At a White House dinner honoring the Special Olympics, President Bush stated "America at its best upholds the value of every person and possibilities of every life." President Bush added that "the story of our country is an ever-widening circle, a society in which everyone has a place and everyone has something to give."1(piii) This quote of our nation's leader serves as an interesting place to begin this issue of Family & Community Health (FCH 28.1) that focuses on the topic of health disparities.
We have all heard about health disparities. Most people have a general understanding that individuals of different cultural backgrounds have unique medical challenges and that not all people have equal access to proper medical care. To put it bluntly, every person in the United States knows that not all people in our country are receiving adequate medical treatment, and individuals from minority, as well as underprivileged backgrounds, do not enjoy the same level of health as the average citizen. It is at this point that President Bush's words come into focus; they hearken back to a prime directive of our country, that being the application of "equal treatment" to all citizens. The idea of "equal treatment," however, must, in turn, apply to opportunities for quality health care. This leads me to present the issue of health disparities from an approach centering on social responsibility and individual responsibility.
In terms of social responsibility, there is little doubt that the US Government is not ignoring the issue of health disparities. In 2000, the US Congress passed the Minority Health and Health Disparities Research and Education Act, which established the National Center on Minority Health and Health Disparities (NCMHD) as part of the National Institutes on Health (NIH). The NCMHD was structured to lead, coordinate, support, and assess the NIH research effort to eliminate health disparities as they affect ethnic and racial communities and medically underserved individuals. Just a glace at recent press releases on the NCMHD Web site reveal several sizable grants have been awarded to reduce health disparities, including a 2003 grant of more than $65 million and a 2002 grant of $85 million. Despite these positive efforts, however, the 2004 National Healthcare Disparities Report produced by the US Department of Health and Human Services Agency for Healthcare Research and Quality demonstrates that little strides have been made to actually eliminate many of the problems. So what do we do now?
With an issue like health disparities, which we know exists and which we are sure not enough is being done to rectify the problem, there are two options. First, we may say that the problem needs to be continually pressed, and if this involves calling current attempts to rectify the problem as failures or criticizing society for continuing to accept the problem, then so be it. A second, option, however, may be to resist the urge to "scream into the wind," which others like me may tend to do, and take time to compliment those that are working diligently to rectify the problem. This option, in turn, may result in increased media exposure and inspire others to act in a similar manner. I prefer to engage in the latter of these two options.
I wholeheartedly agree with Dr. Higginbotham's assertion in the foreword to this journal that the level of health disparities that exist in a country as wealthy and technologically advanced at the United States is not really a disparity, but a disgrace. Even with this understanding, however, I think we must also take time to draw specific attention to those individuals and entities that are working to eliminate health disparities, even if their efforts have not been 100% effective to date. They are the ones who have moved past the idea of "social responsibility," mentioned earlier, and taken on the issue as one of "individual responsibility."
This issue of Family & Community Health highlights several projects designed to eliminate health disparities; each of which deserve attention for their efforts. You will read about the Deep South Network for Cancer Control, an organization specifically designed, among other tasks, to develop and test innovative community-based cancer control measures to eliminate cancer mortality disparities in special populations. This issue has an article from the University of Saint Francis School of Nursing focusing on the study of health-promoting behaviors of sheltered homeless women, and a study detailing the results of a Wheeling, West Virginia, campaign to increase community activity in physical exercise. The final article examines interventions that address cancer health disparities in women. Each article also draws specific attention to the breadth of the problem of health disparities as it currently exists in the United States.
So, while I agree that health disparities is an issue that needs continued fervent attention, I also would like to join many others in recognizing several efforts that are currently ongoing to reduce this problem in our country. While there are many other noteworthy organizations and individuals attempting to reduce health disparities in this country that are not mentioned in this journal, these articles serve to both highlight the problem and to also suggest future research that can be beneficial in our quest to reduce and eventually eliminate the problem. So let us give applause where warranted, but not forget that the problem is still among us-waiting for help.
Jeanette Lancaster
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