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Dr. Maddox provided background information
on the NIMHD and other federal efforts to address
health care disparities, including the 1985 release of
the U.S. Department of Health and Human Services
(HHS) Report of the Task Force on Black and Minority
Health. Several years later, during the Clinton Administration, HHS launched an initiative to address health
disparities with a focus on the following:
• Cancer
• Diabetes
•Human immunodeficiency virus (HIV)
•Cardiovascular health
• Immunization
•Infant mortality
“Have we had success in these six areas? With
respect to cancer, we see about a 1 percent reduc-
tion in cancer deaths each year. When it comes to
cardiovascular disease, we’ve seen about a 60 percent
reduction overall and about a 70 percent reduction
in stroke,” Dr. Maddox said. Across all populations,
infant mortality also has declined, but when the
rates in the African-American population and vari-
ous subpopulations of the Hispanic community are
compared with the Caucasian population, the gap
remains. “Over the last 30 years, infant mortality
has dropped significantly in all populations, but it
will take another 39 years for infant mortality in the
African-American population to get to where it was
39 years ago for the Caucasian population, if we con-
tinue to track the way we’re tracking today,” she said.
Dr. Maddox emphasized the importance of examining health care disparities not only among racial and
ethnic minority populations, but among other subpopulations as well. Examples include the lesbian, gay,
bisexual, transgender, queer (LGBTQ) community;
rural Americans; people who live in low-income, inner-city neighborhoods; and people with disabilities or
special needs.
“We need to be mindful that when you’re going
to do health care disparities research, you need to
look at it from various domains. It’s at the individual domain, it’s at the community domain, it’s at the
provider domain, and it’s at the health care systems
domain,” Dr. Maddox said.
The science of systems
Atul Gawande, MD, MPH, FACS, professor of sur-
gery, Harvard Medical School; professor, Harvard
School of Public Health; general surgeon, Brigham
and Women’s Hospital; and executive director, Ari-
adne Labs, Boston, reinforced some of the concepts
that Dr. Hoyt and Dr. Maddox brought forth, adding
his own insights on global health care disparities in
a keynote address on “the science of systems.”
Dr. Gawande spoke about the increasing inter-
est in addressing global disparities in surgical care
as evidenced by the formation of The Lancet Com-
mission on Global Surgery (LCoGS), on which
he serves. He noted that “surgery was not on the
map” in the global health care community until
the World Health Organization (WHO) released a
report containing a chapter by Haile T. Debas, MD,
FACS, professor emeritus, University of Califor-
nia-San Francisco, on surgery’s effect on lifespan.
Dr. Debas offered evidence that surgery contrib-
uted as significantly to lifespan as many public
health activities, such as vaccinations. “That gave
us an opportunity to approach the World Bank
and tell them [surgical disease] needs to be on the
[research] map along with HIV, along with tuber-
culosis,” and other health care issues.
“We need to be mindful that when you’re going to do health care
disparities research, you need to look at it from various domains. It’s
at the individual domain, it’s at the community domain, it’s at the
provider domain, and it’s at the health care systems domain.”
—Dr. Maddox
