Minority and low-income groups continue to be less likely to have a regular source of health care when compared to the general population, despite efforts over the past decade to remedy the situation. Such health disparities persist across race, ethnicity, income level, and education, according to the final review of Healthy People 2010, which was released on Thursday.
Healthy People 2010 set goals in November 2000 to improve the health of all Americans, and the report details how the country did.
In that time, life expectancy at birth went up a year from 76.8 years in 2000 to 77.8 in 2007. Rates of death from coronary heart disease, stroke, and other illness decreased over the decade. Nonetheless, health disparities remain a major problem.
"It's a source of ongoing frustration," said Howard Koh, assistant secretary at the Department of Health and Human Services, which manages the Healthy People initiative. Much of the movement on disparity-related objectives "is certainly not in the right direction," or is just stagnant, Koh added.
HHS officials expect to renew the emphasis on reducing health disparities as they shift attention to the next set of goals under Healthy People 2020.
The current report measures the success of Healthy People 2010 based on 733 health indicators, each one with a "very ambitious," quantifiable target for improvement, Koh said. Baseline data was collected in the 1990s and early 2000s, and compared to the most recent data, 23 percent of targets were met; another 48 percent of health indicators showed improvement, which Koh viewed "very positively."
A disappointing 24 percent of indicators, however, moved further from their goal.
More than 69 percent of health indicators related to reducing disparities by race, ethnicity, sex, income, and education showed no change at all.
The number of people younger than 65 with health insurance remained steady over the decade, with 83 percent insured in 2008, the latest official figure used in this review.
The proportion of adults 18 and older with a source of ongoing care was down to 84 percent in 2008; in 1998, the baseline used by Healthy People, it was 85 percent. Blacks and Hispanics saw 2 and 3 percentage point drops during that same time period, down to 81 and 69 percent coverage, respectively. There were 4 percent drops among adults earning less than the federal poverty level ($10,890 for an individual) -- just 71 percent had coverage -- and the nearly-poor -- those with incomes up to twice that level -- who fell to 76 percent.
Rates for children, on the other hand, improved between 1998 and 2008, especially among minority populations. The rate for ongoing care among black children went up 3 points and became even with that of the general population at 94 percent. Coverage of Hispanic children rose 3 percentage points but remained at 90 percent in 2008. Among Asian children, there was a 6 point increase to 95 percent coverage, and poor children saw a 4 point increase to 92 percent.
Meanwhile, the number of people who had a usual primary care provider dropped 1 percentage point between 1996 and 2007, to 76 percent overall; it also dropped one point to 73 percent among blacks. Hispanics saw a 1 point increase, although the group’s access was still the lowest of all groups, reaching just 65 percent.
HHS officials expect access to care to dramatically improve in coming years with the implementation of the 2010 health law, which has already yielded a significant increase in coverage for young adults under age 26 who can now stay on their parents' plans.
"We know that very recently there is progress in insurance coverage, and a lot of the [health] improvements we’ll see in the coming years will be linked to health reform," said Ed Sondik, director of the National Center for Health Statistics at the Centers for Disease Control and Prevention. "Without insurance, we’re missing an important part of access to care and preventive regimens."
Prevention was among the bright spots of the Healthy People 2010 findings, according to Carter Blakey, acting director of the Office on Disease Prevention and Health Promotion. The proportion of adults 50 and older screened for colon cancer jumped from 37 percent in 1998 to 55 percent in 2008, exceeding the 50 percent target. Full immunization among children between 19 and 35 months rose from 73 percent in 1998 to 78 percent in 2008, nearing the 80 percent target.
The rate of pneumonia dropped significantly among people age 65 and over between 1997 and 2008, from 62 to 40 cases per 100,000; the goal was 42. Access to mental health treatment for children 4 to 17 increased from 60 to 69 percent, passing the 67 percent target.
Deaths from coronary heart disease dropped from 203 to 144 per 100,000 between 1999 and 2006; the goal was 162. Deaths from stroke also dropped during those years, from 62 to 44 per 100,000; the target was 50.
Another major problem area, Blakey noted, is nutrition. Between 1994 and 2006, the rate of obesity jumped from 23 to 33 percent among adults age 20 and older, and from 11 to 18 percent among adolescents. Those rates were likely not helped by a disappointing change in care: The number of physician office visits that included diet and nutrition counseling for medical conditions dropped from 42 to 35 percent between 1997 and 2005.
Kaiser Health News is an editorially-independent program of the Kaiser Family Foundation, a nonpartisan health care policy organization that is not affiliated with Kaiser Permanente.
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