Feds seek to close African-American health gap

Clara Robertson has traveled many miles from her home in Montgomery, Ala., to walk dirt roads, knock on doors of trailers and help black women face cancer. Robertson, 52, finds free transportation for women who can't get to a screening or an oncologist. She hands out pamphlets. She comforts. She explains that cancer won't care that they don't have the time or money for treatment. "In the South, it's so different," Robertson says. "My mom didn't believe in going to doctors." As a volunteer for a program organized by the Centers for Disease Control and Prevention (CDC) and the University of Alabama, Robertson is a diplomat, working to erase nagging health disparities between black Americans and all other Americans. Death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes, HIV and homicide, the CDC reports. "Educationally, we're doing better. Economically, we're doing better, so why is it that this gap will not go away?" asks Michelle Gourdine, a pediatrician at Johns Hopkins School of Public Health and author of the newly released Reclaiming Our Health: A Guide to African American Wellness. Reasons for the gap, according to Gourdine and other experts: •Poverty. Many black Americans have no health insurance and a trip to the doctor is a major expense, says Mona Fouad, director of the Minority Health and Disparities Center at the University of Alabama-Birmingham. Take Renee Harris of Flomaton, Ala. The 41-year-old wife and mother has diabetes, high blood pressure and a benign breast lump doctors are watching. She has had her gallbladder removed. Harris can't swing her share of the health insurance offered through her security job at a paper mill, especially since her husband was laid off. "I just can't afford it right now," Harris says. •Fatalistic outlook. Leandris Liburd, director of the CDC's Office of Minority Health and Health Equity, says she is taken aback when she visits her hometown of Richmond, Va. "It's not uncommon for me to come upon people I grew up with who are in their early 50s who are double amputees" and who see this as the natural course of aging, Liburd says. New efforts are attacking the gap. As part of last year's health care law, the Department of Health and Human Services put forth a plan in April to better understand and find solutions to health disparities. One element: expand data collected on hospital admissions to include the race, ethnicity and language of patients. "Health disparities … are often driven by the social conditions in which individuals live, work and play," according to the action plan. In May, the department announced $100 million in community grants for programs that promote healthier lifestyles among groups that experience more chronic illness. Separately, the CDC is targeting health problems that occur more frequently in African Americans, Hispanics and other minorities through a program called REACH (Racial and Ethnic Approaches to Community Health) that steers grants to local organizations. In Alabama's Black Belt, an area named for the color of its fertile soil but also associated with a high black population and poverty, the CDC and UAB are working to get more black women screened and treated for breast and cervical cancer. Staffers and volunteers are picked from community members who know everyone. Judy Compton, a retired second-grade teacher, holds weekly classes for two groups of eight to 10 women at Little Zion Tabernacle Holiness Church in rural Dixons Mills, Ala. She gives advice on transportation and on agencies that can help with low-cost care and screenings. Compton finds women ages 45 to 65 who are not getting regular health screenings by speaking at churches and social functions. "Insurance is the biggest problem," she says. Jennifer Cole is the Lowndes County, Ala., coordinator. She teaches healthy eating and says she finds her students have limited access to low-cost nutritional foods. In Flint, Mich., the CDC and the Genesee County Health Department have tackled disparities in infant mortality by hosting tours that take new doctors to the poorest parts of Flint so they can see the barriers their patients face. "We forget, for instance, there are no stores in the neighborhood, and that may be why I'm not following your medical regimen for good vegetables," says Bettina Campbell, founder of a social service organization in Flint who works with the program. "If I'm not on time for your appointment, your staff may see it as me being willfully late, but in actuality, I had to take three buses." Robertson, the Montgomery volunteer, says some of the women she visited who were diagnosed with cancer came to rely on her for support. One showed Robertson her mastectomy scar. Another produced a bag of hair that had fallen out during treatment. "One thing I've learned: They don't want sympathy. They just want to get through it," Robertson says. "Sometimes, it's just listening, getting them transportation, getting the utility bills paid so they can begin to recover."