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The Different Faces of Health Atlanta Is Focus of Effort to Improve Minority Care

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Mary Obie combined gospel music last week with a 10-minute health check-up.

It may have saved her life.

She had high levels of glucose, indicative of Type 2 diabetes.

"I haven't been to the doctor for years," admitted Obie, who just turned 69. "And lately, I've been under a lot of stress, not eating right, not sleeping good."

Setting up free glucose and cholesterol screening during a popular gospel concert is just one strategy the Morehouse School of Medicine is using to help close the "health gap" between white and black America. The medical school also is taking its efforts to churches, community and senior centers and apartment complexes.

African-Americans have much higher rates of heart disease, stroke, cancer, AIDS and diabetes than whites do. Atlanta institutions increasingly have taken a leading role in finding solutions to barriers routinely cited for lopsided mortality rates among African-Americans: poverty, lack of access to health care, no health insurance, distrust and failure to follow through on recommended treatment.

Researchers and physicians at Morehouse, Grady Memorial Hospital, the Centers for Disease Control and Prevention and Emory University head many national projects devoted to improving preventive screening, awareness and access to health care. Additionally, many internationally acclaimed doctors and scientists have been wooed to Georgia.

None of this surprises experts across the country.

"Grants follow certain people, and Atlanta has attracted some top researchers," said David Shore of the Harvard School of Public Health. Shore is founder and director of Trust Initiative, a relatively new group that focuses on reducing health care disparities.

"It makes a fair amount of sense that this kind of focus would occur in Atlanta," Shore said. "It's the hometown of the Rev. Martin Luther King. Jr. and the CDC." Location, demographics

Other factors contribute to Atlanta's newfound status: > A sizable middle-class and upper-middle-class African-American population. > Increasing Latino, Asian and immigrant populations. > A large gay population. > Geographic location in the Southeast, known as the Stroke Belt. > Home office of the Association of Black Cardiologists and American Cancer Society. Federal health officials say one of their top priorities is to eliminate health disparities due to gender, race, ethnicity, education, income, disability, geographic location or sexual orientation.

Efforts are overseen by two large federal offices: The National Center on Minority Health and Health Disparities, a newly created agency within the National Institutes of Health, and the Office of Minority Health within the U.S. Department of Health and Human Services. The NIH agency largely concentrates on medical and behavioral research while the HHS office provides services, outreach and prevention programs.

As these two agencies award more minority health grants, some regions of the country are becoming known for having many health disparity specialists. Atlanta is one of them.

"I think there are some hubs that are starting to form and there's some natural progression to it," said Dr. Nathan Stinson, Jr., director of the Office of Minority Health in Washington. "They are coalescing around places where there's been a history of such research."

Atlanta is a natural because of the CDC, Morehouse and Emory schools of medicine, Stinson said. He also named Chicago, San Antonio and Los Angeles.

Many of the national health-gap initiatives are led by the CDC, including $116 million devoted to community-based prevention activities. One of the biggest programs the CDC heads across the country is the Racial and Ethnic Approaches to Community Health Program, known as REACH. It funds and evaluates locally planned demonstration projects developed to lower rates of HIV/AIDS, infant mortality, cancer, cardiovascular disease, diabetes and immunizations among minorities. The Fulton County Department of Health & Wellness or is one of 40 recipients of REACH community grants.

The cancer mortality gap between whites and minorities is the focus of the Georgia Cancer Center of Excellence, opened a year ago on two remodeled floors of Grady. The center is part of the Georgia Cancer Coalition's efforts to reduce cancer deaths and improve health care access for rural and minority patients. The coalition is a blend of public and private medical organizations.

The Grady cancer center was recently selected by the NIH to expand into a national resource for improving cancer outcomes for minorities. It is one of eight national Centers for Population Health and Health Disparities being created by the NIH with $60.5 million in grants. They are designed to support cutting-edge research to understand and reduce differences in health outcomes, access and care.

Grady's four-year $3.7 million grant will be directed at on-going and new research as well as other projects.

Getting more minorities to participate in clinical trials of potentially lifesaving drugs is a priority, said Dr. Otis Brawley, director of the Grady cancer center. Nationally, minority participation in clinical research trials has hovered around 1 percent.

Two years ago, Grady received a $4.2 million grant from the National Institutes of Health that created the General Clinical Research Center. Patients can enroll in 18 clinical trials of treatments for conditions that particularly affect minorities and the poor: sickle cell disease, AIDS, traumatic injury, premature birth and mental illness. About 95 similar centers exist nationwide, but Grady is one of a few in an urban public hospital. Awareness gap

Numerous studies coming out of Atlanta prove that overcoming a lack of knowledge about potentially fatal diseases is large part of the health gap.

African-Americans in Atlanta and three other cities were profoundly unaware of the risks of kidney disease, a leading crippler and killer, an Emory study released earlier this month revealed. The study also was funded by the National Institutes of Health.

"There are more and more NIH grants being offered for disparities," says Dr. Janice Lea, the associate professor of medicine and kidney specialist at Emory School of Medicine who led the survey among 2,000 black adults. "There's such tremendous opportunity to do research on health disparities here because of the CDC, and two major medical institutions, Morehouse and Emory."

Although African-Americans are four times more likely to develop potentially fatal kidney disease compared with whites, only about one in 10 blacks felt they were at risk, Lea's research found. But in reality, nearly 44 percent already had a major risk factor --- diabetes, high blood pressure or a blood relative with the disease.

Other challenges: > Black men have a 40 percent higher death rate from all cancers compared with white men, and they are twice as likely to die of prostate cancer as white men. > Black women die at a 20 percent higher rate from cancer than white women. > Blacks are 40 percent more likely to die of stroke than whites. > Blacks are five times more likely than whites to go blind from glaucoma.

The National Center for Primary Care at Morehouse School of Medicine is focusing on these problems. Built with a $15 million federal grant, the center focuses on health policy, how to best reach underserved communities and training doctors on how to interact more effectively with minority and poor patients. Dr. David Satcher, who led the CDC from 1993 to 1998 and later served as U.S. surgeon general, leads the Morehouse center.

"In a nation as prosperous as ours, there must be a way to bridge the chasm that lies between minority and majority, rich and poor," he said during the center's opening ceremonies more than a year ago.

Satcher says the desire for better health must come from ordinary people.

"We believe many of the answers are in the community," Satcher said. "We don't have all the answers." Socioeconomic view

Last year, the Morehouse center awarded 20 local grassroots programs grants of $2,000 each for such programs as changing the way people eat and a Latino Health Fair attended by 6,000.

Research at the center includes understanding why black men taking AIDS drugs are more likely to develop kidney disease.

At Grady, Brawley is working at the newly designated NIH Cancer Center for the Reduction of Health Disparities to unravel minority mortality rates.

Brawley is investigating why black women tend to develop more aggressive forms of breast cancer, even though they are less likely than whites to develop breast cancer.

He's also a firm believer that health differences need to be viewed through a socioeconomic lens. In that regard, Georgia is well suited to examine health burdens of low-income, rural whites, he said.

"I'm a great believer that it's a disservice to term health disparities purely in racial terms and exclude poor whites who have just as bad cancer outcomes as blacks," Brawley said. "The biggest minority in this country in terms of health care is poor whites."

Copyright 2004 The Atlanta Journal-Constitution


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