Donna Christensen

Vernal Cave - Aug. 5, 2003

Donna Christensen
August 05, 2003— Philadelphia, Pennsylvania
NMA Symposium
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Good afternoon, to my community medicine and public health family.

It is truly an honor to have been invited to give the 6th annual Black physicians and patients empowerment luncheon and to join the distinguished list of persons who have preceded me.

Today is only superceded by the very great honor of having been the recipient of the Vernal Cave Medical Humanitarian award three years ago. Not being able to be here in person to receive, it I want to thank my sisters, Dr. Lucy Perez, and Dr. Averette Mhoon Parker for standing in to receive it on my behalf and extend my deep appreciation to Health Watch and the Community medicine and Public Health section of the NMA for the recognition.

Just as important, I also want to public ally thank, Lucy and Averette for going beyond the call of duty to support and guide the Health Braintrust and my Virgin Islands community. At the very least, I am triply indebted to them and all of you today.

This luncheon, lecture series and award are so appropriately named for Dr. Vernal Cave. It would be so for his scholarship, leadership and contributions in medicine alone, but his legacy goes far beyond that. He like our honoree today, Dr. Muriel Petioni, understood that the practice of medicine and the care of patients extend beyond the office, into the community if one is to fully and faithfully live up to our oath to heal.

Their lives and service calls to mind a quote with which I opened my presentation to the CBC at the retreat held to plan for the challenges of the 108th Congress. It comes from yet another Institute of medicine Report on "The future of Public Health in the 21st century."

It reads:

"The health of populations and individuals is shaped by a wide range of factors in the social, economic, natural, built and political environments. These factors interact in complex ways with each other, and with innate individual traits such as gender and genetics. Approaching health from such a broad perspective takes into account the potential effects of social connectedness, economic inequality, social norms and public policies on health behaviors and on health status."

Their lives of complete service to patients and community have been the embodiment of public and community health. It is totally fitting that this petite lady, and physician in the best sense of the word -- small in stature, but huge in charm, heart, intellect, and skill and service be the recipient of the Vernal Cave M.D. Humanitarian Award. She, like Dr. Cave has provided the strong shoulders on which we can stand and one of the finest examples of public service to follow.

Let me also use this opportunity to thank the Community Medicine section as a part of the NMA, for the role that this organization has played in my life, my growth and my being able to serve not only the Virgin Islands, but all of you, all African Americans, my Caribbean region, and as it turns out people of African descent and others everywhere. I have been blessed. Being in the Congress has given me a profound opportunity to serve, and I plan to make the most of it. I enjoy what I am doing now, as much as I enjoyed family practice, even when the battles get fiercely partisan and intense.

I bring greetings from the Congressional Black Caucus and our Health Braintrust, and add their congratulations to mine for Dr. Petioni.

I hope that many of you will join us for our Annual Legislative Conference, September 24th to 27th this year at the new D.C. convention Center.

I have been asked to share with you today, the current minority health legislative issues on the hill, and an update on where we are, one year after the landmark IOM report, "UNEQUAL TREATMENT: Confronting Racial and Ethnic Disparities in Health Care.

I guess the real question is have we confronted that reality as a Congress and as a Country as we should have. The answer would have to be a resounding no!

Although we who have been feeling it knew it, the information summarized in this report, which reviewed hundreds of scientific data and papers, should have sent shock waves through this country, and many aftershocks for some time to come.

Yet, but for the CBC and the other minority caucuses, foundations like the Robert Wood Johnson, Kaiser Family Foundation, Kellogg and the California Endowment; the National Conference on Community Justice, AETNA and a few others, and of course the NMA there has hardly been a tremor, and stony silence.

So have we met its first recommendation, which was to inform the public and policy makers about the importance of these health disparities to our communities and to the nation's health and well-being?

The Health braintrust's first response was to call a hearing, and invite the Hispanic, Asian Pacific, and Native American Caucuses to join us. We had some of the IOM committee there, and following their presentations, asked the Department of Health and Human Services and its agencies to report what they had done in the past to eliminate disparities, and the institutional racism and discrimination, what they planned to do in the future, and how much funding would be applied to close the gaps in healthcare that we have suffered for so long.

Their pretty well laundered testimony told us very little, but that may have been an accurate representation of what they had done and planned to do.

I would single out CMS, Mr. Rubin King-Shaw, and AHQR, Ms. Carolyn Clancy as being the most informative of those who represented their agencies.

Our current chair, Elijah Cummings was so moved by what he had heard from the committee and appalled by what he had heard from the Department that he followed up with a Government Reform subcommittee on health hearing which was a formal hearing and thus made the testimony part of the official record of the Committee and the House.

This was followed by briefings on the hill, and two years of member testimony at the relevant committees. It was and will continue to be a central topic of the town meetings the minority Caucuses are coming together to hold around the country.

That report and many of the other important ones on the impact of the lack of insurance, the present and future needs of public health, Bioshield and bioterrorism which are still in progress, and even the letter on the Small pox vaccine program, which the president and the secretary should have listened to, informs and shapes our agenda. As does input from the NMA, the foundations and our many other national, local and community based organizations.

Persistence may be our best strategy. This year we did have a pretty lively dialogue with Chairman Regula on many of the issues raised by the recommendations. It was not the first time the issues, such as the need to invest in outreach and education in the health professions in communities of color, one of the most important recommendations, had been raised, but usually in the past they had been met with polite smiles and thank yous for your testimony. So perhaps there is reason for hope. But they need to show us the money.

The test of Atarand against which many of our proposals to close the gaps in care and health status in our community is that the matter must be of "compelling government interest."

I have to ask, is not the data on our health compelling enough? Are we not of compelling government interest?

  • We. African Americans have the highest death rates for cancer of all groups.
  • We are more likely to die after a stroke
  • Heart disease mortality rates for adults 25 to 65 are almost twice as high among African Americans as among whites.
  • While the overall infant mortality rates have declined, the gap between whites and Blacks has widened.
  • SIDS deaths in our infants is 2X higher than in their white counterparts.
  • African Americans are about 2 times more likely to have diabetes, and we together with Native Americans have higher rates of complications and death from it.
  • In 2001 more African Americans were reported with AIDS than any other racial or ethnic group. 63% of women with AIDS and 65% of children with AIDS are Black.
  • While there is essentially no difference in incidence of asthma between white and black children, ours are hospitalized 4 times more often.
  • And I could go on and on, to include mental illness, violence, substance abuse and disabilities. The picture would be the same or worse.

Again I ask are we not of compelling government interest?

  • We are about 19% of the uninsured. 23% of African Americans are uninsured. 24% are on Medicaid/ 32% of African Americans on Medicare have no prescription drug coverage.
  • Lack of insurance is the 7th leading cause of death in this country.
  • Hundreds of African Americans die every day prematurely, from preventable causes.
  • Our life expectancy is lower than any other at every stage in our lives, and African American men have the lowest of all, dying on average 8 years earlier than White men. We live longer, but still 6 years earlier than our white sisters.

Aren't our issues or our lives of compelling government interest?

  • Insurance and access is no guarantee as the March 2002 IOM report clearly showed. Even when we have insurance we are less likely to undergo coronary angioplasty, and bypass surgery; the length of time between an abnormal screening mammogram and the follow up diagnostic tests are twice as long in Black women, and African Americans with HIV infections are less likely to be on anti-retroviral therapy, less likely to receive prophylaxis for pneumocystis, and to be receiving protease inhibitors;
  • Only 7 percent of African American children compared to 21% of white children are prescribed routine medicines for asthma.

Aren't our children of compelling government interest?

It is not that our efforts have failed to meet with any success. They have, but we still have so much that needs to be done.

  • We have our Center at NIH,
  • We have a sense of Congress that April should be National Minority Health month;
  • We have raised the funding for our Minority HIV/AIDS initiative, although as I am sure Health Watch is very aware, new language and departmental policy have blunted our effectiveness, and threatens to take the dollars out of our communities.
  • We have increased funding for global AIDS, although we have not been able to get the president or our Republican Congress to make good on his January promise
  • We have extended the reach of his initiative from 2 to 14 Caribbean countries. Now all the President needs to do is to put his money where his mouth is.
  • The five of us on the homeland security committee are working very hard to ensure that a meaningful investment will be made in our public health system and infrastructure, and that our HBCU's fully participate in the research we are funding.

But I am sure that you have noticed that the more successful our effort, the more obstacles are created and placed in our way.

So it is very clear, especially when one looks at the changes in funding and program design that are adverse to our communities in so many areas, that the remedy must be a political one.

Nothing less will get us the attention and the investment we need to respond to the recommendations of the IOM report, and to do all that we know is needed to make our people and our communities whole.

Nothing less will keep the minority HIV/AIDS initiative intact, true to its original intent, and providing badly needed, and well-used resources tour community organizations and the people they serve.

This program as many know and as Health Watch has been a stellar part of, is but a small part of the total AIDS budget and is intended to build capacity in our own home grown community and faith based organizations. From the outset we had some barriers chiefly because it changed the whole paradigm of how the department did business with us. But we had a friendlier administration, and friends on the inside, who helped us usher the program in. With the new administration just as we were beginning to see some of the results of our and your efforts, came what I consider an all-out assault on the program, which is ongoing.

It began with declaring the targeting of the dollars to minority community based organizations illegal or unconstitutional.

Again I ask, are we not a compelling government interest?

If the organizations which had previously reaped the grants had been able to reach us, would we be 47 percent of new AIDS cases and 57 percent of new HIV infections today? This and every other health intervention must be community driven. It is for everyone else, and in our communities we must accept no less. Our programs must be for us, by us.

The second assault came in the form of three rounds of audits. Now if we needed the dollars and technical assistance to build capacity, and we did, auditing is not the right way to go. We began with the assumption that we did not have the experience, expertise or infrastructure.

The purpose of the MHAI was to build it. We needed information and support, not audits.

The last is the new CDC initiative which shifts the focus from primary prevention and our dollars to a focus on HIV positives and treatment. Something we are not prepared now to do, and for which they have offered no training, assistance or funding to help our organizations adopt and to form the partnerships necessary to comply with the new emphasis. AND THEY ARE USING SOME OF OUR MONEY TO FUND THIS INITIATIVE, WHICHWILL LEAVE MORE NOT LESS OF OUR PEOPLE BEHIND!

The CBC has strongly objected, and we need to continue to do so. We also need our community partners to make sure that good tried and true public health is not thrown out of the window, and that this vital program continues.

Nothing less than a political fix will change the worsening budget picture. There are so many cuts in programs and services that are important to the health and well-being of our communities; I cannot call it a health budget.

Congress has improved on much of what the president sent down, but it took a lot of pressure from the CBC and Democrats. I am not being partisan, I am just telling the truth, and the budget battle is not over yet.

This has not been easy, amid the many fires in education, housing, jobs, the environment, and other hot button health issues we are called upon to put out every day.

But on one of the most important recommendations from the report, the increase needed in health providers of color, instead of being able to increase NHSC, HCOP, loan repayment programs and others that would help us meet that goal, we were only able to reach flat funding in some, others remain below 2003 levels.

We began the Lou Stokes Health Policy Fellowship to interest and train our young and even not so young people to be the determiners of health policy not the victims. Our first fellow began last month.

On another the office of Civil rights, there is a $1million dollar increase, which hardly begins to make up for the years of no increases, and leaves them grossly under-funded at a time when their job is so very important.

We have saved data collection by race and ethnicity in the reauthorization of at least one program where it was slated for deletion.

That fight is taking front and center stage in California right now, and I am sure you know that nothing happens only in California, and so the defeat of Proposition 54 which would prohibit the collection of racial and ethnic data is a fight we must get involved in because it is one we cannot afford to lose.

Our fight for health must be, as I said before a political one, and we have to be ready to fight it on all the fronts on which it is attacked.

Our most important response is to move away from the piecemeal approach we have taken so far on our issues, and develop a comprehensive minority Health bill. It is now in the writing, and there is still opportunity for input, but we hope to introduce it, together with our partner caucuses, in September.

It is our intention to build this legislation, which if we get our acronym right may known as the HEAL America Act of 2003, around several key sections:

  • The reauthorization of a strong well-funded OMH, and a better Center or institute at NIH.
  • The creation of a package of incentives, special programs, preferred access to programs and other measures that will empower communities to work towards wellness.
  • Mandatory data collection by race, ethnicity and other socio-economic factors
  • A robust health professions program, with outreach and enrichment programs for individuals as well as institutions
  • Enhanced community based research and clinical trials in our communities
  • As well as some or perhaps all of the elements in other legislation that would improve the health of minorities and other special populations.

We have not decided whether we will include the universal coverage piece in it or not. If we don't it will be a separate, side-by-side bill, and we will push them together.

Writing and introducing the bill will be the easiest part of what lies ahead. As we invite your input, we will need your help.

We are natural partners, because the goals of the Caucus are your goals, and are embodied in the name of this luncheon—Black physicians and patient empowerment.

As I told the Ophthalmologists last evening, there is no way the 39 of us can do it alone. The support and advocacy of the NMA, as well as individuals and other organizations have been critical to any success we have enjoyed.

I also called to mind our CBC motto, and a call issued by President Bush almost two years ago.

Our motto:

"No permanent friends, no permanent enemies, just permanent interests"

It is critical that we, who are directly burdened by the policy shifts, and the major dollar shifts that we are experiencing today recognize that we must stay focused on the unrealized dreams which shape those interests.

Dreams, which can and must no longer be deferred. The time to act is now, and the ones to act are we!

Like Esther, I believe that we, like our ancestors in other times have been placed here for such a time as this.

To take our country back, to heal her, through healing all of her children, and to help her be the best she can be. We were well on our way as we closed out the last century and faced this one filled with optimism and with hope.

And the time is now. We may not get another chance!

After September 11th, President Bush called for us to get back to normal. Well for us "normal" is not where we need or want to be.

Last Saturday, at the Black Congress on Health, Law and Economics, John Conyers of Michigan, the dean of the CBC, also just one person away from being the Dean of the entire house, and your vote away from the chairmanship of the Judiciary committee, reminded all assembled that lest we forget, it was us who built and have sustained this country, and that at every major point of change in its history we were at the center of it.

More than ever, this country needs our moral compass to guide it, our unwavering faith to sustain it, and our courage to save it.

We can never settle for going back to normal, but each and every one of us must commit to making this country and thus and our lives the best it and we can be.

That can only be done when we actively work in and with our communities, steadfastly serve our organizations, and vote like our lives depend on it.

It is up to us, who have had the privilege of knowing or knowing of Dr. Cave, and Dr, Petioni and what their lives have been and stood for, to ensure that these United States lives up to its full promise of liberty and justice for all.