HARVARD GAZETTE ARCHIVES

Carolyn Clancy, director, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services: 'Disparities continue to be pervasive across the entire continuum of care.' (Staff photos Stephanie Mitchell/Harvard News Office)

The event was the first in a series of three symposia this spring that will examine the issue of health disparities and government.

Harvard School of Public Health Dean Barry R. Bloom said the symposia are designed to not only generate information, but to help devise a plan of action to address the problem of differences in health care quality and access among different groups.

Bloom said the symposia stem from a faculty retreat out of which grew a sense that the United States is at a point of opportunity to act on health disparities. Bloom said a large amount of research on the social and behavioral aspects of health and disparities has been conducted in recent decades and what is needed now is a way to link the knowledge gained with people who can use it in ways that actually reduce the gaps.

Irene Nilsson Carlsson, Sweden's director of the Division for Public Health, said that Sweden has struggled with health care disparities between natives and immigrants, between urbanites and rural dwellers, and between men and women.

"This is a moment of opportunity," Bloom said.

Bloom said he hoped the symposia would show what kind of needed information is still lacking.

"This is somewhat different from most academic symposia because it points to the need and opportunity for action," Bloom said. "We hope the symposia will add to the national and global action agenda."

David Studdert, associate professor of law and public health at the Harvard School of Public Health and one of Thursday's (March 3) symposium's organizers, said that health care will be an increasingly important part of the nation's economy. Health care is expected to continue to grow as a portion of the U.S. economy, reaching $1.8 trillion over 10 years, so that by 2014 it will account for 18 percent of the gross domestic product. The balance between the amount of health care costs paid by private payers and the government will increasingly shift to the government, which will pay fully half of health care costs by 2014.

Carolyn Clancy, director of the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, agreed with Bloom's assertion that the past two decades have seen a lot of new research on the connections between social status and health.

"You can't get anywhere unless people understand there's an issue that needs to be addressed," Clancy said.

Though raising awareness of the issue is an important first step, it is not a substitute for action, Clancy said.

Cost may be an important driver of reform, Clancy said, as the cost of health insurance is one of the top complaints of businesses. Clancy said that is particularly a problem for those who hire a lot of entry-level workers whose health care can cost employers more than their salaries.

Clancy presented research that showed that, while disparities by race, ethnicity and socioeconomic groups remain, all groups are underutilizing the health care system.

Clancy cited a study five years ago that measured rates of utilization of recommended medicine for heart attacks. It showed that just 59 percent of white males, typically the group with the best health care, got the recommended treatment.

The goal in the United States, therefore, shouldn't just be to close the gap between the highest and lowest groups but to raise all to a higher level of care.

"We have big-time quality-of-care issues for everyone," Clancy said.

Recent reports by the Department of Health and Human Services on the quality of health care in the United States highlight the problem, with a 2003 report showing either no improvement or actual deterioration in 37 of 57 categories measured. The report, for example, showed that fewer than one in five suffering from high blood pressure have the condition under control and one in five elderly have at some point been prescribed inappropriate or potentially harmful medication.

The reports show that blacks and Hispanics have lower quality health care than whites and that Asians and Hispanics have more difficulty accessing health care than whites.

"Disparities continue to be pervasive across the entire continuum of care," Clancy said.

Irene Nilsson Carlsson, director of the Division for Public Health in Sweden, said that nation has a generally healthy population, but has struggled with disparities between native Swedes and immigrants, between city and rural dwellers, between those in the nation's north, who tend to eat high-fat diets, and those in the south, and between men and women, who have a longer life expectancy.

Carlsson said the government has reorganized its National Institute for the Public Health and set up a national steering committee. The steering committee, which includes members from many parts of the government, is critical in efforts to address health disparities because many of the areas where action is required are in other parts of the government than those overseen by health officials, Carlsson said.

The importance of a cross-governmental effort was echoed by Fiona Adshead, deputy chief medical officer for the United Kingdom's Department of Health.

Adshead said years of reports have shown that health care in the United Kingdom has gotten worse. She said the time has come to move from studying the problem to action. A government-crafted reform plan is national in scope, focuses on prevention, targets efforts at the lowest 30 to 40 percent of the population, and uses two measures for success: life expectancy and infant mortality. The plan's goal is to reduce disparities in those two measures by 2010.

Asa Christina Laurell, secretary of health in Mexico City, described a sweeping, but geographically restricted effort to address health disparities. Limited to Mexico City, the effort provides free health services and drugs for city residents. Though everyone is eligible, Laurell said, the poor are the ones to benefit most. City officials estimate they've saved beneficiaries $170 million that can be used for other necessities.

The program, which also strengthened the city's health infrastructure, resulted in a 45 percent increase in the health budget over four years.

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