Ex-Surgeon General: U.S. has means to heal racial gaps in health care

New London - The strong evidence of the racial and ethnic health gap in this country and good understanding of many of its causes means that at least some of the solutions are also within reach, former U.S. Surgeon General David Satcher said Thursday.

Satcher, surgeon general in the Clinton administration and now director of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, made his remarks during his keynote address at a two-day symposium on inequality in health care at Connecticut College.

After first listing some of the data showing blacks and other minorities have poorer overall health than whites - higher death rates for heart disease and cancer; shorter life expectancies; higher death rates for infants during the first year of life - he outlined the causes. These include environmental factors such as greater exposure to indoor and outdoor air pollutants; poor access to stores that sell fresh fruits and vegetables; lack of safe places to exercise in urban areas where most minorities live; greater genetic predispositions to certain diseases; less availability of medical care and greater prevalence of behaviors that undermine health.

"Are we helpless in the face of the disparities in health on a racial and ethnic level?" he rhetorically asked his audience of mainly students.

Solutions that would close "the gap between what we know and what we do," he said, range from changes in zoning rules so that urban neighborhoods have easier access to stores that sell fresh produce, more and safer parks and sidewalks, better education and targeted interventions to respond to an individual's genetic makeup and better access to health care providers, particularly primary care doctors. Incentives that encourage people to eat better, exercise more and take more responsibility for their own health are also essential, he said.

"If we're going to pay $2.5 trillion a year to treat diseases, many of which could be prevented," said Satcher, referring to the total amount spent for health care in this country annually, "then it's time to pay for incentives to help people be well. We spend less than 3 percent (of all health care spending) on community wellness. The most important thing we can do for the health of the American people is to put more emphasis on prevention and primary care, but with the system now we don't reward those things."

Spiraling health care costs can never be reined in, he added, without using incentives to keep people from getting sick in the first place. He noted that despite higher health care spending than most other industrialized countries, the United States ranks 25th or below in health measures such as life expectancy.

Satcher said that while he is "still optimistic and praying" that a measure to reform the health care system will ultimately be passed by Congress, "I'm also worried" about how health care reform proposals have been politicized and distorted.

"What's not talked about is what will happen to costs if we do nothing. They're going to continue to go up," he said.

During a question-and-answer period, one audience member asked whether the "socialized medicine" system that the congressional health reform bills would create would result in lower-quality health care.

Satcher responded that the label didn't really fit the proposals any more than it did Medicare, the federal health insurance system for the elderly.

"We have 47 million people in this wealthy nation without access to care. This is about people. The question is, how are we going to get them care?" he said. "It doesn't take socialized medicine to do that, but it is going to take a public-private partnership."

j.benson@theday.com