By Yvonne Graham
Whether we live in the United States, the middle East, Europe, Africa, the Caribbean or north-central Brooklyn, access to quality health care and a decent standard of living are pre-requisites for optimal health, and the lack thereof is demonstrated in differences in life expectancy and the chronic disease rates. For example, in the United States in 2010, the average life expectancy for a white female was approximately 80 years while that of a black female about 72 years, a disparity of 8 years. Even more startling is that a white female is expected to live approximately 15 years longer than a black male.
While it is difficult to obtain that level of granularity in the data with respect to Caribbean immigrants, we know from Community Health profiles published by New York City Department of Health and Mental Hygiene, that areas such as Central Brooklyn which have a large Caribbean population, show higher rates of illnesses and deaths from chronic diseases than the borough wide and city-wide averages.
The reasons for this difference in longevity, and higher morbidity and mortality rates are complex and not fully understood. What we do know however, is that study after study indicate, that they are closely associated with differences in access to health care, income, education and environmental conditions commonly referred to as social determinants. In fact, last October the theme of the World Health Organization global conference was “Addressing the Social Determinants of Health” guided by the premise that our health is determined by much more than our access to health care, but also by broader quality of life issues.
The challenge for those of us in health care is that many quality of life determinants fall outside of the health care domain. Therefore, closing health care gaps and improving health outcomes will require a combination of equitable and effective health care systems along with the involvement of different parts of society - professional and civic associations; faith based institutions, community-based organizations, the private sector and individuals, working together to address the comprehensive needs of individuals and their families.
Professional Associations play a critical role in ameliorating the harsh effects of inequalities by providing health education and direct services to needy community members particularly in areas where there is a shortage of health manpower, and by effecting changes in policy and advocacy.
The Health Resources and Services Administration (HRSA) estimates that in the U.S., approximately 65 million people live in primary care Health Profession Shortage Areas (HPSAs), and 49 million people live in dental HPSAs. It is noteworthy to mention that many neighborhoods that are heavily populated by Caribbean immigrants fall into this designation. In addition, HRSA estimates that it will take 16,643 primary care practitioners and 9,642 dental health care professionals to address the health workforce shortage and meet the health needs of people living in these areas.
Clearly, the Caribbean American Medical and Scientific Association’s strong educational presence in the New York Metropolitan area is helping to fill a critical gap, but the extent of the need calls for broader collaboration with other health care associations and non-health related stakeholders. Further, as Caribbean nationals, they are in a unique position to respond to issues of cultural sensitivity, health literacy and other barriers that impede access to care for Caribbean-Americans. And, now more than ever your help in providing accurate information about the health reform process will be critical to increasing access to expanded health care coverage which is one of the major provisions of the Affordable care Act.
In addition to the work you are currently undertaking, I want to suggest four other major imperatives. The first is advocating for appropriate policies and programs to meet the health and social needs of vulnerable populations. The ethical basis for health professionals’ advocacy is articulated in many international and national professional association codes. For example, the UN Declaration of Human Rights from as far back as 1948, states that “ everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, medical care and necessary social services.
Alongside your scientific knowledge and your community volunteer activities, an important part of the democratic process is to raise your voices to elected officials and policy makers about issues of fairness and inclusiveness in health resource allocation, including appropriations to respond to the broad social and economic conditions that give rise to health inequities. As one who has worked with government, the public health community and in the professional arena, I know firsthand that advocacy works so I implore you to join with others in calling on our government to expand health care coverage for all, remove regulatory obstacles that create barriers to care, and increase funding for community driven preventive health care services.
The next imperative is engaging in continued research to document the differential health experiences of the Caribbean-American population highlighting the crosscutting issues that result in disparate health outcomes. Today, research and data drive funding and “if you can’t prove it they may not fund it”.
The third imperative is collaboration. I am pleased that this an area that CAMSA has place much emphasis on, because it is through partnerships with a broad range of stakeholders, including non-health related entities, that we will be able to harness the talents and resources to stimulate action in those areas that can lead to improvements in functional life span.
The fourth imperative is mentoring. The Institute of Medicine’s report “In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce” documents evidence showing that the health status of racial and ethnic minorities will improve by creating a healthcare workforce that more closely mirrors the diversity of the population it serves. As individuals in the health professions, you can play a role in encouraging teaching hospitals and academic medical centers to nurture community-based partnerships to respond to the shortage of minorities in the health professions. You can also link with other efforts to work with minority students in expanding their exposure to the health professions, strengthen their competencies in the sciences and help them overcome obstacles to a college career in the health professions. In addition, we need to encourage those students upon graduation, to give back to their communities through involvement in community-based health care efforts...
We know that in addition to the global financial crisis, health care systems in the Caribbean leave much to be desired. While organizations such as CAMSA have been able to accomplish much through outreach and clinical activities, and by responding in times crisis, I believe that together we can still do more if we harness the collective professional, technical and financial talent of our people in the Diaspora.
(Yvonne Graham is an Associate Commissioner of Health in the New York State Department of Health. She was addressing the Caribbean American Medical and Scientific Association in New York)