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2004 Health Legacy of Cleveland Award and Scholarship Dinner
Dear Friends of Health Legacy of Cleveland:

Welcome to the inaugural Health Legacy Award and Scholarship Dinner. We chose our theme "Bridging the Gap in Health Care Disparity" to bring awareness to the issue of health care disparity and one solution that can make an impact.

Promoting health and preventing diseases are concepts and goals that Americans whole heartedly support. For the third decade, the United States has developed a plan for prevention of disease and the promotion of health, embodied in the U.S. Department of Health and Human Services document (2000), Healthy People 2010. It is the hope to eliminate disparities in health, prevent oral diseases, cancer, birth defects, AIDS, mental illness, suicide and chronic diseases of aging. These lofty ideals serve also to highlight the reality of health care disparities experienced by minorities, especially African-Americans.

In over 500 peer-reviewed articles published in the last 15 years, ethnic/race based differences in health outcomes have been well documented. Even after controlling for socio-economic status, education, income, severity of illness, patient preferences and type of insurance, disparities still exist. For instance, African-American infant mortality is 14 deaths per 1000 live births compared to 6.9 deaths per 1000 births in the general population; African-American maternal mortality is more than three times that of white women, a statistic that has changed little in 20 years; minorities, including blacks, are less likely to be given the appropriate medications or to undergo bypass surgery and related procedures when suffering from cardio-vascular disease. African-Americans have strokes about a third more often than whites, yet they are less likely to receive proper interventions. In addition, African-Americans and other minorities are less likely to be placed on waiting lists for kidney transplants or receive either dialysis or transplants; a lower percentage of blacks receive needed surgery for lung cancer than whites; and, overall, blacks and other minorities receive lower quality care when compared to whites even if they are insured. The information regarding oral health is equally engaging.

The Healthy People 2010 initiative has established that 24% of non-Hispanic black children aged 2-4 years have experienced dental caries in their primary teeth compared to 15% of non-Hispanic whites. Blacks also have higher incidence of gingivitis, periodontal loss of attachment and missing teeth. Further, African-American males have the highest incidence of oral cavity and pharyngeal cancers with associated lower survival rates.

What are the causes of these disparities? The Institute of Medicine recent report (2002), Unequal Treatment, outlined multiple causes for racial disparities including the way health care systems are organized and financed; the availability of certain services; bias and prejudice on the part of health care providers; poor quality of care by some providers as well as lack of trust in health care providers; and variation among racial and ethnic groups in the preferences of patients. It would appear from the genome project and other related research that most of the variations that cannot be explained are not genetic, but are as a result of differential exposure to environmental causes.

How then can the spectrum of health disparities be addressed? The Institute of Medicine Report (2002) and the Surgeon General Report on Oral Health (Dr. David Satcher, 2000) listed a range of interventions to address the disparities in health that will not be explored in depth in this communication. However, a common theme in both reports is to “… increase the proportion of underrepresented U.S. racial and ethnic minorities among health professionals”. Patients and providers of the same ethnic and racial backgrounds promote “… greater patient participation in care processes, higher patient satisfaction and greater adherence to treatment”. Further, African-American and other minority providers are more apt to serve in medically underserved communities. This is significant, since both nationally and locally, there is under-representation of African-American physicians and dentists. The following facts are noteworthy:

MEDICINE

• U.S. population: >292 million
• 12-13% of the population is black
• 4% of the nation’s physicians are black (over 600,000 physicians in the US)
• 7% of the medical students are black (4,637/66,253)
• Enrollment has decreased by 12.5% over the past 10 years; for the 2003-2004 academic year, the number of black applicants rose almost 5% but the number who entered medical school declined 6%
• The average cost of a medical education is $120-130,000. Tuition is increasing by 5% annually
• The average debt for a recent medical graduate is over $100,000

• Population: 500,000
• 50% of the population is black
• number of physicians that are black - validated data is unavailable

• Population: 1.3 million
• 25% of the population is black
• 3.5-5% of the physicians are black of 4,000 total physicians - validated data is unavailable

• U.S. population and percentage of blacks as listed for medicine
• < 2% of the nation’s dentists are black (2,500/128,000)
• < 5% of dental students are black (832/17,349)
• Dental student enrollment decreased by 5.75% in 1995 and by 4.7% in 2000
• Average cost of a dental education is $112,000-260,000 contingent on private/public education
• The entire applicant pool for African-American students has been less than 500 students per year in the past 20 years
• The average debt of a recent dental graduate is $150,000-250,000 contingent on private/public education

• 1.7% of the dentists are black (16/900)

• 5.6% of dentists are black (66/1171)
• 15% decrease (78-66) in the number of African-American dentists practicing in Cuyahoga County over 1990-2001.

In the publication of the Surgeon General’s Report on Oral Health (2000), Dr. David Satcher remarked:

"To improve quality of life and eliminate health disparities demands the understanding, compassion, and will of the American people. These are opportunities for all health professions, individuals, and communities to work together to improve health". In our own community, more than a dozen Northeast Ohio hospitals, foundations and organizations have recently collaborated to form a task force to study and eliminate racial health disparities. Health legacy’s contribution in this overall initiative is to increase the local African-American physician and dental workforce in order to improve the access of all to quality care with a specific focus on the African-American population. In this effort, the poet Goethe, probably best sums up our challenge:

"Knowing is not enough; we must apply. Willing is not enough; we must do."

Thank you for helping us take action and continue the great health care legacy in Cleveland.

Sincerely,

Bradley A. Dennis, M.D., MS
Chairman