Spiritual_Wellness_Holistic_Health_and_the_Practic

The Role of Health Education Advocacy in Removing Disparities 321
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Heart disease, the leading cause of death and a common cause of morbidity in the
U.S., occurs at nearly twice the rate in African American men compared to
Caucasian men. The age - adjusted death rate for coronary heart disease for the total
population declined by 20 percent from 1987 to 1995, but for blacks, the overall
decrease was only 13 percent. Compared with rates for whites, coronary heart disease
mortality was 40 percent lower for Asian Americans but 40 percent higher
for blacks in 1995.
Native Americans suffer from diabetes at nearly three times the average rate,
while African Americans suffer 70 percent higher rates than Caucasians; the
prevalence of diabetes in Hispanics is nearly double that of Caucasians.
Racial and ethnic minorities constitute approximately 25 percent of the total
population, yet they account for nearly 54 percent of all AIDS cases.
Such disparities in health status, however, are not constrained to racial and ethnic
minority groups. The disparities have become increasingly evident for women, people
with low incomes, people with disabilities, and specific age groups, including children,
adolescents, and the elderly, as well as by geographic location.
MAJOR CONTRIBUTING FACTORS TO HEALTH DISPARITIES
The causes of health disparities have long been of interest to epidemiologists, sociologists,
and public health professionals. Among the major contributing factors to these
disparities are race and ethnicity, socioeconomic status, gender, age, geographic location,
insurance coverage, and political will.
Race and Ethnicity
Health disparities by race and ethnicity are especially pronounced among Americans
(Council on Ethical and Judicial Affairs, 1990). For example, studies have found
that African American men living in Harlem have a life expectancy that is less than
that of men living in Bangladesh (McCord & Freeman, 1990); that there are dramatic
racial differences in preventable deaths in the Medicare population (Woolander et al.,
1985); that race can influence the stage at diagnosis for endometrial cancer (Barrett
et al., 1995), as well as colon cancer survival (Mayberry et al., 1995); and that the
prevalence of arthritis and other potentially disabling musculoskeletal conditions is
higher in African Americans than other groups (Charlson, Allegrante, & Robbins,
1993).
In addition, numerous studies have documented disparities in access to health services.
Studies of access by African Americans to emergency room services (Perkoff &
Anderson, 1970), health and hospital services (Gornick et al., 1996; Yergan, Flood,
LoGerfo, & Diehr, 1987), organ transplantation (Kasiske et al., 1991), total joint
replacement (Katz, Freund, Heck, & Dittus, 1996), and treatment for chest pain
and recommendations for cardiac catheterization (Schulman et al., 1999) have all