January 24, 2003

Satcher urges closing gap of racial disparities in health care

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Dr. David Satcher, former U.S. Surgeon General, discusses racial disparities at a VUMC lecture this week. (photo by Dana Johnson)

Satcher urges closing gap of racial disparities in health care

Academic health centers, like Vanderbilt, have a responsibility to improve the health and health care of everyone in their communities, former U.S. Surgeon General David Satcher said Wednesday during a “town hall meeting” at Langford Auditorium.

They can do that by ensuring that the health providers they train are exposed to the diverse experiences and cultures of the patients they will be expected to care for, by advocating for environmental changes in their communities that can foster good health, and by balancing the need for basic scientific research with population-based studies focused on disease prevention.

Academic health centers certainly are not alone, Satcher added. The responsibility for improving health and health care also must be borne by government, schools, churches, private business and society at large. But health centers, as a major part of the nation’s health care system and research enterprise, are in a unique position to contribute.

Unless action is taken, and soon, he said, the burden of preventable health problems like diabetes will continue to grow, and continue to fall disproportionately on minority groups.

Satcher, a former president of Meharry Medical College and a former director of the U.S. Centers for Disease Control and Prevention, currently directs the National Center for Primary Care at the Morehouse School of Medicine in Atlanta.

He said he disagreed with President Bush’s condemnation last week of the affirmative action program at the University of Michigan. “I disagree that the program they have is a quota system,” Satcher said. “I don’t see any evidence of that. But we also have to be honest and admit we don’t have any perfect strategies for admitting the best people.”

“We need to have representation from all ethnic and racial groups. But I don’t think it stops there,” he added. “We have a responsibility to make sure that all of our students in all of our professional fields in their training come to understand the population that we as a group are expected to serve.”

A second responsibility has to do with improving the health of the community, by leading efforts to remove lead from old buildings, for example, or establishing safe areas for people to walk and exercise.

Some studies suggest that lifestyles are responsible for at least 50 percent of variations in mortality, Satcher said. Lack of exercise and over-consumption of fatty foods, for example, is linked to the twin epidemics of obesity and type 2 diabetes.

“We now believe that over 65 percent of Americans are overweight and 33 percent are obese,” he said. “If it continues as it is now, it could overtake tobacco as a leading cause of death in this country.”

There’s a seemingly simple solution — get people to exercise and watch what they eat. “Physical activity in my opinion is probably the most underutilized intervention as it relates to health,” Satcher said. “I’ve tried very hard to get physicians to decide to write prescriptions for their patients for physical activity — whatever it takes to get them up and moving.”

Exercise is not just the individual’s responsibility, however. “If people don’t have anywhere where it’s safe to get out and walk, then the community is not living up to its responsibility,” Satcher said.

“If we’re not making sure that our children are getting physical education in school, and we’re not adequately supporting the schools for that, we’re not living up to our responsibility as a community.”

The third area of responsibility is ensuring that research conducted by academic health centers is balanced. “We need strong basic and biomedical research, but to solve these problems we also need … clinical health services, behavioral and community-based prevention,” Satcher said.