David Satcher, M.D., the 16th U.S. Surgeon General, has sought to bring attention to health disparities since long before the issue came to the forefront in public health.
At the St. Louis College of Pharmacy last Wednesday, Dr. Satcher spoke to students and audience members about America's responsibility to do something about health inequities by improving health outcomes for poor people, persons of color and those who are underserved by the health care system.
As the nation's top health advocate during the Clinton administration, his "Surgeon General's Prescription to the American People" prescribed preventive health measures - moderate exercise, five daily servings of fruit and vegetables; avoiding smoking, alcohol, drugs and other toxins; and responsible sexual behavior.
In 2001, his "Surgeon General's Report" focused on overweight and obesity.
"At that time, we called obesity an epidemic because it was growing so rapidly in children and adults in America," Satcher said in his lecture. "The only way we were wrong is that it's not just an epidemic - it's a pandemic."
A race-based disparity is detectable within this pandemic.
"African Americans are much more likely to be overweight and obese, even though it affects every group in this country," Satcher said. "One-third of Americans are overweight or obese today."
Race-based disparities are to be found in so many critical health areas.
Cardiovascular disease is the leading cause of death in this country, and African Americans are taking that health risk to the grave at the highest rates. Satcher said the same is true with cancer.
"Lung cancer, breast cancer, prostate cancer, colorectal cancer - the four leading causes of cancer deaths in this country - and today, in all of those areas, African Americans have the largest death rates," Satcher said.
Hope from health reform
Dire data aside, Satcher said health reform will allow the nation to take advantage of resources at hand for a diverse team approach that will improve health outcomes.
"I believe the best days are ahead, because I believe this country is moving in a direction that's really going to focus on the medical team more than ever before - the medical home and the medical team," Satcher said.
In terms of health disparities, Satcher said the most critical elements found in health reform are items that relate to preventive care and the prevention council, overseen by the surgeon general, which includes the secretaries of all departments.
"Not only the secretary of Health and Human Services, but the secretary of education; secretary of the U.S. Department of Agriculture, of Commerce - all of those people talking about the health of the American people," Satcher said.
"And that's actually what is going to take. It's going to take a comprehensive look at the social environment and the social determinants of health, at the same time as we work to improve health care."
Mindful of the lecture venue and audience, Satcher said pharmacists can have a tremendous role in improving health care, because the nation needs people who can better inform people, especially about taking their medication.
"The misuse of medication is one of the major problems in health care in this country. The number of people who actually follow their prescription as written is a very small percentage," Satcher said.
"That's an area where we can make a lot of progress. Someone has to take the time to follow people closely and monitor how they are doing in terms of their medication."
Value of diversity
Satcher said health reform can improve health outcomes and cost-effectiveness. But having a diverse team of professionals who are respectful of other cultures and aware of their own culture is what will make it happen.
"None of us will ever be experts in another person's culture, but we don't have to be if we build teams around us that are diverse, if we have diversity as a part of our education," Satcher said.
"That means you have to have diversity in your faculty, in your administration. You've got to have diversity, so that the people who are being trained to treat diverse populations are going to be comfortable taking care of them. Without increased diversity we will not eliminate disparities in health."