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Seeking Equality in Health Care

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Economic and educational differences are at the heart of the health disparities, he says, "forcing people into lower-level jobs and encouraging unpleasant and harmful lifestyles. Poor housing and work environment depresses the spirit as well as the health. Being crushed with the burdens of life, not having a chance to develop one's mind or to enjoy life -- it's a whole combination of factors, and that's why the solution has to be a whole combination of factors."

Access to health care has been cited as an important issue. Many members of minority groups do not have health insurance and cannot pay for the care they need. Distrust -- of the health-care system and of doctors -- is also at the heart of the disparities, says Stephen Thomas, PhD, director of Emory University's Institute of Minority Health Research in the Rollins School of Public Health. He has spent 15 years studying the issue.

"Racism in medicine and public health still exists, because people who run these systems are human ... with bias and prejudice that we must acknowledge," Thomas tells WebMD. "We need more minority providers. We need to look at the training our physicians get.

"We also need to realize that for African-Americans, the faith community -- the churches -- is critical in building trust and educating people about health care and prevention. Their influence has not been fully mobilized."

Fewer black people enroll in clinical trials than whites, largely because they lack trust in the health-care system, says B. Lee Green, PhD, a researcher in the University of Alabama's School of Public Health. In a study published recently in the journal Ethnicity and Medicine, Green writes: "Many ... thought that the motives of the researchers might not be in [their] best interests. ... Many were uncomfortable with studies that involved blood, injections, and radiation."

But a study by the National Cancer Institute in 1999 found that when black people with colon cancer enroll in clinical studies, they fare nearly as well as white people -- and do significantly better than other blacks who develop colon cancer. The difference, says researcher James J. Dingnam, PhD, is due to standardized treatment, which is often lacking in the real world. "It is not uncommon to find that treatment is not in keeping with what is recommended," Dignam told WebMD in a 1999 interview.

As the Healthy People 2010 initiative grapples with these issues, the NIH's Office of Research on Minority Health has launched a hopeful effort. Its new web site offers a wealth of information on health topics and clinical research. It includes information on ways to improve prenatal health and reduce infant mortality; studies of childhood lead poisoning, HIV infection and AIDS, and alcohol and drug abuse; and research on cancer, diabetes, obesity, cardiovascular diseases, and other ailments.

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