Monday, November 17, 2008 thru Friday, November 21, 2008

• American Indian Tribes Hope for Improvements in IHS With Tom Daschle as HHS Secretary
  [Nov 21, 2008]

American Indian Tribes Hope for Improvements in IHS With Tom Daschle as HHS Secretary
[Nov 21, 2008]

      American Indian tribal leaders are anticipating that former Senate Majority Leader Tom Daschle (D-S.D.) could make significant improvements to Indian Health Services to address funding shortages, health disparities and access to care if he is confirmed as HHS secretary, the Sioux Falls Argus Leader reports (Bremner, Sioux Falls Argus Leader, 11/21). Daschle has reportedly accepted an offer from President-elect Barack Obama to become the new HHS secretary, according to Democratic officials. Obama likely will make an official announcement about the nomination of Daschle early next week, according to a Democratic official familiar with the process (Kaiser Daily Health Policy Report, 11/20).

During his 26 years in Congress, Daschle was a "good friend" to American Indians and for more than a decade tried unsuccessfully to get Congress to add billions of dollars in funding to IHS' budget and pass legislation that modernizes the agency, the Argus Leader reports. Various changes are needed to update the agency, including increasing emphasis on preventive health care, such as diabetes education, and permitting tribes to establish home health care for the elderly and hospice programs. Tribal leaders contend that as HHS secretary, Daschle would "be in an even better position to see that the federal government lives up to its treaty obligations," the Argus Leader reports.

In the last fiscal year, IHS received $4.3 billion in funding, which tribal leaders say was less than half of what the agency needed to fully fund its health programs. Leaders said that funding for specialty health care services, such as cancer treatment and hospital care, is usually depleted three months before the end of the budget year. James Melbourne, director of the Fort Peck Tribal Health Department in Montana, said, "When the money runs out, you ration health care, people die" (Sioux Falls Argus Leader, 11/21).

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Texas, Florida Facing Physician Shortages; Hispanics Largely Affected
[Nov 17, 2008]

      Texas will need an additional 40,000 doctors by 2025 to keep up with a growing population, particularly among Hispanics, the San Antonio Express-News reports. About 20,000 of the 37,000 doctors currently practicing in Texas will have retired or left their practices over the next 17 years, Karl Eschbach, state demographer and director of the Institute of Demographic and Socioeconomic Research, said Thursday at the San Antonio Hispanic Chamber of Commerce Third Annual Healthcare Summit.

Access to care is a particularly "dire" issue for Hispanics, who have limited access to physicians because they are mostly employed by small businesses and are uninsured, the Express-News reports. Hispanics make up the largest group of uninsured people in Texas border cities. About 66% of Hispanic workers are employed by companies that provide employer-sponsored health insurance, Roland Angel, professor of sociology at the University of Texas-Austin, said. In comparison, more than 80% of blacks and whites have employer-sponsored health insurance (Poling, San Antonio Express-News, 11/14).

As Central Florida faces a physician shortage, some hospitals are recruiting physicians directly from Puerto Rico "because Puerto Rican doctors know Spanish" and "they are a good cultural fit for Metro Orlando," which has a large Hispanic population, the Orlando Sentinel reports. According to the U.S. Census Bureau's American Community Survey, an estimated 455,592 Hispanics live in the area.

Jorge Lopez -- president of Florida Emergency Physicians, who recruits physicians for the Florida Hospital System -- has traveled many times to Puerto Rico to recruit physicians. He said, "What we try to do is identify those who have already decided to leave. And when we go, we're lucky if we can recruit one or two because there are so many other hospitals competing for them." He added, "They are very competent doctors with fantastic hands-on experience. They are American citizens and bilingual. It's one of our favorite places to recruit"

The American Association of Family Physicians reports that Florida must increase its physician population by 63% over the next 15 years in order to meet demands of a growing number of aging baby boomers. In addition, 40% of the state's current physician population are age 55 or older and will reach retirement age at a time when fewer medical students are choosing to practice primary care medicine, according to the Sentinel. Other medical specialties also are facing shortages and fewer U.S. students are graduating from medical school.

Experts estimate that the nationwide physician shortage could be 200,000 by 2010; at the same time, the patient population is expected to increase by 24%. Puerto Rico is facing its own physician shortage. The island also does not have enough hospitals to meet demand and other facilities are in poor physical condition. Coupled with undesirable socioeconomic conditions, low wages and few to no benefits, many physicians are willing to leave, according to the Sentinel (Rivera-Lyles, Orlando Sentinel, 11/16).

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Black, Less-Educated Women Less Likely To Undergo Breast Reconstruction Surgery After Mastectomy, Study Finds
[Nov 18, 2008]

      Black women are 47% less likely than other women to undergo breast reconstruction after having a mastectomy, according to a study published in the November issue of Archives of Surgery, HealthDay/U.S. News & World Report reports. Undergoing breast reconstruction surgery immediately after having a mastectomy has several advantages, including aesthetic, psychosocial well-being and cost-effectiveness, according to the Johns Hopkins University researchers who conducted the study.

Researchers led by Gedge Rosson, an assistant professor of plastic surgery, analyzed data on 17,925 black and white women who had a mastectomy between 1995 and 2004; 27.9% of the women had breast reconstruction immediately after their mastectomy. The researchers also analyzed data on the communities where the women lived. Researchers found that being older, living in inner cities with high black populations and having a high school education or less all were factors indicating likeliness to not have reconstruction surgery. Wealthy women, those with more education and those who did not live in inner cities were more likely to have immediate reconstruction surgery, according to the study.

Researchers noted that even white women living in poor black neighborhoods were less likely to undergo the procedure. Rosson said, "The community a patient lives in actually does influence, in some way, the access they have to breast reconstruction. We need to learn more about why that is." He added, "People have noticed that African-Americans have fewer referrals to plastic surgeons, and if they do have a referral, they have a lower rate of going to those referrals. Strangely, even once they see the plastic surgeon, reconstruction seems to be offered with less frequency."

Researchers believe that more education programs are needed to inform women of the benefits of breast reconstruction and a particular emphasis is needed in racial and ethnic minority communities (Reinberg, HealthDay/U.S. News & World Report, 11/17).

The study is available online.

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Studies To Examine Factors Behind Racial Disparities in Breast, Colon Cancers
[Nov 17, 2008]

      The following summarizes articles about two cancer studies that examine racial disparities.

• Breast cancer: Researchers from the University of North Carolina's Lineberger Comprehensive Cancer Center are expanding the Carolina Breast Cancer Study to examine why black women are more likely than white women to die from the disease, the Raleigh News & Observer reports. As part of the study, researchers will examine subtypes of breast cancer, continuing on the findings from the larger study, which includes the largest breast cancer database in the U.S. Robert Millikan of UNC's Gillings School of Global Public Health said that through 2012 researchers will enroll 1,000 black women who have newly diagnosed cases of invasive breast cancer into the larger study, more than doubling the number of black participants. Researchers will interview participants about breast cancer risk factors, take blood samples and review medical records related to cancer diagnosis and treatment (Raleigh News & Observer, 11/16).
  
  
• Colon cancer: Researchers from the Virginia Commonwealth University will study whether doctors treat patients with similar conditions the same regardless of race or gender, with a specific focus on colon cancer, the Richmond Times-Dispatch reports. Blacks are diagnosed with colon cancer and die from the disease at a higher rate than other ethnicities, according to the Times-Dispatch. Study leader Laura Siminoff -- associate director of the cancer prevention and control research program at VCU's Massey Cancer Center -- said the disparity could be because of health insurance status, access to the health system, a lack of knowledge of the signs of the disease, cultural barriers, reluctance to visit a doctor or other factors. She noted that blacks also are diagnosed with colon cancer at later stages. As part of the study, actors posing as patients will visit physician offices participating in the study to track the care they received. Siminoff said, "We are not really looking for discrimination per se. Just a lot of different ways people unconsciously respond to and communicate with people that may make diagnosing a patient more or less difficult." The study is being funding with a five-year, $2.89 million grant from the National Cancer Institute. A separate study, funded with a three-year $1.4 million NCI grant, will interview black patients recently diagnosed with colon cancer (Smith, Richmond Times-Dispatch, 11/15).
  

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Many Elderly California Residents Have Chronic Health Conditions; Racial Disparities Remain, Study Finds
[Nov 21, 2008]

      A growing number of elderly California residents are in poor health, suffering from chronic health conditions, and minorities are some of the most affected, according to a University of California-Los Angeles study released on Thursday, the Los Angeles Times reports. The study is based on the California Health Interview Survey, which polls about 50,000 households statewide every two years.

Researchers led by Steven Wallace, a UCLA professor of public health, found that three out of five elderly California residents had high blood pressure in 2005, up from half in 2001. One in six elderly residents had diabetes, which is the fifth most common cause of death among older adults in the U.S. Researchers also found significant racial disparities. Diabetes and obesity rates were nearly twice as high for elderly blacks and Hispanics as whites, according to the study. In addition, elderly Asian-Americans, blacks and Hispanics were three times as likely to report having a lack of access to food (Lin, Los Angeles Times, 11/21).

Researchers said that poverty, language barriers, immigration status, obesity and physical inactivity might play a role in the disparities. Lack of treatment can also cause complications that worsen manageable conditions like diabetes or high blood pressure, Wallace added. "If you can't communicate with your provider effectively, that's a barrier to treatment," he said (Clemings, Fresno Bee, 11/20).

The report is available online.

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Maryland Conference Addresses Issue of Providing Culturally Competent Health Care Services
[Nov 19, 2008]

      Participants at Adventist HealthCare's Center on Health Disparities fall conference in Maryland discussed the issue of culture-based health care services on Tuesday, the Montgomery County Gazette reports.

"Even with the help of good translators, cultural differences can stymie the delivery of care," the Gazette reports. The conference's keynote speaker -- Amy Wilson-Stronks, principal investigator of a Joint Commission study on hospitals, language and culture -- said about 90% of respondents in a survey of care providers from 60 hospitals across the nation said they have some bilingual staff and about half were doing cultural competency training or assessments.

In the study, respondents were asked how they would treat a fictional Mexican immigrant who did not speak English and had severe abdominal pain. The fictional patient, whose English-speaking young daughter served as a translator, wanted doctors to give him temporary relief until he was able to visit a traditional healer to help him remove the hex he believes is causing the pain. Wilson-Stronks said that some of the respondents said they would order a psychiatric evaluation of the patient or try to convince him that his beliefs were not true. Others said they would try to communicate with him through writing or drawing.

She said the Joint Commission is working to develop standards for culturally competent, patient-centered care that would assist physicians in such situations. She said patients "deserve to be able to communicate our needs to our providers -- we all deserve to be heard," adding, "Providers also need the resources available to them to do their jobs" (Hyslop, Montgomery County Gazette, 11/19).

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Proposed Biomass Plant in Leon County, Fla., Might Exacerbate Area's High Black Infant Mortality Rate, Opinion Piece Says
[Nov 20, 2008]

      A "biomass plant should not be built" in Leon County, Fla., Edward Holifield, a retired Tallahassee physician writes in a Tallahassee Democrat opinion piece. The Florida Department of Health has "documented conclusively that black infants in Leon County are dying at Third World levels" and "the environmental poisons in Leon County are concentrated on the south side of town, which houses the greatest concentration of the blacks and the poor," Holifield writes.

He notes that a 2003 Quarterly Journal of Economics linked "air pollution to the death of black babies" and that "Leon County ranked the worst in the state in 2008 for annual particle pollution of the air." In addition, Massachusetts Institute of Technology researchers found that "'a 1% reduction in total suspended particulates (TSPs) results in a 0.35% decline in the infant mortality rate at the county level,'" Holifield writes, adding, "Most of the decline in infant mortality occurred within the first month of birth, suggesting that fetal exposure was the mechanism responsible for the deaths." He continues, "The analysis also noted 'nonlinear effects of TSPs pollution and greater sensitivity of black infant mortality at the county level.'"

Holifield writes, "The bottom line is that air pollution may have an even greater adverse effect on black infants compared with whites. Black people have already suffered enough" (Holifield, Tallahassee Democrat, 11/20).

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Ventura County, Calif., Effort Seeks To Encourage Hispanics To Talk Openly About HIV/AIDS
[Nov 21, 2008]

      A task force of Hispanic community leaders in Ventura County, Calif., this week launched a campaign that aims to encourage the Hispanic community to talk openly about HIV/AIDS, the Ventura County Star reports. One-third of the Ventura County population in 2005 was Hispanic, and the group made up 60% of new AIDS cases that year, according to the Ventura County AIDS Partnership, which is launching the campaign. The subject of HIV/AIDS is sometimes considered taboo in the Hispanic community, the Star reports.

Cultural norms, taboos and myths about HIV/AIDS contribute to the spread of the disease in the Hispanic communities across the nation, according to Jesus Torres, social marketing chair of the partnership. Madhu Bajaj, executive director of the group, said he was prompted by results of local surveys, focus groups and other research to begin the initiative, called Cuidate, which means "take care" in Spanish. As part of the effort, the group is running newspaper advertisements beginning this week and lasting through February. The task force also will start training groups that teach others how to talk openly about HIV/AIDS and will first target mothers and teenage daughters.

"Our campaign tag is 'Let's start the conversation,'" Bajaj said, adding "There's a stigma. There's a silence" about HIV/AIDS in the Hispanic community. Torres said, "With this campaign, we will give the tools, resources and know-how to our Latino community so that they may protect their health" (Ventura County Star, 11/21).

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Magazine Aims To Raise Black Health Awareness; New York Group Offers Health Services to African Refugees
[Nov 21, 2008]

      The following summarizes efforts that seek address racial and ethnic health disparities.

• African Refuge: The African Refuge provides mental health and other services to immigrants who relocated to New York's Staten Island to escape global conflicts. Tens of thousands of African immigrants reside in Staten Island and roughly 6,000 Liberian immigrants live in the Park Hill neighborhood where the organization is located, according to the group's founder, Jack Saul, a psychologist who specializes in treating trauma victims and assistant professor at Columbia University. The organization also provides African immigrants assistance with their immigration status, health screenings, employment services and help with food (Richardson, New York Daily News, 11/14).
  
  
• Black Health magazine: The first issue of Black Health, a new bimonthly publication that aims to increase awareness of black health issues, is now on newstands. The magazine is published by Marcus Oaks, who created the magazine after he found that aside from the "stray health column" in black publications, few promoted healthy living, the Mobile Press-Register reports. Oaks said the magazine focuses on key health conditions that affect blacks: high blood pressure, high cholesterol, diabetes, HIV/AIDS, obesity and cancer. He said he hopes the publication will provide a "positive" spin on health issues and avoid the "bad news" stigma (Brantley, Mobile Press-Register, 11/11).
  

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Study Looks at How Medicare Beneficiaries' Familiarity With the Program Affects Their Access to Care
[Nov 19, 2008]

      "Does Poorer Familiarity With Medicare Translate Into Worse Access to Health Care?" Journal of the American Geriatrics Society: Robert Morgan, a professor of management, policy and community health at the University of Texas School of Public Health, and colleagues surveyed 2,997 white, black and Hispanic Medicare beneficiaries. According to the study, about one-third of beneficiaries said they were unfamiliar or very unfamiliar with their Medicare benefits and blacks and Hispanics were more likely than whites to be unfamiliar with their Medicare benefits. Researchers also found that familiarity with Medicare benefits is lower among Medicare managed care plan beneficiaries, as well as those with lower incomes and education. Morgan said, "Beneficiaries' understanding of their health benefits ultimately may affect the quality and outcomes of their care. Well designed educational interventions or policies simplifying Medicare benefit programs could have a significant effect on beneficiaries' abilities to get needed care" (Wiley-Blackwell release, 11/18).

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AARP Public Policy Institute Releases Issues Report on Racial, Ethnic Disparities in Medicare Beneficiaries' Immunizations
[Nov 20, 2008]

      "Racial and Ethnic Disparities in Influenza and Pneumococcal Immunization Rates Among Medicare Beneficiaries" (.pdf), AARP Public Policy Institute: The issues report discusses factors that might contribute to black and Hispanic Medicare beneficiaries' access to immunizations. The report presents data on racial and ethnic immunization disparities that indicate black and Hispanic Medicare beneficiaries have lower inoculation rates for pneumonia and influenza, despite Medicare's coverage of such immunizations. The report also examines current Medicare immunization coverage policies and makes recommendations on how governments can address the disparities (Flowers et al., AARP Public Policy Institute, October 2008).

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Study Looks at Physicians' Likeliness To Refer Minority Patients to Clinical Trials
[Nov 20, 2008]

      "Factors Influencing Physician Referrals of Patients to Clinical Trials" (.pdf), Journal of the National Medical Association: The study, by University of South Carolina medical researchers, looks at physicians' attitudes and beliefs about recruiting patients to clinical trials, particularly minorities. Researchers surveyed 200 physicians from areas near clinics that recruited patients for Parkinson's disease. Researchers found that black physicians and physicians with a large minority patient population measured low on the Trust in Medical Researchers Scale, which indicated their likelihood of referring a patient to a clinical trial. Respondents also were more likely to refer a patient to a trial if they had previously referred patients to trials. The study concludes that the findings "emphasize the importance of developing a trusting relationship with local physicians if investigators expect these physicians to refer their patients to clinical trials" and that the "trust-related barriers for minority-serving physicians, regardless of their own race/ethnicity, seem to mirror the trust-related issues for their minority patients" (Mainous et al., Journal of the National Medical Association, November 2008).

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Event Date: 11/24/2008
Host: Institute for Alternative Futures and Congressional Hispanic Caucus Institute
Event: The Health Disparities Collaboratives: Enhancing Quality and Reducing Disparities
Location: Rayburn Building, B369
Event Contact: 703-684-5880, ext. 18. Please RSVP; or visit Web site.