Glenn Ellis

*The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. Most U.S. residents want a society in which all persons live long, healthy lives; however, that vision is yet to be realized fully, even in the face of the recent Health Reform legislation.

In spite of the fact that The United Nations has declared 2011 “The International Year for People of African Descent”, African Americans are still experiencing inequity and disparities in health care.

According to the organizations website, “The Year aims at strengthening national actions and regional and international cooperation for the benefit of people of African descent in relation to their full enjoyment of economic, cultural, social, civil and political rights, their participation and integration in all political, economic, social and cultural aspects of society, and the promotion of a greater knowledge of and respect for their diverse heritage and culture.”

Health equity is the right of all members of society to achieve the best possible health and to not have their health negatively affected by avoidable, unfair, and unjust policies or conditions within the system in which they live. However, not everyone has a voice at the table – especially underrepresented groups who are socioeconomically disadvantaged or who have been victims of historical injustices. Inequitable distribution of or access to social, economic, and health resources can affect a groups’ attitude, behavior and health outcomes.

The socioeconomic circumstances of persons and the places where they live and work strongly influence their health. In the United States, as elsewhere, the risk for mortality, morbidity, unhealthy behaviors, reduced access to health care, and poor quality of care increases with decreasing socioeconomic circumstances.

Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.

Social determinants of health are the key factors in the health status gap between blacks and whites. Social determinants of health are the social, economic and political forces under which people live that affect their health. Social determinants include wealth/income, education, physical environment, health care, housing, employment, stress and racism/discrimination. In fact, for blacks racism is a key factor. Even when economics are controlled, blacks have poorer health. That is, middle-class blacks have poorer health than middle-class whites. In fact, middle-class whites live 10 years longer than middle-class blacks. The stress of living in a racialized discriminatory society accounts for these racial health disparities.

The single biggest threat to stemming rising costs, that Heath Reform is supposed to address, is the uncontrolled increase in chronic illnesses like diabetes and asthma, and related conditions such as obesity. We as a nation must give chronic diseases the attention they demand.

Chronic diseases are characterized by often being permanent; rarely cured; and needing long-term care. Nearly one in two Americans (133 million) has a chronic medical condition of one kind or another. The leading chronic diseases in developed countries include arthritis, cardiovascular disease such as heart attacks and stroke, cancer such as breast and colon cancer, diabetes, epilepsy and seizures, obesity, and oral health problems.

The real tragedy is that many of the 1.7 million deaths among Americans from chronic diseases each year are in large part preventable. Chronic diseases impose an enormous financial and societal burden on the United States.

According to the Centers for Disease Control and Prevention (CDC), chronic diseases today account for 70% of the deaths of all Americans and 75% of this country’s annual health care costs. Unless we take steps now to deal effectively with chronic diseases, our nation is headed for a serious financial and quality-of-life crisis. Among the contributing factors to this crisis are the aging of our population; increases in obesity, particularly among adolescents; and the tragedy of tobacco addiction.

They represent 75 percent of the $2.2 trillion spent on health care in the U.S. in 2007 – and are the primary driver of rising costs. In taxpayer-funded programs such as Medicare and Medicaid, the proportions are even higher: 96% and 83%, respectively.

In 1900, the top three causes of death in the United States were pneumonia/influenza, tuberculosis, and diarrhea. Communicable diseases accounted for about 60 percent of all deaths. In 1900, heart disease and cancer were ranked number four and eight respectively. Since the 1940s, most deaths in the United States have resulted from heart disease, cancer, and other degenerative diseases. And, by the late 1990s, degenerative diseases accounted for more than 60 percent of all deaths.

Scientific evidence suggests that it is possible that maintaining a healthy lifestyle can prevent and control chronic disease. Major risk factors that have been proven to contribute to chronic diseases are unhealthy diets, lack of physical activity, and smoking.

Taking steps to reduce risk factors throughout life can have a massive impact on the control of chronic disease. For instance, 80% of cases of coronary heart disease, 90% of cases of type 2 diabetes, and about one-third of cancers could be avoided by elimination of certain risk factors.

Four healthy lifestyle factors can help keep the most common and deadly chronic diseases at bay. The four healthy lifestyle factors are never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet.

Socio-economic & environmental factors that influence to health outcomes:

– Education

– Employment

– Family structure

– Housing and home environment

– History

– Community infrastructure

The Centers for Disease Control and Prevention (CDC) has identified the following behaviors that put people at risk for chronic disease and premature death:

  • Smoking and other tobacco use
  • High-fat, low fiber diet
  • Physically inactive
  • Lack of preventative health services (cancer screenings, cholesterol checks, blood pressure checks)

To put it in better perspective, Alcohol, Tobacco, and Hydrogenated Oils, are all legal, yet have all been shown to have a direct link to chronic deadly diseases.

Because of the increasing burden of chronic diseases, the United States faces a potential financial and health care crisis of unparalleled proportion. And while the human cost is enormous, the economic cost also is great. The cost of treating these conditions — without even taking into consideration the many secondary health problems they cause — totaled $277 billion in 2003, ad continues to climb. These conditions also reduce productivity at the workplace, as ill employees and their caregivers are often forced either to miss work days (absenteeism) or to show up but not perform well. The impact of lost workdays and lower employee productivity resulted in an annual economic loss in The United States of over $1 trillion in 2003.Chronic disease prevention is a beneficial method of cost reduction in health care services. For example, each dollar spent on school-based tobacco, drug, alcohol, and sexuality education programs provides a savings of $14 in health care costs.

It is incumbent upon us, in spite of what they are calling “Health Reform”, to join in ensuring that our nation’s political leaders and the citizens they represent better understand the profound burden of chronic disease and the positive efforts that need to be taken now to reduce that burden. Our nation, our communities, and our families deserve no less.

Any serious proposal to reform our health care system must address preventable chronic disease. As Democrats and Republicans alike look at the impact chronic disease has on the federal budget, on employers and on individual households they must realize that the best way to stem rising costs is to stop incurring them in the first place — meaning we need real Reform that gets Americans healthy and help them stay healthy.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible!

Glenn Ellis,  is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and is  a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics.

His second book, “Information is the Best Medicine”, is due out in Fall, 2011.

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