Louisville (Ky.) Courier-Journal, 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.