Former Surgeon General M. Joycelyn Elders

February 26, 2002

NEW YORK - Former U.S. Surgeon General M. Joycelyn Elders today said that many medical problems continue to disproportionately impact the nation's poor and minorities and that health disparities "are getting worse."

Elders, the first African-American woman to serve as Surgeon General, made her comments during an event at The New York Academy of Medicine. The outspoken sharecropper's daughter criticized the Bush administration for not doing enough to eliminate the gaps in care. The national goal of eliminating health disparities by 2010 will not be achievable, she said.

"The Administration has been so involved in the war, they've not thought about things they need to do to improve domestic issues," said Elders, a pediatrician. Elders noted that four of the nation's top health leadership positions - the Surgeon General, the director of the Centers for Disease Control and Prevention, the director of the National Institutes of Health, and the head of the Food and Drug Administration (as of March 31) - are vacant.

Elders was the keynote speaker at a day-long seminar at the Academy called "Eliminating Health Disparities Through Strengthening Community Capacity." The Academy, the New York City Department of Health, the city Health and Hospitals Corporation, and the federal Health Resources and Services Administration co-sponsored the event. The conference provided a forum for community caregivers and health leaders to attend workshops on mental health, HIV/AIDS, infant mortality and chronic diseases.

"We are concerned to a significant degree with disparities in health and life expectancy, and with understanding what accounts for those, which we only understand in the very broadest sense," said Academy President Dr. Jeremiah Barondess, among those to give opening remarks.

Involvement from people on communities' front-lines is critical, Barondess said. They best understand the challenges facing their neighbors and can offer input on surmounting them. Environmental forces such as air pollution and prevalence of cigarettes, alcohol and unhealthy foods, are among the roadblocks to health in urban communities, Barondess said. So is a lack of education.

"Education is a fundamental element of better health," Barondess said.

Barondess recalled that North Carolina had the nation's highest infant mortality rate in 1988. Research showed the mortality was prevalent in geographic pockets with high illiteracy rates. An education program regarding prenatal care helped improve the state's ranking to 46th this year.

Among African Americans, Elders said, "Infant mortality is 2.5 times as high, teen pregnancy is two times as high, black men are two times more likely to die of prostate cancer, and black women are more likely to die of breast cancer." Across the nation, African-Americans continue to suffer disproportionately from many diseases and from inferior access to health care, said Elders, who was Surgeon General from 1993-94. African-Americans make up almost 37 percent of all AIDS cases reported in this country, for example, although they account for only 12 percent of the total population.

Reasons for the disparities are many, the Arkansas native explained. Poverty and a lack of education keep some minorities away from the doctor, and they may seek medical attention only when their ailment is at an advanced stage. A shortage of minority health care providers, who are most likely to practice in inner cities, exacerbates the problem, she said.

Health disparities are nothing new, of course. "They've been there forever," Elders said. What's surprising is that the situation is not noticeably improving, said Elders, now a lecturer and distinguished professor of public health at the University of Arkansas.

There is no quick fix, Elders said. Better role models and improved education are both needed, she said. Society must also toil to eliminate conditions that contribute to the cycle of poverty, such as teen pregnancy.

"It starts in kindergarten, " she said. "We have to educate people against smoking, against drinking. We've got to have mentors in our community, more role models.

"We can't be, what we can't see," she said.

Posted on February 26, 2002

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Andrew J. Martin
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The New York Academy of Medicine
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