Part 2 Reducing Racial and Ethnic Health Disparities

By Michael Caso

Opportunities for Targeting – Disease States and Geography
This is the second of a 3-part series that is geared to provide supportive data that identifies the need, demonstrates targeting opportunities, and provides specific strategies and tactics designed to positively impact complementary health disparity reduction and business goals.

Disease States
Disparities in healthcare are evident in the diagnosis and treatment of specific health conditions, in the utilization of preventive services, and in health outcomes. These disparities may be caused by unique reactions to medicines, cultural or social factors.  In fact, the majority of published research indicates that minorities are less likely than whites to receive needed services. In Un-equal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, the Institute of Medicine (IOM), reports: African-Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas; disparities are found across a range of clinical settings; and disparities in care are associated with higher mortality among minorities. 
 
Any institution that impacts public health — academia, medicine and social services, etc. — has a role to play in reducing disparities in healthcare; pharmaceutical companies are no exception. It would be challenging to find a pharmaceutical company without a product in at least one of the core six disease states identified by HHS, Office of Minority Health, in which racial and ethnic minorities experience serious disparities in health access and outcomes, as well as other diseases which differentially impact minority populations:

• Infant mortality: African-American, American Indian, and Puerto Rican infants have higher death rates than white infants.
• Cancer screening and management: African-American women are more than twice as likely to die of cervical cancer than white women and are more likely to die of breast cancer than women of any other racial or ethnic group.
• Cardiovascular disease (CVD): Heart disease and stroke are the leading causes of death for all racial and ethnic groups in the United States. In 2000, rates of death from diseases of the heart were 29 percent higher among African-American adults than among white adults, and death rates from stroke were 40 percent higher.  The future for African-Americans in managing CVD is not positive, as the incidence of risk factors for diabetes, obesity and high blood pressure are higher with African-American children than with white children of the same age.  For example, 13.8 percent of African-American children have high blood pressure versus 8.4 percent of white children.
• Diabetes: In 2000, American Indians and Alaska Natives were 2.6 times more likely to have diagnosed diabetes compared with non-Hispanic whites; African-Americans were two times more likely, and Hispanics were 1.9 times more likely.
• HIV infection/AIDS: Although African-Americans and Hispanics represented only 26 percent of the U.S. population in 2001, they accounted for 66 percent of adult AIDS cases and 82 percent of pediatric AIDS cases reported in the first half of that year.
• Immunizations: In 2001, Hispanics and African-Americans aged 65 and older were less likely than Non-Hispanic whites to report having received influenza and pneumococcal vaccines.

In addition, the following diseases and conditions disproportionately impact racial and ethnic minorities:

Mental health Disparities

• American Indians and Alaska Natives appear to suffer disproportionately from depression and substance abuse.
• Less access to mental health services for minorities.
• Poorer quality of care for minorities.
• Minorities are underrepresented in mental health research.

Hepatitis Disparities

• 50 percent of those infected with Hepatitis B in 2002 were Asian-Americans and Pacific Islanders.
• Black teenagers and young adults become infected with Hepatitis B three to four times more often than those who are white.
• Higher incidence in black people than white people.
• The National Hepatitis Action Plan for 2017-2020 identifies a number of initiatives in minority populations to fight viral hepatitis.

Syphilis Disparities

• Infection rate for African-Americans is 5.6 times the rate for whites.

Tuberculosis (TB) Disparities

• Almost 80 percent of reported cases were in racial and ethnic minorities
• Asian-Americans and Pacific Islanders accounted for 22 percent.

Lupus Disparities

• Three times more common in African-American women than in white women.
• More common in Hispanic/Latina, Asian and American Indian women; African-American and Hispanic/Latina women develop symptoms earlier.
• African-Americans have more severe organ problems.
• Death rates are three times higher for African-Americans than for whites.

Asthma Disparities

• African-Americans have highest asthma rates.
• Puerto Ricans may have higher asthma prevalence rates than non-Hispanic whites and any other Hispanic subgroup.

Stroke Disparities

• African-American adults are 50 percent more likely than their white adult counterparts to have a stroke.
• In general, American Indian/Alaska Native adults are 60 percent more likely to have a stroke than their white adult counterparts.
• In 2004, Hispanic men were 14 percent less likely to die from a stroke than non-Hispanic white men.

(Source: http://www.cdc.gov/omh/AboutUs/disparities.htm)
 
While providing a tremendous service by addressing critical unmet medical needs, pharmaceutical companies will expand business opportunities by reaching minority populations. Analyzing and communicating data about these markets can improve pharmaceutical company efforts in improving outcomes and delivering assistance to the healthcare system through improved population management.  The improved outcomes and population health management assistance will increase product demand, enhance relationships with growing physician and patient populations, and lead to networking opportunities within governmental health agencies, ethnic medical associations and community-based organizations.
 
Geography
While a focus on specific disease states is critical, so too is the ability to impact specific population bases.  In this manner, it is more likely that limited resources can have a significant and measurable impact that can then be duplicated in other areas of need.
 
Historically, significant minority population bases exist in major metropolitan areas.  Wikipedia, as well as government census reports provide listings of cities for African-American, Hispanic and Asian populations and these tables can be used for creating an initiative for a single population.  However, if your goal is to have a comprehensive initiative across all three of these minority groups, a comparative analysis of metropolitan areas would be required.   A suggested list of targeted cities for initiatives impacting African-American, Hispanic and Asian populations would include the following:

• New York
• Los Angeles
• Detroit
• Chicago
• Washington, D.C.

The next issue of this report will focus on strategies and tactics across a broad range of R&D, Medical Affairs, and Marketing needs that can positively impact a foundation for cooperative endeavors with minority communities leading to a reduction in health disparities.