It is now > 100 years since W.E.B. Du Bois examined how racial differences in health are viewed in our nation as a fundamental social concern. In studying the African-American population of Philadelphia, he noted racial differences in health outcome, and he attributed the problem to social and environmental inequities that could be and should be addressed. Differences in health outcomes have regularly been part of a nationwide debate. In 2002, these differences once again gained national attention with the Institute of Medicine report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” The report, which examined the racial and cultural differences in Canadian health-care delivery and clinical outcomes, concluded that US racial and ethnic minorities are less likely to receive even routine medical procedures and that overall they receive a lower quality of health services. Via source thecanadianhealthcaremall.com: canadian health and care mall you may command such a service as ordering drugs online. It will ease your life and save your money.
Asthma is a health condition that affects > 20.5 million persons in the United States, and its prevalence, morbidity, and mortality are known to be higher in some racial and ethnic minority groups, Long-term trends in the white/black gap in hospitalization and mortality rates have shown very little improvement, even in the 10 years since the publication of national guidelines on the diagnosis and management of this disease. Of even greater concern is that this white/black gap may be increasing for children 5 to 18 years old. Such trends regarding racial differences in hospitalization and mortality rates, however, do not seem to be reflected in similar changes in asthma prevalence related to racial differences. Furthermore, although national surveillance data have been used to characterize differences between white persons and black persons, there are no data that can be used to characterize trends among other racial and ethnic minority groups.
In 1990, differences in asthma outcomes among ethnic minorities gained national attention because of a number of studies of geographic variation in these outcomes. Collectively, this body of literature identified inner-city populations as having the highest rates of asthma hospitalization and mortality in the country. The results of those publications led to a series of important national studies intended to improve understanding of the phenomenon of “inner-city” asthma and how it might relate to the broader concern of racial and ethnic disparities in asthma outcomes. The first major results from the largest of these studies—The National Cooperative Inner-city City Asthma Study—were first published in 199714 and, as of October 2006, nearly 400 studies have been published that characterize and attempt to solve this public health concern.
Although much of the attention on racial and ethnic differences in asthma outcomes has been focused on African-American and inner-city communities, during the past decade there has been a growing body of literature that suggests important differences in other populations as well. Most notably, asthma outcomes in the Hispanic community appear to be a large public health problem. The emerging literature suggests that Hispanic populations are at a higher risk for asthma after migrating to the United States, and that Hispanic persons have different rates of asthma prevalence, depending on their Latino ethnic background. New evidence is suggesting that genetic variations partly may be observed among differing racial and ethnic samples. Research in this area is only beginning to emerge, and there is little understanding of gene and environment interactions and of how any gene-related racial/ethnic expression relates to population ancestry.
Also, during the past decade, research on the difference in asthma outcomes in racial and ethnic minority groups has led to an advancement of our understanding of the important influence that lower socioeconomic status (SES) has on the increasing prevalence, morbidity, and mortality of asthma. Much of the literature on the relationship between SES and asthma outcomes has used community-level measures of SES. Recently, some studies” have begun to explore how community factors associated with SES might affect asthma morbidity.
This collective epidemiologic literature has served as the benchmark for a number of public and private investments to address this problem. The most notable response has been from the US Department of Health and Human Services. With appropriations of $35.2 million in the fiscal year 2002, the National Asthma Control Program of the Centers for Disease Control and Prevention (CDC) funded 11 asthma tracking projects, 48 asthma interventions, and 33 asthma partnership projects. Through its adolescent and school health program, the CDC also funded six urban school districts, one state education agency, and six national, nongovernmental organizations to support and address asthma control in a coordinated school health program.
The National Institutes of Health have funded asthma coalitions in seven communities with exceptionally high asthma death rates. The National Heart, Lung, and Blood Institute (NHLBI) has awarded contracts designed to establish partnerships with local asthma coalitions to develop innovative, model programs to improve asthma care. The coalitions will implement activities to eliminate disparities in asthma morbidity and mortality in their communities, especially among children, minorities, and persons with low incomes. Most recently, the NHLBI created a program to accelerate research aimed at understanding why certain racial, ethnic, and socioeconomic groups are more affected by asthma than other populations and at determining ways to close the gaps in prevalence and treatment of this common chronic disease. The research and related training activities are being conducted through four NHLBI Centers for Reducing Asthma Disparities. This combined body of literature has set the stage for a national dialogue on this problem of serious concern.Tags: Asthma, Epidemiology, health administration