On February 21, 1998, former President Clinton committed the nation to eliminate racial and ethnic health disparities in 6 areas by 2010:

1. Infant mortality

2. Cancer screening and management

3. Cardiovascular disease

4. Diabetes

5. HIV infection/AIDS

6. Immunizations

This year represents the halfway mark of this objective. So, how are we doing?

While progress has been made, there are still tremendous disparities. In July 2003, the US Department of Health and Human Services Agency for Healthcare Research and Quality produced a National Healthcare Disparities Report (NHDR). While initially distributed under controversial auspices, the full, original report was made available in February 2004. According to the NHDR:

* African Americans still experience infant mortality rates at nearly 2.5 times higher than those of Whites.

* Minorities and persons of lower socioeconomic status are still less likely to receive cancer screening services and more likely to have late stage cancer when diagnosed.

* Many minorities are still less likely to receive screening and effective treatment for cardiovascular disease risk factors.

* Those who suffer from diabetes and are of lower socioeconomic status are still less likely to receive recommended diabetic services and more likely to be hospitalized for diabetes and its complications.

* Minorities and people of lower socioeconomic status are still more likely to die from HIV, and minorities now account for a disproportionate share of new AIDS cases.

* Minorities and persons of lower socioeconomic status are less likely to receive recommended childhood and adult immunizations. If hospitalized for pneumonia, these groups also suffer a poorer quality of care.

The NHDR defines disparity as "the condition or fact of being unequal, as in age, rank, or degree." The report also provides a list of synonyms: inequality, unlikeness, disproportion, and difference. These terms are lacking, inadequate, insufficient, and just plain wrong. How can we call it a disparity when African American women die from breast cancer more often than White women? How can we call it a disparity when Vietnamese American women die from cervical cancer at a higher rate than any other minority and higher rates than the majority population? How can we call it a disparity when Hispanic Americans are nearly twice as likely to have diabetes as non-Hispanic Whites, and how can it be a disparity when African American and Native American babies die of Sudden Infant Death Syndrome two and three times more often than any other racial group? These are not disparities. Here in the United States, where we have one of the most technologically advanced health care systems in the world, these are not disparities. Here in the United States, where we spend more on health care than any other nation in the world, these are not disparities. Here in the United States, where spending on research by the National Institutes of Health exceeds the Gross National Product of most other nations, these are not disparities.

These are disgraces.

So, what must we do? If we are to eliminate these disgraces, we must look deeply and honestly at them. We must go into the places that make us uncomfortable, places we may not want to go. Our efforts must be more than mere window dressing. We must do the work that will change the way we think, the way we act, the way we live, and the way we die.

If we are to eliminate these disgraces, we must work with communities-not on them. One of my favorite Nursery rhymes is Humpty Dumpty. You know [horizontal ellipsis] "Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the King's horses and all the King's men could not put Humpty together again." Well, nobody asked Humpty!! It is only when we work together as individuals, as communities, as organizations, and with government that we can eliminate these disgraces.

These are not problems we can fix with a Band-Aid, or with a nurse or a physician. It is going to take a nurse and a physician. It is going to take other health care providers. It is going to take a teacher and a preacher. It is going to take people who work for a living and people who work to live. It is going to take prescription medications, transportation, good housing, and livable wages. It is going to take all of us. This may be a big dream, but without dreams there is little hope. And without hope [horizontal ellipsis] there are only disparities.

This issue of Family & Community Health, (FCH 28.1), looks at efforts directed at working with communities to reduce these disgraces. These efforts are a good start. But we have more work to do.