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James R. Knickman

James R. Knickman

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Eliminate the "Health Gap"

Posted: 02/28/11 02:11 PM ET

As we mark Black History Month in February, I think about the progress that has been made to eliminate racial inequities, but also about the work that still needs to be done. When it comes to reducing disparities in health -- rates of diabetes, asthma, even premature death -- New York State still has a long way to go.

Statewide, hospitalization rates resulting from diabetes complications are four times higher for black people than for whites, according to the State Department of Health. Black New Yorkers are nearly five times more likely than whites to be hospitalized for asthma complications.

We see geographic difference in health layered with racial and ethnic disparities. People who live in East Harlem are four times more likely to be obese than those who live just a few blocks away on the Upper East Side. In the Williamsburg/Bushwick area of Brooklyn, rates of diabetes are nearly four times higher than in Greenwich Village.

So what is the solution? In a recent New Yorker article, "The Hot Spotters", Atul Gawande wrote compellingly about the efforts that some committed health care providers in Camden, NJ, are making to improve the health of their sickest, costliest patients. These health care teams must not only address the health care issues facing their patients (for example, a lack of regular access to care or an inability to pay for needed medications) but also the nonmedical factors that influence health -- poverty, poor housing, smoking, a lack of access to affordable healthy foods.

Similarly, in New York City (as well as in Baltimore, Boston, Chicago, Providence, and Washington, D.C.), a program called Health Leads operates in health centers and hospitals to fill non-medical "prescriptions" for patients who need assistance with food, housing, utilities, child care, jobs, health insurance, or a range of other factors that affect health.

Whole communities are also coming together to tackle the environmental and social factors that influence health, through federal Promise Neighborhood grants. For example, Lutheran Family Health Centers -- the grantee for the Brooklyn Promise Neighborhood in Sunset Park -- is working with the community service and child welfare agency, the community board, providers of early childhood services, and academic institutions to improve children's education and development. (It seems worth noting that three of the 21 planning grants for Promise Neighborhoods support community coalitions in New York: Brooklyn, Harlem and Buffalo.)

Promise Neighborhoods are primarily about improving education, but take a holistic approach that recognizes that issues related to education, housing, and health are linked inextricably. Children need to be healthy if they are going to succeed in school and in life. Families need to have safe places to live, to be able to pay for their medications, to have access to affordable healthy foods, to have their basic human needs met if they are going to be healthy. If a person with asthma can't afford an inhaler, or lives in a poorly-maintained building that triggers asthma symptoms, of course that patient will be more likely to end up in the hospital than someone who has the basic tools to manage the disease.

If we fail to address these basic disparities in resources and access, we will never eliminate disparities in health outcomes. There are promising models and approaches underway in New York State and across the country to do so. Let's use Black History Month as a jumping-off point to make health disparities part of the past rather than the future.