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Racial and Ethnic Approaches to Community Health (REACH 2010 Program)
The health objectives for the United States for the 21st century have been described in The Federal Initiative to Eliminate Racial and Ethnic Health Disparities and Healthy People 2010. The national interest in the areas of racial and ethnic disparities has been renewed with the public health initiatives with the leadership for the discussion being taken by the Center for Disease Control and Prevention. The overall health of the nation has improved a lot, but the members of the minority groups in the ethnic and racial areas have not been benefited. This includes the African-Americans, Alaska Natives, American Indians, Asian-Americans, Hispanic-Americans and Pacific Islanders.
This segment of our population is more likely to have poor health and premature deaths than the white Americans. During 1992 to 1998, the deaths from breast cancer have come down noticeably, but there are more deaths among black women than whites. Even in the area of Pap tests, the white women have greater chances of receiving these tests. These tests detect precarious changes in the cervix, which help to prevent the invasive cervix cancer. Looking at figures for 1999, African-Americans had a 29% higher chance of death from diseases of the heart. This led to a 40% higher probability of death due to strokes. In the case of diabetes, and compared to whites, American Indians and Alaska Natives are 2.6 times more susceptible, African-Americans are 2.0 times susceptible, and Hispanics are 1.9 times more susceptible. (Racial and Ethnic Approaches to Community Health (REACH) 2010: Addressing Disparities in Health 2003)
Only 25% of the U.S. population is African-American or Hispanics, but they constitute 56% of the adult AIDS cases, 73% of the new HIV infections among adults, and 82% of the pediatric AIDS cases. The National Immunization Survey for 1998-2000 shows 11 major urban areas with racial or ethnic disproportionate populations, which is 10% when compared to the national level, and they show age-appropriate childhood immunization. The studies in 2001, for Hispanics and African-Americans more than 65 years, showed that they were less likely to be vaccinated for influenza or pneumonia. The infants from the African-American, American Indian and Puerto Rican infants had much higher infant mortality rates than whites, though the overall U.S. infant mortality in 2000 had come down to 6.9 infant deaths per 1000 live births. The ratio of deaths among blacks when compared to whites was 2.5. (Racial and Ethnic Approaches to Community Health (REACH) 2010: Addressing Disparities in Health 2003)
In the coming years, it is expected that the population in the racial and ethnic minority groups are going to be an even larger portion of the U.S. population. Without a concerted effort to eliminate the differences in the health situation of the minorities, the numbers affected among them will continue to increase. For eliminating the racial and ethnic disparities in health, community driven programs are critical, as they will be easily acceptable to the communities. These need the support from sound prevention research in order to be successful. The federal, state, local and tribal governments and communities must support this research with new and innovative partnerships. The Racial and Ethnic Approaches to Community Health (REACH 2010) had been organized by CDC for eliminating disparities in health status that are seen among the ethnic minority population in important health areas. This was started in 1999 to concentrate on six very important health problems: cardiovascular disease, immunizations, breast and cervical cancer screening and management, diabetes, HIV / AIDS, and infant mortality. African-Americans, American Indians, Alaska Natives, Asian-Americans, Hispanic-Americans, and Pacific Islanders are the minorities being targeted by REACH.
Community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities will be supported by REACH through a two-phase, 5-year demonstration project. The coalition organizations used by REACH 2010 will have the community organization and three others. One of these other three will be a local or state health department, or a university or a research organization. The planning will be done over 12 months and the receivers of the REACH grants will use local data to design a complete community action plan that will concentrate on one of the six areas already decided, and specifically concentrate on one or more of the ethnic minorities. This plan will then be executed over the next four years, with the community groups carrying out the activities and also evaluating. CDC will thus be the major leader in carrying out these objectives, as mentioned. (Racial and Ethnic Approaches to Community Health (REACH) 2010: Addressing Disparities in Health 2003)
Now let us analyze the health disparities in a particular state. We have taken the study of the state of Alabama for this purpose. The total population of Alabama is 4,369,862, consisting of 52% women - 2,272,543 in number. The distribution of these women in racial and ethnic terms gives whites 71.2%, blacks as 26.95%, Asians and Pacific Islanders together as 0.66%, the American Indian and Alaska Natives together as 0.33%, and Hispanics as 0.81%. (Overview of Region lV) Heart diseases, cancer, stroke and COPD (Chronic Obstructive Pulmonary Disease) are the major causes of death. The National level of death due to heart diseases and stroke is exceeded by the rate for Alabama women. This is the leading cause for death in Alabama, and in 2000 has caused 30% of the deaths in the state, or a total of 13,406. Individually, stroke has caused 3,183 deaths in the same year, which is about 7% of the states deaths, and comes out as the third most important cause. According to the BRFSS (Behavioral Risk Factor Surveillance System), which is another survey conducted in Alabama in 2001, the adults in Alabama had high blood pressure among 31.6% of the adults, blood cholesterol in 32.7%, diabetes in 9.6%, current smoking habits in 23.8%, overweight or obesity in 62.6%. These are all high risk factors for heart diseases. Of the five factors mentioned, at least one was present in 82% of the population. (State Program: Alabama Capacity Building)
Heart disease, cancer, unintentional injuries, homicide/suicide and HIV infection are judged to be the leading cause for years of potential life lost (YPLL) before the age of 75 for the entire population. Alabama had the tenth-highest rate of death due to lung cancer among all the states. Of all the deaths in Alabama, in 1999, Cancer accounted for 21%. The deaths among men from this disease were 69% higher among men than women. In 2002, the American Cancer Society has estimated that a total of 22,600 new cases will be diagnosed, of whom, 3,200 will be for lung, 2,200 of colorectal, and 3,100 among women for breast. (Chronic Diseases, Risk Factors, and Preventive Services, Alabama) The death has been estimated by the Society to be 9,800 among Alabama residents. Death rates for cancer and COPD for Alabama women are in line with the national rates. Looking into the figures for counties, there were some in which the breast cancer deaths among African-American women were higher at 30 per 100,000 as compared to 20 per 100,000 for the white women. Diabetes had been diagnosed among 241,000 adults in Alabama in 2000. In 1999, there were 1,341 deaths due to diabetes in Alabama, and this was the eighth highest rate in the country. Asthma is not tracked in Alabama even though the attacks from the disease cause the highest amount of school absenteeism, and the disease attacks have increased by 75% from 1980, by 1994. Except HIV, Alabama has a higher rate of infection than all other diseases. (Overview of Region lV)
With regard to the disparities in health in Alabama, the Hispanics had the lowest rate of deaths due to strokes, while the blacks had the highest rates. Again with regard to the incidences of stomach, gall bladder, liver and cervical cancers, Hispanics were found to have a higher rate. Another case on insulin sensitivity showed that black children were 405 more sensitive than white children, and the insulin response was twice as high. African-American, Mexican-American and Pima Indian youth have been shown in studies to have higher insulin levels, which suggest a genetic predisposition to insulin resistance. This suggests compensated insulin resistance, and when this is coupled with the insulin resistance that occurs during puberty and due to obesity, the result could be Type 2 diabetes. (Health Disparities and Non-insulin Type 2 Diabetes) There is also a health disparity for the people in the have-not and have sections of the population, which could be a reflection of the baby boom echo or the aging of baby boomers. This is especially seen in the racial and ethnic minorities. The absence of teeth among people above 65 is 1 out of 4 on a national level, but in Alabama, it is one out of 3. Teeth loss has been coming down from the 50s. Dental caries, untreated is found among 1 in 5 children nationally, but in Alabama, it is one in three.
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