Health Equity? Still Waiting But On the Right Track

As an African-American female who has worked in public health for 20 years I am a little exhausted of the slow progress that the United States has made concerning health equity for minority populations.

April is STD Awareness month.  This article is one in a series published by Rewire in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.

As an African-American female who has worked in public health for 20 years, and seen many STD Awareness Month campaigns come and go, I am a little exhausted – or as those of a more sour demeanor might say, “sick and tired” of the slow progress that the United States has made concerning health equity for minority populations. Of course, as everyone in the public health field knows, improving the health status and opportunities of entire populations doesn’t happen overnight or even in some lifetimes. 

Public health literature defines health equity as “the opportunity for everyone to attain their full potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstances.”

When I entered public health in the early 90’s, the rates of sexually transmitted diseases among African Americans were significantly higher than that of our white counterparts. Despite declines in gonorrhea rates for most racial and ethnic groups during the 1980s, African American adolescents did not show declining rates until 1992 and by 1998 the rates for black females ages 15 to 19 years had increased by nearly 10 percent.  At that time, research consisting of socioeconomic factors and later social determinants was in the initial stages and although we knew the correlations, there were few national or community-based programs that addressed the myriad issues related to disease transmission among people of color, such as poverty, decreased education levels, high incarceration rates, substance abuse, violence and inadequate access to health care and gainful employment. And although these issues affect all races and ethnicities, many urban and rural populations of color are hardest hit.  To further complicate the issue, data on Native American populations, the only population in the 1990s that showed an increase in syphilis rates, was practically unheard of and racial/ethnicity questions for Native Americans, and in some cases Latino populations, weren’t included on many clinic forms.

Now two decades later the rates of sexually transmitted diseases among minority populations isn’t any better and in some cases they are far worse.  In 2009, according to CDC surveillance data, Blacks accounted for about 48 percent of all chlamydia cases. The chlamydia rate among black men was 12 times as high as the rate among white men.   That same year, blacks accounted for 71 percent of all reported gonorrhea cases.  The gonorrhea rates for Native American and Latino populations, were 113.3 and 58.6 cases per 100,000 respectively.  Although, we now collect data on Latino and to a lesser extent, Native American populations – the data shows that these populations also have significantly higher rates of sexually transmitted disease when compared to their White counterparts.  But things have and are changing for the better.

Today much attention is focused on achieving health equity through programs and policy initiatives.  Federal monies are available for organizations and programs to advocate for health equity; promote an understanding of the social determinants of health and to develop and disseminate best practices for working with special populations in achieving this goal.  The Centers for Disease Control has put the reduction of health inequities at the forefront of its work.  In addition, my organization, The National Coalition of STD Directors has made the promotion of health equity a priority within the organization and its membership. We now have programs to address the sexual health care needs of Black and Latino gay and bisexual men; to decrease risky behaviors and promote positive decision-making of youth and youth of color; and to provide comprehensive sexual health education to female students at historically black colleges and universities (HBCUs).  I am excited about the national initiatives and the work being done at the community level.  I believe we can do this and I think I have another 20 years left in me.