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by Derrick Z. Jackson
IN JULY OF 2002, Health and Human Services Secretary Tommy Thompson told the National Conference of La Raza, "I want to discuss some of the things that have the most direct bearing on the health and well-being of Hispanic men, women, and children. First is the issue of disparities in health and treatment."
In September of 2002, Thompson said, "Communities of color suffer disproportionately from diabetes, heart disease, HIV/AIDS, cancer, stroke, and infant mortality. Eliminating these and other health disparities is a priority of HHS."
In April of 2003, Thompson said, "I believe the health problems that plague minority communities must be faced, and we must tear down the barriers."
On the January holiday for Martin Luther King Jr., Thompson said, "Part of racial equality is health equality."
For all of those lofty speeches, Thompson momentarily sank to the gutters of the Bush administration. In December, HHS published a final draft of a national report on health care disparities. But The Washington Post discovered just before the King holiday that the final version was so rosy it amounted to a virtual censoring of the draft report.
The draft version began: "Inequalities in health care that affect some racial, ethnic, socioeconomic, and geographical subpopulations in the United States ultimately affect every American. From a societal perspective, we aspire to equality of opportunities for all our citizens. Persistent disparities in health care are inconsistent with our American values."
The final report began: "The overall health of Americans has improved dramatically over the last century. Just in the last decade, the United States has seen significant reductions in infant mortality, record-high rates of childhood vaccinations, declines in substance abuse, lower death rates from coronary disease, and promising new treatments for cancer."
In the draft report, four of the seven "Key Findings" used the word "disparities" or "inequality." Those findings were: "Inequality in quality exists; disparities come at a personal and societal price; differential access may lead to disparities in quality, and knowledge of why disparities exist is limited." The draft said, "This first report clearly demonstrates that racial, ethnic, and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions -- in fact, disparities are pervasive in our health care system."
The key findings of the final report delete the words "disparities" and "inequality." The final replaced "Inequality in quality exists" with "Americans have exceptional quality of health care; but some socioeconomic, racial, ethnic, and geographical differences exist." Despite the indisputable fact that African-Americans, Latinos, and Native Americans do worse on almost all major indicators of health, Thompson had the gall to replace "Disparities come at a personal and societal price" with "Some `priority populations' do as well or better than the general population in some aspects of health care."
Thompson's two lead examples of "priority populations" doing better was the fact that Asian-Americans have a lower death rate from cancer and that Asian-Americans also have less hospitalization for diabetes.
Instead of disparities being declared a "pervasive" problem, the final report merely said, "Despite the high quality of care available, some studies and commentators have suggested that a gap exists." Instead of disparities being declared a "national problem" the final report said, "Although some research studies have suggested differences in health care services among different groups of Americans, these examinations are often limited to specific populations with specific conditions."
Eliminated from the final report was any reference to health care disparities being costly to taxpayers. Eliminated was "The personal cost of disparities can lead to significant morbidity, disability, and lost productivity." Eliminated were examples that patients of color were more likely than white patients to be diagnosed with late-stage breast and colorectal cancers; that people of color and people of low income are more likely to die from AIDS, and Latinos are less likely to receive the best care for myocardial infarction.
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