One More River to Cross—Looking Back, Moving Forward: THE NMA “EQUALITY AGENDA”

As I share with you our priorities for the coming year, I must emphasize that the overarching focus of our ongoing work at the NMA is to eradicate health disparities and create a healthier people.

As African-American physicians standing on the shoulders of those who have gone before us, there can be no greater cause than to ensure that African-American people receive better healthcare and live healthier and longer lives.

This is what I refer to as our “equality agenda.” The operating principle behind this agenda is that health inequality is a multifaceted problem that calls for a multidimensional response. Under my watch, and in keeping with the guiding policies of the NMA House of Delegates and the Board of Trustees, I will advance this work in four key areas:

1. Increase Membership and Mentorship

First, we will continue the efforts, pushed forward by our past-president Dr. Price, to strengthen the infrastructure of the NMA. Our capacity to intensify our response to the enduring crisis of health inequality is limited not by our will, but by our available human resources.

Simply put, we need to increase our membership. In the coming days, I will be calling upon state and local societies to step up their present efforts to increase membership so that we can bring more soldiers to the frontlines of our programs and activities. And I am going to challenge each NMA member to adopt the national strategy of “Each One, Reach One.” If every current member recruits just one new member, our human capital would double in a single year. This is a doable undertaking.

In the days ahead, I will also be calling upon major denominational leaders in the Black Church and other religious leaders, asking them to pass the word throughout their respective congregations and constituencies—through newsletters and church announcements—that the NMA is calling all doctors.

Increasing our human resources also means that we must bring more up-and-coming physicians into the fold. Here again, the national office will be asking our state and local societies to step up their mentoring activities with minority medical students in the local area and from respective alma maters. The national office will continue to provide technical assistance to these crucial efforts.

We will also be working with the leadership of the Student National Medical Association to explore new and relevant ways that the NMA can assist them in their efforts to access mentors and enhance the institutional climates of the nation’s medical schools.

2. National Health Plan

Second, we must deal with the growing crisis of the uninsured. There are 45 million uninsured citizens— and 50 million underinsured citizens—in America, and these numbers rise each year. Throughout the last decade, the number of uninsured increased by roughly 1 million annually. And disproportionately, the unin­sured are people of color. Minorities comprise one-third of the nation’s population but over half of the uninsured. One out of five blacks and one out of 10 whites do not have coverage. And 80% of the uninsured come from working families.

Researchers tell us that uninsured individuals are more likely to postpone or forgo care, which increases their chances of illness, disability and premature death.

Perhaps the most disturbing finding comes from the Institute of Medicine, which says that 18,000 Americans die prematurely each year because they do not have insurance.

The NMA will continue to forcefully advocate for universal health insurance coverage for all Americans, for a system where everybody has a health insurance card that allows them to receive all medically necessary services by the physician of their choice.

Today, there are over 40 Congressional leaders supporting universal health insurance, including Dr. Donna Christensen, chair of the Congressional Black Caucus’ Health Braintrust and our very own doctor in the House. Rep. John Conyers of Michigan, the second most senior ranking member of the House and the founder and chairman of the Congressional Universal Healthcare Task Force, has pushed for a universal health plan for 40 years!

The NMA will continue to stand with our colleagues in this battle, and we will be calling upon our state and local chapters to step up their efforts to reach out to community-based institutions to promote awareness and grassroots advocacy around this crucial issue.

3. Transplantation & Organ Donation

Third, we must find more effective ways to address the grave and troubling challenges of kidney failure and kidney transplantation among African Americans.

Blacks are four times more likely to develop ESRD than other Americans and we have the highest rate of kidney failure in the country. African Americans comprise less than 13% of the U.S. population but nearly one-third of all kidney patients.

As with many other chronic diseases that wreak havoc on the American public in general and the black community in particular, the behavioral risk factors for ESRD are well known: diet, physical activity and stress management.

We also know the value of regular doctor visits and early detection screening for hypertension and diabetes, which are leading risk conditions for kidney disease and for other major chronic illnesses as well.

In so many ways, the crisis of kidney failure in the African-American community also mirrors the dilemma of healthcare disparities. While it is most certainly true that there is a kidney “supply and demand” problem for all renal patients regardless of race or ethnicity, it is also true that black ESRD patients tend to receive disproportionately fewer kidney transplants. In contrast to their white counterparts, black ESRD patients are less likely to be referred for transplantation evaluation. And when they are referred, they must wait nearly two years longer for a kidney.

Researchers tells us that even among kidney patients who want a transplant and who are considered appropriate for transplantation, black patients are still significantly less likely to be referred for evaluation, to be placed on waiting lists and to undergo transplantation. Even after adjusting for biological matching and blood type compatibility, transplantation rates for black ESRD patients are 34% lower than that of white patients.

The IOM’s “Unequal Treatment” report suggests that physicians—at least at a subconscious level—can make stereotypic assumptions about a minority patient’s capacity or willingness to undertake certain medical options. Other factors—related to cultural competence and the quality of the patient-provider relationship—also play a role in these kinds of treatment disparities.

We should also be mindful that the lack of parity in medical treatment is only compounded by barriers in healthcare access:

When I arrived in Gary, IN in the early 1980s, I was appalled to learn that there was no dialysis service among the city’s 125,000 mostly black and low-income residents. Kidney patients from Gary had to travel 8 miles to Hammond or 24 miles to Chicago, or even 56 miles to South Bend to get dialysis.

That was a healthcare atrocity and something needed to be done about it!

After talking with a number of people, including more than a few naysayers, about the possibility of opening a dialysis center for the people of Gary, I was fortunate to find Dr. Paul Baiter and other supporters to wage the fight.

I am proud to say that in the summer of 1985, after dozens of hearings and consultations and heaps of red tape, we were finally able to establish the first freestanding dialysis center in the city of Gary and northwest Indiana.

And so I intend to bring this same energy to the ongoing challenge we face today in kidney disease and renal care disparities among African Americans.

I will be working with NMA staff in the coming year to step up public health efforts to increase ESRD awareness and prevention in the community. For kidney disease as well as for other major chronic illnesses, health promotion must become our mantra and disease prevention must become our religion.

To increase the number of African-American kidney donors, the NMA will be working more closely in the coming days with the Minority Organ Tissue Transplant Education Program (MOTTEP) at Howard University, the Association of Organ Procurement Organizations, the National Kidney Foundation, The Gift of Hope and our other partners in the kidney care community.

We will be looking for ways to overcome misconceptions and distrusts pertaining to transplantation; and we will advance projects that provide face-to-face dialogue and culturally tailored messages to promote organ donation and disease prevention.

And the NMA will continue to advance efforts to increase diversity and cultural competence in the nation’s healthcare workforce so that all patients receive appropriate medical care, including organ transplantation.

4. Health Disparities

And finally, as we enter the second half of the decade and swiftly approach the goals of Healthy People 2010 and the national mandate to wipe out health disparities, I believe that we must strategically reposition ourselves on the frontline of the battle.

There is a tremendous and growing response in the nation’s health sciences community to the ongoing problem of health disparities. This is visible in the work of thousands of researchers, clinicians, policymakers, public health workers and health educators.

Today, there are any number of conferences, symposiums and other scientific meetings exploring the many dimensions of our health disparity problem. And the last few decades have witnessed the publication of literally hundreds of peer-reviewed research studies, including eight major studies, affirming that there is a serious problem.

At the same time, the complexity of our language in the healthcare sector, our rapid advances in medical innovations and the evolving technological shift in patient management systems all suggest a heightened need to promote diversity and cultural competence among healthcare professionals and health literacy among our patients.

Likewise, the persistence of exceedingly high levels of preventable disease among African Americans suggests that we must draw from our best knowledge in health communications and find creative and effective new ways to boost our health promotion and disease-prevention efforts. And we must strategize our work in a way that draws more deeply from the talents and commitment of our state and local chapters and our community-based institutions.

W. MONTAGUE COBB HEALTH POLICY INSTITUTE

To this end, the NMA will endeavor to fully support the W. Montague Cobb Health Policy Institute, as it moves beyond just raising awareness about health disparities and hones in on the development of national policies and programmatic solutions that can eradicate health disparities.

We congratulate and affirm our full support for the new interim director, Dr. Randall Morgan, my mentor and a past-president of the NMA.

In the days ahead, the institute will be working closely with a variety of stakeholders, professional groups, allied health organizations and our talented partners at AstraZeneca to build a powerful platform for a broader national health disparities movement. rosiglitazone diabetes

STATE AND LOCAL EFFORTS

The NMA will also intensify the on-the-ground work of our national office and affiliate chapters to bring these health disparity efforts to a new level.

With over 100 state and local affiliates across the country, the NMA has an extensive national infrastructure that can provide new opportunities for members to become active or to expand their current involvements in health disparity initiatives.

In the coming days, I am going to ask our state and local society presidents to provide an assessment of the most pressing health disparity needs in their local area and to report these needs to the national office. buy actos

The national office will support its affiliates in identifying resources for local members to support a range of health disparity initiatives—including health promotion and disease prevention; health literacy; and advocating at state and local levels for diversity, cultural competence and universal health insurance coverage.

I am going to ask our affiliate members to reignite health disparity collaborations with local institutions, including the NAACP, the Urban League, sororities and fraternities, and other com­munity-based partners.

And I will ask affiliate members to write a health editorial or column for their local newspapers, to work closely with community health leaders to support health fairs that provide screening for hypertension and diabetes, and to develop local health literacy campaigns that educate community members on how to most effectively interact with their healthcare providers.

I am proud to say that our affiliate chapters are already doing many of these things—but we must renew and intensify our efforts and find creative ways to stay relevant.

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