected as primary members of the Task Force have programmatic authority that enhances the opportunity to implement recommendations of the Task Force. A special office (Office of Minority Health) has been established in DHHS to manage the implementation of the recommendations. Copies of the executive summary of the report may be requested from Health Information Clearing House, P.O. Box 1133, Washington, D.C. 20013-1133: telephone (800) 336-4797 (in Virginia: (703) 522-2590).

References

1. U.S. Bureau of the Census. America's black population, 1970 to 1982: a statistical view. Washington, D.C.: U.S. Department of Commerce, 1983.

2. U.S. Bureau of the Census. American Indian, Eskimo, and Aleut populations. Washington, D.C.: U.S. Department of Commerce, 1984.

3. U.S. Bureau of the Census. Asian and Pacific Islander population. Washington, D.C.: U.S. Department of Commerce, 1984.

4. National Center for Health Statistics. Health indicators for Hispanic, black, and white Americans. Washington, D.C.: U.S. Department of Health and Human Services, 1984; DHHS publication no. (PHS) 84-1576.

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