History's Burden

Article excerpt

AFTER DECADES OF NEGLECT, AN ACADEMIC RESEARCH AGENDA IS BEING BUILT AROUND HEALTH DISPARITIES

It's been described as the leading civil rights issue of the day. The persistence of racial disparities in health outcomes, such as mortality rates from cancer and heart disease, weighs more heavily on African Americans in comparison to Whites. For example, the prevalence of diabetes in African Americans is approximately 70 percent higher than Whites. For men and women combined, African Americans have a cancer death rate about 35 percent higher than that for Whites. African American women develop breast cancer less often than White women, but have a higher mortality rate. African American women have higher cervical cancer death rates than White women. The incidence rate for lung cancer in African American men is about 50 percent higher than in White men and the death rate is about 27 percent higher. The prostate cancer mortality rate for African American men is more than twice that of White men.

"We have known for years that Americans of color die before our time from a wide range of illnesses. And we have known that Black mortality rates are higher than those of Caucasians," Congressional Black Caucus chairman Rep. Elijah Cummings, D-Md., has said.

In recent years, the federal government has developed programs to reduce racial disparities in health outcomes and health-care treatment. The efforts, coming after decades of neglect by what some perceive as a racially insensitive health-care establishment in the United States, is underwriting an academic research agenda around health disparities. The mission of the health disparities research is focused upon bettering outcomes in six key areas: infant mortality, cancer, cardiovascular disease, diabetes, HIV infection and AIDS, and childhood immunizations.

For historically Black institutions, health disparities research is helping to invigorate a longstanding commitment Black schools, particularly the historically Black medical schools, have had for most of their history. A number of HBCUs are building new research programs altogether, and others are beefing up their overall existing research capacity and infrastructure.

For majority White schools, some are using the health disparities funding to expand upon their existing but modest minority health initiatives while others are undertaking Black, Latino and American Indian outreach for the first time in their research programs.

"Scientists want to do research where the money is," says Dr. Marian Johnson-Thompson, the director of education and biomedical research development for the National Institute of Environmental Health Sciences (NIEHS).

Scholars and public officials say the current push by the federal government in health disparities research has to contend with the legacy the federal government established with the infamous Tuskegee syphilis study. Conducted between 1932 and 1972 by the U.S. Public Health Service, the Tuskegee study included 399 Black men with syphilis and 201 men without the disease in Macon County, Ala. The 399 men with syphilis were never told they had the disease and medical treatment was not provided to them. In 1997, President Clinton issued a formal apology to the surviving participants of the study.

That study is said to have caused many African Americans to be reluctant to participate in public health studies because of a mistrust of the medical profession. Scholars say that the Tuskegee study is a major reason why fewer African Americans participate in clinical trials and organ donation efforts.

"We have to re-establish trust," says Dr. Stephen Thomas, director at the University of Pittsburgh's Center for Minority Health, of the government and academic institutions. "Those Black men who were in the Tuskegee study trusted their doctors."

Traditionally, the issue of health disparities had not attracted a great deal of interest outside of the minority-serving institutions. …