• published: 30 May 2014
• views: 81

Good Afternoon Chairperson Alexander, other Councilpersons, and colleagues. My name is Guy Weston. I am the Executive Director of DC CARE Consortium, which is an HIV/AIDS services organization located in Ward 4. I would like to commend your leadership and foresight in introducing this bill. My experience working on projects related to health disparities goes back to the period of the 1985 HHS Secretary's Report on Black and Minority Health. I would like to briefly share with you some observations from initiatives in various jurisdictions, including the District of Columbia, over the last three decades that either facilitate or complicate efforts to promote health equity among populations that bear disproportionate burdens of adverse health conditions. Given our time limit, I will focus solely on the first duty of the proposed commission, which is examining health disparities. The proposed legislation calls for comprehensive recommendations which examine health disparities in each Ward of the District. This sounds like a relatively simple proposition, but in fact it frequently becomes quite complicated. First and foremost, we do not have consistent data collection by Ward across the multitude of databases that would be utilized for such an endeavor; where data do exist it's not uncommon to use zip code as a proxy for Ward. This is not a reliable method, as it produces errors in about 30% of cases. If we want to examine health outcomes by Ward, we need a reliable system to collect data by Ward. There are a number of other data issues to consider when assessing health outcomes among diverse populations. Prominent among them is misclassification of Latino populations in health statistics. A number of studies have demonstrated that Latino populations are frequently undercounted due, in large part to misunderstanding of federal standards for race/ethnicity classification in health statistics, also known as OMB Directive 15. Secondly, health disparities are largely a social phenomenon. Over the last decade or so, social determinants of health has become a popular buzzword. Nevertheless, we have a public health workforce and a mentality about health promotion, which relies largely on training in the biological sciences and biostatistics. If health disparities are a social phenomenon, then we need to also engage the expertise of medical sociologists and anthropologist to better elucidate the issues as well as effective intervention strategies. To use my field of HIV/AIDS as an example, when we ask questions like why African American women account for 92% of HIV/AIDS cases, when African Americans account for 51% of the District's population, rarely do we get a straight answer. If we can't get a reasonable answer to that question, we can't expect a reasonable strategy to be implemented to address the problem. In brief, we know that HIV/AIDS rates should be understood in the larger context of the inferior health status of the African American population as a whole. In brief, we know that the leading causes of death in the US are Heart disease, Cancer, Chronic lower respiratory diseases, Stroke, Alzheimer's disease, and Diabetes. African Americans are disproportionately affected by all of these. So maybe reducing the incidence of HIV infection among African American women is less about a fancy condom campaign and more about addressing the root causes of why the African American population overall has poorer health outcomes. Thirdly, we need a better understanding of how social determinants such as geography, social networks, stigma, poverty, insurance status, traditional gender roles, religious beliefs, as well as racism and homophobia, whether perceived or real, impact health behaviors and utilization of health services. Lastly, we would be remiss if we did not include individual behavior in defining the problem. At the same time, we must recognize that individual behavior is not the only factor to target in health programs and it does not occur in a vacuum. In closing, I would like to comment on a question that came up in one of the earlier panels. A single disease approach would not be effective, in addressing health disparities, in my view, because the issues are much larger than any one disease or health condition. There are cross cutting factors, such as health beliefs, health behaviors, and patterns of utilization of healthcare services, healthcare infrastructure, cultural competence, and provider relationships with underserved populations, among many others that need to be addressed to effectively reduce health disparities in our communities. Only a comprehensive approach that addresses these issues in a multidisciplinary fashion will be effective in solving the issues we are discussing today. I thank you for the opportunity to share my perspectives with you today, and I look forward to the passage of this bill and the important work to follow.

• published: 30 May 2014
• views: 81

Good Afternoon Chairperson Alexander, other Councilpersons, and colleagues. My name is Guy Weston. I am the Executive Director of DC CARE Consortium, which is an HIV/AIDS services organization located in Ward 4. I would like to commend your leadership and foresight in introducing this bill. My experience working on projects related to health disparities goes back to the period of the 1985 HHS Secretary's Report on Black and Minority Health. I would like to briefly share with you some observations from initiatives in various jurisdictions, including the District of Columbia, over the last three decades that either facilitate or complicate efforts to promote health equity among populations that bear disproportionate burdens of adverse health conditions. Given our time limit, I will focus solely on the first duty of the proposed commission, which is examining health disparities. The proposed legislation calls for comprehensive recommendations which examine health disparities in each Ward of the District. This sounds like a relatively simple proposition, but in fact it frequently becomes quite complicated. First and foremost, we do not have consistent data collection by Ward across the multitude of databases that would be utilized for such an endeavor; where data do exist it's not uncommon to use zip code as a proxy for Ward. This is not a reliable method, as it produces errors in about 30% of cases. If we want to examine health outcomes by Ward, we need a reliable system to collect data by Ward. There are a number of other data issues to consider when assessing health outcomes among diverse populations. Prominent among them is misclassification of Latino populations in health statistics. A number of studies have demonstrated that Latino populations are frequently undercounted due, in large part to misunderstanding of federal standards for race/ethnicity classification in health statistics, also known as OMB Directive 15. Secondly, health disparities are largely a social phenomenon. Over the last decade or so, social determinants of health has become a popular buzzword. Nevertheless, we have a public health workforce and a mentality about health promotion, which relies largely on training in the biological sciences and biostatistics. If health disparities are a social phenomenon, then we need to also engage the expertise of medical sociologists and anthropologist to better elucidate the issues as well as effective intervention strategies. To use my field of HIV/AIDS as an example, when we ask questions like why African American women account for 92% of HIV/AIDS cases, when African Americans account for 51% of the District's population, rarely do we get a straight answer. If we can't get a reasonable answer to that question, we can't expect a reasonable strategy to be implemented to address the problem. In brief, we know that HIV/AIDS rates should be understood in the larger context of the inferior health status of the African American population as a whole. In brief, we know that the leading causes of death in the US are Heart disease, Cancer, Chronic lower respiratory diseases, Stroke, Alzheimer's disease, and Diabetes. African Americans are disproportionately affected by all of these. So maybe reducing the incidence of HIV infection among African American women is less about a fancy condom campaign and more about addressing the root causes of why the African American population overall has poorer health outcomes. Thirdly, we need a better understanding of how social determinants such as geography, social networks, stigma, poverty, insurance status, traditional gender roles, religious beliefs, as well as racism and homophobia, whether perceived or real, impact health behaviors and utilization of health services. Lastly, we would be remiss if we did not include individual behavior in defining the problem. At the same time, we must recognize that individual behavior is not the only factor to target in health programs and it does not occur in a vacuum. In closing, I would like to comment on a question that came up in one of the earlier panels. A single disease approach would not be effective, in addressing health disparities, in my view, because the issues are much larger than any one disease or health condition. There are cross cutting factors, such as health beliefs, health behaviors, and patterns of utilization of healthcare services, healthcare infrastructure, cultural competence, and provider relationships with underserved populations, among many others that need to be addressed to effectively reduce health disparities in our communities. Only a comprehensive approach that addresses these issues in a multidisciplinary fashion will be effective in solving the issues we are discussing today. I thank you for the opportunity to share my perspectives with you today, and I look forward to the passage of this bill and the important work to follow.