The Democratization Of Health Care: Beyond Health Disparities

February is Black History Month—an opportunity to reflect on our past, but more important, an opportunity to contemplate our future.

The disparities in health status between minorities and white Americans were not new when they were so well documented in the 1985 US Department of Health and Human Services Report of the Secretary’s Task Force on Black & Minority Health. In 1906, The Health and Physique of the Negro American, edited by W.E.B.DuBois, called attention to disparities. In 1914, Booker T. Washington, founder of the Tuskegee Institute, addressed the issue by offering up some startling facts concerning excessive illnesses and deaths among blacks, and the costs to the nation of this disease burden. A century later, we find ourselves still wrestling with disparities in health outcomes for blacks and other racial and ethnic populations that are in the minority.

For most of the 20th century, health disparities in the United States were defined as differential health outcomes between non-Hispanic whites and racial and ethnic minorities (Hispanics, blacks or African Americans, American Indians or Alaska Natives, Asians, and Native Hawaiians or other Pacific Islanders). The core idea for efforts to eliminate health disparities was to close the outcomes gap—to reach equity, where health outcomes for racial and ethnic minorities would be quantitatively and qualitatively equivalent to those for whites. This goal was articulated in an age when whites were the majority population and the society was contemplating the health needs of its minority (numerically and politically) populations.

The National Minority Quality Forum has been thinking about and addressing racial and ethnic health disparities since 1998. We have come to recognize that aspiring only to achieve minority health outcomes equivalent to those of whites misunderstands our future. The goal that all populations share in the 21st century is to take command of our future as it relates to the existential struggle to survive. The salient questions are: Can we build sustainable communities that enhance the potential of future generations while meeting contemporary needs? Can we control health outcomes and reduce acute events (hospitalizations, emergency-room visits, disabilities, and deaths)?

We do not want to limit our lives to our parents’ vision for the future: an equitable world where we all die at the same rate. Our view is more radical: breaking the chains that bind us by controlling and maximizing health outcomes for all of us.

We are maturing, becoming smarter and more innovative every day. We can build our economies and reorganize our communities so that sustainability is a manageable and measurable function of everyday life. We may arrogantly believe that our exceptional abilities compared with the other forms of life will spare us from extinction, but there is no such guarantee. What we have is a unique set of skills and untapped potential that may offer us a fighting chance.

This reframing of the health care conversation moves us beyond disparities. We are discussing a paradigm shift: a movement toward accountability for events that were once thought to be beyond our control. We are rejecting victimhood and taking command of our fate, working to organize our health care research, finance, and delivery system to empower our communities to control and improve health outcomes.

We are setting the bar high, and achieving our goals will be an iterative process. The first and greatest step is to recognize that we can and should gain control of our health outcomes. Looking back at the broad sweep of African American history, with its roots in slavery and segregation that engendered health disparities and despair, this generation can move forward to complete the Founding Fathers’ vision by embracing the concept of building sustainable communities that are the ultimate expression of our inalienable rights: life, liberty, and the pursuit of happiness.