October 2000 (Vol. 1, No. 4)
Racial Inequities in Health in Wisconsin
By Catherine Frey, Andrea Lasker, Kristin Bray, David Kindig

Racial differences in health status measures exist in the U.S. and Wisconsin. In the context of this brief, racial inequalities are differences in health outcomes, such as mortality, that occur by race or ethnicity. According to the National Center for Health Statistics, the average white person now lives seven years longer than the average black person. Death rates from conditions such as cancer, stroke, and heart disease are all higher in blacks. In the case of strokes, blacks are dying at twice the rates that whites are. These differences are also evident for disease incidence: blacks have much higher rates of diabetes, hypertension, and HIV-AIDS. Black mothers receive less prenatal care and are almost twice as likely to be uninsured. Non-Hispanic blacks and Hispanic persons (of any race) are more likely to report their health status as fair or poor. Similar disparities exist in Native American and among some Asian immigrant populations.

Of course, race is a complex indicator. It is not always evident what is being measured by this variable. Much of the association of race with poor health indicators can be attributed to lower socioeconomic status, prompting some researchers and journal editors to urge caution in ascribing findings to inherent or genetic aspects of a racial designation (1). However, after adjusting for income or education, racial disparities are often observed so continued attention to such associations is warranted.

Eliminating racial inequalities in health is a priority for both the nation and the state of Wisconsin. Both have initiatives to address it. The Federal Government has made the elimination of health disparities a national priority in Healthy People 2010, the document setting the nation’s health objectives for the 21st century (2). But finding the appropriate data to accurately assess disparities between different groups adds to the complexity of race as an indicator of health. The National Institute of Health (NIH), Working Group on Health Disparities recommends establishing standard definitions so that monitoring, reporting and analysis of data will have consistency and reliability.

A recent paper from the Network describes racial gaps in national mortality rates for1970 to 1996(3). Figure 1 tracks the gap in life expectancy between whites and blacks over this period. It is important to note that the disparities in life expectancy between white and black men is much greater than the gap for white and black women. The study also analyzed the causes of death that contributed to the increasing gap. In 1996, heart disease, cancer, HIV and homicide were the most significant contributors to the gap in life expectancy in blacks and whites. The paper concludes that the time required to reduce the overall gap will depend on intensive efforts in both the prevention and treatment of these leading cause-specific mortality differences; the authors estimated that eliminating age differences could take almost half a century. The paper’s authors state, "We believe that much of the gap is attributable, not to race per se, but to non-medical determinants of health, such as income, social class, and the environment."

The goal of eliminating health disparities is also an important priority for the State of Wisconsin. The Minority Health Program in the Department of Public Health and Family Services was established as a focal point to address minority health issues and recommend strategies to eliminate health disparities in Wisconsin. Furthermore, elimination of health disparities is an overarching goal that drives the development of the state public health plan known as Turning Point. The state of Wisconsin has coordinated special initiatives to address in infant mortality. asthma, diabetes, cardiovascular disease ,and stroke, cancer, HIV/AIDS, syphilis, smoking, oral health, and health care access, to name a few. Moreover, the State is working to enhance surveillance of minority populations statewide and improve the consistency and reliability of minority health data. These improved data will permit government and community stakeholders to evaluate Wisconsin’s progress in reducing racial inequities in health status.

Wisconsin is not only missing the Healthy People 2000 goal of reducing health disparities among Americans, but is actually losing ground. In Wisconsin, across all ages and races, age-adjusted mortality rate declined by 13% from the time period of 1979-1983 to 1992-1996 (4). At the same time, while the mortality rate for whites decreased by 14%, the mortality rate for blacks increased by 3%. Table 1 shows that the gap in mortality between blacks and whites has increased in every age group in Wisconsin. The greatest increase is among those 15-24, where the mortality rate went from 0.9 in 1979-83 to 2.4 in 1992-96. The 1996 black infant mortality rate was 18.3/1000 live births versus a white rate of 5.9/1000, which also represents the widening gap between the two groups (5).

Table 1: Percent Change in Wisconsin Mortality Rates by Age Groups from 1979-1983 to 1992-1996.

  All Races Whites Blacks
All Ages -13%* -14%* +3%
<1 Year -26%* -32%* -10%
1-14 Years -24%* -27%* -12%
15-24 Years -16%* -24%* +100%*
25-44 Years -4% -8% +25%*
45-64 Years -20%* -21%* -9%*
65+ Years -9% -9%* +3%

* Indicates significance at p<0.05

The ability to improve the health of Wisconsin’s citizens over the next decade will in large part be influenced by our success in reducing or eliminating the racial inequalities in health among our minority groups. The results of these studies emphasize the need for Wisconsin-based research efforts to better understand the determinants of health and reasons for the increasing gap in health status measures among minority groups. New knowledge dedicated to helping policy makers, community leaders and public health professionals implement accessible and effective treatment and preventive services including lifestyle modification is also needed. Those services will also need to take a multidisciplinary approach in achieving health equity that also includes education, housing and the physical environment.


References:

Rose Marie Martinez, Marsah Lillie-Blanton, "Why Race and Gender Remain Important in Health Services Research." American Journal of Preventive Medicine, 1996, vol. 12 (5) p316-318

United States Department of Health and Human Services, Healthy People 2010, National Objectives for the Nation, January 2000

H.Wang, P. Remington, D. Kindig, "How Fast Can the Racial Gap in Life Expectancy Between Whites and Blacks be Eliminated"? Medscape, September 1999 (www.medscape.com/Medscape/GeneralM...01.n09/mgm0923.wang/pnt-mgm0923.wang.htm

Patrick Remington MD, MPH, "Increasing Racial Mortality Disparities and Wisconsin 1979-1996", University of Wisconsin Department of Preventive Medicine, 1999

Perinatal Foundation Report. Research Examines Racial Disparity in Infant Mortality and Low Birth Weight in Milwaukee, Fall, 2000 Madison, WI.