Two issues have concerned me for many years: have we made any real significant progress in addressing health inequities, and are we going to continue to go along to get along? These were the questions I asked myself three decades ago as I sat in LAX waiting for my red eye to wing my way back to Houston for a morning meeting. I sat there wondering if our nation truly wanted to eliminate health inequities, or have we created just another industry that relies on health to continue in order to become another employment opportunity? Today, in 2019, I find myself asking the same questions. This is not to say there are not islands of hope. Unfortunately, these islands of today are basically reinventing the wheel with better scientific tools. And what about the diversity in those addressing the science; has that really changed? Unfortunately, today, more than four decades later, I find that we have yet to make any real significant progress.

So do we all know what health disparities/inequities really are?

“They are areas where there is significant disparity in overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in [one] population as compared to the status of the general population.” Minority Health and Health Disparities Research and Education Act of 2000

Even today, compared to white Americans, the figures for African Americans have not really changed. I have chosen African Americans because the figures continue to remain at crisis level. This does not negate the issues that face other people of color as well as poor whites. I could pull similar data for others of color and even poor white Americans, but why? Hopefully, this should get your attention.

African Americans

• Still account for for nearly half of all new HIV infections

• Are still 2 times more likely to die of cardiovascular disease (heart)

• Are still 8 times more likely to contract tuberculosis

• Still have a significant increase in the death rate from cerebrovascular disease (Strokes)

• Have a 27% increase in the death rate from diabetes

• Are still three times more likely to die from Asthma related diseases

• Still have an over 30% higher incidence rate of lung cancer

• Still accounts for nearly 50% of all AIDS-related deaths!

• Still have a 31/2 year shorter life expectancy

• Still have a higher infant mortality ratio than whites; it has not changed in over 100 years and is getting worse.

• Along with Native American and Alaska Native women, African American women are about three times more likely to die from causes related to pregnancy, compared to White women in the United States.

A decade prior to sitting in LAX, I was writing Congress to create a center like no other to address the issue of health inequities. I had written grant applications through the standard funding mechanism, only to be told that the biopsychosocial approach I was proposing to address this issue was not real science. I once wrote back to a review committee, paraphrasing Albert Einstein, saying how can one expect an intelligent review from a panel of individuals who benefit from the problem? It is in the vested interest of the beneficiary to continue the situation.

In March 2008, an article produced by the American Medical Association stated, “we have not made any significant gains in reducing health disparities over the past two decades.” About the same time, a report by researchers at John Hopkins University and the University of Maryland indicated that the impact of health disparities in one four-year period had cost this nation a total of $1.24 TRILLION. YES, $1.24 TRILLION. So if one assumed a steady state, which is not true in reality, but let’s assume so, the cost of the impact of health inequities over the next 10 year period will approach $3.1 TRILLION if nothing is accomplished to address the inequities. That was in 2009. Although progress has been made in some area, I do believe if we were to look at the data, would be able to say that significant progress has been made.

So why am I saying there is no real interest in addressing the issue of health inequities? In 2009, I wrote an opinion piece on how this nation could cover the cost of the ACA by addressing health inequities based on the data presented by researchers at John Hopkins University and the University of Maryland. At the time the ACA was passed, it was estimated that, if fully implemented, the ACA would cost over $1 Trillion for 10 years. Based on the numbers generated in the report by researchers at John Hopkins University and the University of Maryland and dollar savings by implementing prevention recommended by the National Commission on Prevention Priorities, I stated that it was feasible to propose reducing health inequities by 33%, and, with such, we could fully cover the cost of a fully implemented ACA. We didn’t need to completely eliminate health inequities, but only reduce them by one third. Let’s see, 33% of $3.1 TRILLION is approximately $1.023 TRILLION. So if we subtract $1.023 TRILLION from the TRILLION that the proposed ACA was projected to cost, we would have had a surplus of $23 BILLION today. That $23 Billion could then be used to work toward eliminating health inequalities. Well, the response to this proposal…let’s just say there was no response.

So let me again bring this idea forward for consideration by the 2020 Presidential candidates’ field. Is this worth a discussion in terms of a way to cover the cost Health Care For All, the new health care discussion?

I would urge all of the 2020 Presidential candidates to put forth proposals with a set of reasonable milestones and work toward the elimination of health inequities. Why not truly set a Presidential goal of reducing health inequities by the end of the next decade like Kennedy did for space exploration? In spite of the lack of anything that could support a man in space, in less than 10 years, it was accomplished. Why not seek the reduction and ultimate elimination of health inequities before 2030 with Healthy People having ONE GOAL that would benefit ALL?

I believe that this nation should commit itself to achieving a milestone of reducing health disparities by at least 33% before 2030. No single health initiative in this period will be more impressive to mankind, or more important for the long-range survival of this nation. I propose to move toward eliminating the gap by delivering what we already know today–but to all Americans: to eliminate the gap between discovery and delivery and accelerate the development of programs to address the math and science gaps that exist in our schools. We need more people, especially persons of color, to achieve this goal. We propose to develop alternatives to what we have always done, and to supply additional funds for other programs to address the need for more health care personnel.

An unhealthy nation is not an economically viable nation. In a very real sense, eliminating health disparities will not just address the health of the underserved and/or minorities, but the health of all Americans. All of us must work together to make this happen. For as Franklin Roosevelt would have stated in his last, but undelivered speech, “Today, we are faced with the preeminent fact that, if civilization is to survive, we must cultivate the science of human relationships – the ability of all peoples, of all kinds, to live together and work together in the same world, at peace.”

If reducing health inequities is a true national priority, then we need to find the money to make this happen. From what I have seen over the last decade, we continue spending our time describing the problem, with little time addressing the problem. Discussion around health inequities has been replaced by discussion around the Opioid Epidemic. This is not to say such is not a problem, it is. Bu it is part of the inequity issue. The only difference is that it is occurring in white America, especially poor white America. If we would only take race out of the equation and address the problem, it would truly give the promise to someday eliminate health inequities, not only in this country, but the world at large.

Let me be clear that I am asking the White House and Congress, as well as the country, to accept a firm commitment to a new course of action–a course that will last for many years and carry very heavy costs, but the ultimate financial gain will far exceed the initial investment. The White House and Members of Congress must make this judgment, but at this moment, I am not so confident they will. Just going half way and giving lip service is not going to solve the problem. This decision demands a major national commitment to scientific and technical manpower, material and facilities and the possibility of their deversion frim other funded activities, where they are already thinly spread. It means a degree of dedication, organization and discipline that have not always characterized our research and development efforts in this area. It means we cannot afford undue work stoppages, inflated costs of materials or talent, wasteful inter-agency rivalries, a high turnover of key personnel, or the impact of institutional racialism on our decisions. We all have biases; the problem is what we have done with those biases. The results so far have not been pretty for the health of our nation.

New objectives and new money alone cannot solve these problems. They could, in fact, aggravate the problems further, as we have seen with new discoveries and a lack of delivery to the people who need these discoveries the most. Unless every scientist, every physician, every health care professional, every politician, businessperson, and civil servant gives his/her personal pledge that this nation will move forward with the full speed of freedom to address the issue of health inequities, we will not be successful. This kind of change will require dedication and a genuine willingness to address health inequities despite biases and perceptions. In doing so, we will also need to learn to speak with one voice in unity. Think about the impact that such would have across the fabric of this Nation!