Louisville (Ky.) Courier-Journal  [Printer-friendly version]
June 29, 2006

FACING CITY'S HEALTH INEQUITIES

[Rachel's introduction: The health department of Louisville, Kentucky
has set up a Center for Health Equity to focus on the social
determinants of health such as a person's job, neighborhood, income
and education, as well as personal responsibility. It will also
examine the potential for discrimination in the delivery of health
care and will seek solutions. The aim is to create programs that can
be replicated in other cities.]

By Adewale Troutman**

Special to The Courier-Journal

When babies in some racial and ethnic groups are dying twice as often
as those in other groups, when there are more than 83,000 excess
deaths per year among certain groups, and when death rates for members
of some groups are nearly 30 percent higher than for members of other
groups -- then you know you have a problem in your society.

These statistics do not refer to health inequities that exist in some
far, distant developing nation, but in our own United States and in
our own hometown of Louisville.

Despite progress in civil rights, housing and education since 1960,
the health gap between black and white Americans has remained constant
over the past 45 years and has actually gotten worse for some
categories.

In 1960, for example, the African-American infant mortality rate (the
rate at which babies die before their first birthday) stood about 1.5
times higher than the white infant mortality rate. By 2000, the infant
mortality rate among African Americans was more than double that of
whites. While infant mortality fell for both groups, it fell
proportionately further for white than for African-American babies.
Similarly in 1960, deaths for African-American men were 1.37 times
higher than they were for white men. By 2000, this gap had increased
to 1.48 times higher.

Louisville mirrors these national trends. Heart disease death rates
were 37 percent higher in 2003 for black residents of Louisville than
they were for white residents. The percentage of diabetes in 2004 was
43 percent higher for black residents. The overall mortality rate in
Louisville in 2003 was 30 percent higher for black residents than for
white residents.

Data collected since 1985 also point to similar disparities between
other communities of color such as Latinos and the rest of the
American population. The U.S. Department of Health and Human Services,
for example, reports that Latinos are twice as likely to die from
diabetes.

To begin to close the health gap, Mayor Jerry Abramson and the
Louisville Metro Health Department are establishing the Center for
Health Equity. Located in historic Hampton House, the center will set
up best practices models that can be replicated in other cities
throughout America. The Center for Health Equity will focus on the
social determinants of health such as a person's job, neighborhood,
income and education, as well as personal responsibility. It will also
examine the potential for discrimination in the delivery of health
care and seek solutions.

The center will partner with the University of Louisville School of
Public Health and Information Sciences and other institutions to
continue to research the causes of health inequities to develop
creative and innovative solutions to this tragedy.

One of the first projects of the Center for Health Equity will be the
Tommie Smith Track Club youth initiative. Olympic gold medalist Tommie
Smith was in Louisville in February to help us begin organizing the
clubs. Working with a broad range of community partners, the Center
for Health Equity is establishing 10 to 15 track clubs for elementary
and middle school children. The clubs are designed so that children of
all ability levels can be successful. The Louisville clubs will
include instruction on nutrition, attention to self esteem, and the
importance of education, as well as fitness assessments by the Health
Promotion Schools of Excellence.

The Center for Health Equity will address the high rates of heart
disease and diabetes in communities of color here in Metro Louisville.
It will also seek to impact high rates of HIV/AIDS and violence among
African Americans and Latinos.

The Center for Health Equity will not be limited to dealing with
African Americans. The Latino population in Louisville has more than
doubled in the past 10 years. The center will deal with the health
issues of this growing segment of our community. It will also confront
health issues faced by other emerging populations in our city as well
as those faced by lower income populations of all races and ethnic
groups.

The Center for Health Equity will benefit the entire Louisville
community. Bringing about equity in health means that we recognize
that health is a right and that it is connected to a wide range of
social and structural factors, all of which must be addressed to
secure that right. We all win when our city becomes a healthier, safer
and more livable place.

**Adewale Troutman, M.D., M.P.H., M.A., is director of health for
Louisville Metro.