Minority Politicians and Health Disparities: The Messenger, the Message

In 2002 the Institute of Medicine through the actions, concern and political will of the minority caucuses of the U.S. (primarily House Democrats)making a request to the National Academy of Sciences to create a comprehensive report (Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care) on ethnic and racial disparities that has become one of the definitive if not the most definitive report on health disparities that has ever been published.

The publications created a foundational conversation that, as I have shared before in other writings, politicized the issue and raised the level of the conversation. This has been a very good thing.

However, what has not happened is a moving of the health disparities conversation from a single-faceted issue to one that is central to the success of our healthcare system and to the overall success of health reform.

Quality accessible healthcare, cultural competency, eliminating disparities, workforce diversity, patient-centered care and many other aspects of what one would consider successful outcomes of healthcare organizational excellence are all necessary to consistently make successful outcomes a reality.

Now, more so, than perhaps any other period in recent history is time to align our message and enroll messengers to deliver it consistently.

So, on Monday(6/8)there was a flurry of activity in the media announcing that the Congressional Black Caucus (CBC) sent President Obama a letter outlining their desire to assure that health disparities are a core issue in the health reform conversation. They had a meeting about this and subsequently, Health and Human Services Secretary Sebelius published a report (I say a Brief) entitled Health Disparities: A Case for Closing the Gap that outlined some of the pertinent health disparities issues connoting a need for the issue to be addressed comprehensively as part of health reform. It was published on HealthReform.gov.

I agree with the need to focus, who wouldn't. However, I am concerned by two things in particular:

1) The Messenger. Health disparities is a very broad and complicated issue. Even though racial and ethnic disparities are very prevalent and have been central to the issue, what we are facing is much bigger. We are facing the dynamics of access combined with multiple populations that are vulnerable to adverse health outcomes regardless of accessibility of services and not because of their race or ethnicity.

HEALTH DISPARITIES IS AN ISSUE THAT IMPACTS ALL AMERICANS.

So, my concern is that the messenger is generally minority. This is not a bad thing, someone has to say something. The challenge is that when the CBC and other minority caucuses are the predominant leaders in this conversation about how to make health disparities a part of the overall health reform agenda, the issue settles consciously or unconsciously in many of our minds as an issue that they are responsible for. An issue that is all about them.

By not consistently engaging and enrolling a variety of groups such as representatives from the Lesbian, Gay, Bisexual, and Trans-gender communities, the disabled, veterans, non-minority women, and others we miss the opportunity to frame health disparities, health equity, and cultural competency as an issue that simultaneously is inclusive of and transcends "minorities". It is an issue that affects everyone living in the U.S. directly or indirectly.

2) The Message.
--What is framework for the health disparities conversation within the context of health reform?
--What does it need to be?
--As a health professional or other professional, if you believe that addressing health disparities, quality affordable/accessible care, cultural competence, patient-centered care are important: How do you articulate their interdependence? (more)