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Office of Minority Health and Health Disparities OMHD

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1. Office of Minority Health and Health Disparities (OMHD) An Overview Updated 5/8/07 Office of Minority Health and Health Disparities (OMHD) An Overview Updated 5/8/07 Office of Minority Health and Health Disparities (OMHD) An Overview

3. “Health Disparity” in Public Health – Operational Definition Quantitative measures: rates, percents, means… The Quantity that separates a group from a reference point on a particular measure of health Calls attention to differences in health between groups regardless of cause Can be measured in absolute or relative terms “Health Disparity” in Public Health – Operational Definition Quantitative measures: rates, percents, means… The Quantity that separates a group from a reference point on a particular measure of health Calls attention to differences in health between groups regardless of cause Can be measured in absolute or relative terms -Source: Dr. Williams’ Slide Set Disparity and difference are synonyms in most dictionaries. The population-based objectives in HP2010 are measured in terms of rates, percents, means, proportions, or some other quantitative measure. In the context of public health, a disparity is the quantity that separates a group from a reference point on a particular measure of health that is expressed in terms of a rate, proportion, mean, or some other quantitative measure. The purpose of the second goal of HP2010 is to call attention to differences in health between groups regardless of the cause…. To eliminate disparities, ultimately specific causes or determinants need to be identified. Changes in disparity over time can be measured in absolute or relative terms. ADD notes: see pages 7-8, Keppel et al. Source: “Slides for Judith.ppt” “Health Disparity” in Public Health – Operational Definition Quantitative measures: rates, percents, means… The Quantity that separates a group from a reference point on a particular measure of health Calls attention to differences in health between groups regardless of cause Can be measured in absolute or relative terms -Source: Dr. Williams’ Slide Set Disparity and difference are synonyms in most dictionaries. The population-based objectives in HP2010 are measured in terms of rates, percents, means, proportions, or some other quantitative measure. In the context of public health, a disparity is the quantity that separates a group from a reference point on a particular measure of health that is expressed in terms of a rate, proportion, mean, or some other quantitative measure. The purpose of the second goal of HP2010 is to call attention to differences in health between groups regardless of the cause…. To eliminate disparities, ultimately specific causes or determinants need to be identified. Changes in disparity over time can be measured in absolute or relative terms. ADD notes: see pages 7-8, Keppel et al. Source: “Slides for Judith.ppt”

4. Health Disparities Communities of Color are Disproportionately Affected Health Disparities Communities of Color are Disproportionately Affected We need to sharpen and intensify our national focus on health disparities so we can close up -- if not eliminate -- the health status gaps in this country. The need to take action could not be more urgent. Since 1950, considerable gains in health status have been documented in the United States among racial and ethnic minority groups. However, racial disparities in health have changed little since then. In fact in many health areas, the statistics show that the gap has actually widened for some health indicators. Source: “Slides for Judith.ppt” Health DisparitiesCommunities of Color are Disproportionately Affected We need to sharpen and intensify our national focus on health disparities so we can close up -- if not eliminate -- the health status gaps in this country. The need to take action could not be more urgent. Since 1950, considerable gains in health status have been documented in the United States among racial and ethnic minority groups. However, racial disparities in health have changed little since then. In fact in many health areas, the statistics show that the gap has actually widened for some health indicators. Source: “Slides for Judith.ppt”

5. Racial and Ethnic Minority Populations American Indian/Alaska Native (AI/AN) Asian American Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander (NHOPI) Racial and Ethnic Minority Populations: Dramatic and persistent health disparities have been described among -- American Indian/Alaska Native (AI/AN): People having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. -- Asian American: People having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. -- Black or African American: People having origins in any of the black racial groups of Africa. -- Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. -- Native Hawaiian or Other Pacific Islander (NHOPI): People having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Note: Census 2000 adheres to the federal standards for collecting and presenting data on race and Hispanic origin as established by the Office of Management and Budget (OMB) in October 1997 and subsequent guidelines.  One of the most important changes for Census 2000 was the revision of the questions on race and Hispanic origin to better reflect the country’s growing diversity. The federal government considers race and Hispanic origin to be two separate and distinct concepts. In addition, Asian Americans and Native Hawaiians and Other Pacific Islanders are counted as two separate and distinct racial groups. Because of these changes, the Census 2000 data on race are not directly comparable with data from the 1990 census or earlier censuses. Caution must be used when interpreting changes in the racial composition of the U.S. population over time. Sources: CDC’s Office of Minority Health (and Health Disparities), Definitions of Racial and Ethnic Populations, http://www.cdc.gov/omh/Populations/definitions.htm Racial and Ethnic Minority Populations: Dramatic and persistent health disparities have been described among -- American Indian/Alaska Native (AI/AN): People having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. -- Asian American: People having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. -- Black or African American: People having origins in any of the black racial groups of Africa. -- Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. -- Native Hawaiian or Other Pacific Islander (NHOPI): People having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Note: Census 2000 adheres to the federal standards for collecting and presenting data on race and Hispanic origin as established by the Office of Management and Budget (OMB) in October 1997 and subsequent guidelines.  One of the most important changes for Census 2000 was the revision of the questions on race and Hispanic origin to better reflect the country’s growing diversity. The federal government considers race and Hispanic origin to be two separate and distinct concepts. In addition, Asian Americans and Native Hawaiians and Other Pacific Islanders are counted as two separate and distinct racial groups. Because of these changes, the Census 2000 data on race are not directly comparable with data from the 1990 census or earlier censuses. Caution must be used when interpreting changes in the racial composition of the U.S. population over time. Sources: CDC’s Office of Minority Health (and Health Disparities), Definitions of Racial and Ethnic Populations, http://www.cdc.gov/omh/Populations/definitions.htm

6. Other Populations By . . . Socio-economic status Geography (urban or rural) Gender Age Disability status Risk status related to sex and gender Health disparities have been described among other Populations By . . . (insert definitions when they become available) -- Socio-economic status -- Geography (urban or rural) -- Gender -- Age -- Disability status -- High-risk status related to sex and gender Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)Health disparities have been described among other Populations By . . . (insert definitions when they become available) -- Socio-economic status -- Geography (urban or rural) -- Gender -- Age -- Disability status -- High-risk status related to sex and gender Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

7. OMHD Mission The Office of Minority Health and Health Disparities (OMHD) aims to accelerate CDC’s health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities. OMHD Mission OMHD aims to accelerate CDC’s health impact in the U.S. population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, and risk status related to sex and gender. Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD) (with revisions by Dr. Williams)OMHD Mission OMHD aims to accelerate CDC’s health impact in the U.S. population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, and risk status related to sex and gender. Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD) (with revisions by Dr. Williams)

8. What are OMHD Critical Goals? Equity in health impact Diversity in customer focus Access to and participation in public health systems Participation in the conduct and use of public health research to solve community wide health problems The benefits of global health protection, especially among immigrants and border populations A verifiable commitment to operational efficiency, program effectiveness, and accountability for public resources. What are OMHD Critical Goals? OMHD’s goals derive from the strategic imperatives and address CDC’s need to achieve health impact for at-risk populations: (1) equity in health impact, (2) diversity in customer focus, (3) access to and participation in public health systems, (4) participation in the conduct and use of public health research to solve community-wide health problems, (5) the benefits of global health protection, especially among immigrants, indigenous and border populations, and (6) a verifiable commitment to operational efficiency, program effectiveness, and accountability for public resources. Source: Increasing CDC’s Impact on Health Disparities, slide 14 Stakeholder Meeting on Health Equity2.pptWhat are OMHD Critical Goals? OMHD’s goals derive from the strategic imperatives and address CDC’s need to achieve health impact for at-risk populations: (1) equity in health impact, (2) diversity in customer focus, (3) access to and participation in public health systems, (4) participation in the conduct and use of public health research to solve community-wide health problems, (5) the benefits of global health protection, especially among immigrants, indigenous and border populations, and (6) a verifiable commitment to operational efficiency, program effectiveness, and accountability for public resources. Source: Increasing CDC’s Impact on Health Disparities, slide 14 Stakeholder Meeting on Health Equity2.ppt

9. What are the OMHD Core Functions? 1. Maintaining core functions of the Office of Minority Health (OMH) without loss of priority, resources, or visibility 2. Developing CDC-wide health disparities elimination strategies, policies, goals, and programs What are the OMHD Core Functions? 1. Maintaining core functions of the Office of Minority Health (OMH) without loss of priority, resources, or visibility -- Promoting minority heath and eliminating racial and ethnic health disparities -- Promoting health and preventing disease in Indian Country (i.e., American Indian and Alaska Native communities, their sovereign governments and other institutions in the U.S.) 2. Developing CDC-wide health disparities elimination strategies, policies, goals, and programs -- Defining disparities elimination sub-goals for each health impact goal -- Monitoring and reporting progress toward health disparities elimination goals -- Evaluating impact of policies and programs to achieve health disparities elimination Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)What are the OMHD Core Functions? 1. Maintaining core functions of the Office of Minority Health (OMH) without loss of priority, resources, or visibility-- Promoting minority heath and eliminating racial and ethnic health disparities -- Promoting health and preventing disease in Indian Country (i.e., American Indian and Alaska Native communities, their sovereign governments and other institutions in the U.S.) 2. Developing CDC-wide health disparities elimination strategies, policies, goals, and programs -- Defining disparities elimination sub-goals for each health impact goal -- Monitoring and reporting progress toward health disparities elimination goals -- Evaluating impact of policies and programs to achieve health disparities elimination Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

10. What are the OMHD Core Functions? 3. Managing health disparities elimination goals through scanning, analysis, knowledge management, decision-support systems, and reporting Key Performance Indicators *, Government Performance and Results Act**, Program Assessment Rating Tool*** *(GPRA) **( PART) ***(KPI) What are the OMHD Core Functions? 3. Managing health disparities elimination goals through scanning, analysis, knowledge management, decision-support systems, and reporting Key Performance Indicators *, Government Performance and Results Act**, Program Assessment Rating Tool*** -- Mobilizing resources and advocating for health disparities elimination programs -- Aligning use of resources with accomplishment of health disparities elimination goals *(GPRA) **( PART) ***(KPI) Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD) What are the OMHD Core Functions? 3. Managing health disparities elimination goals through scanning, analysis, knowledge management, decision-support systems, and reporting Key Performance Indicators *, Government Performance and Results Act**, Program Assessment Rating Tool*** -- Mobilizing resources and advocating for health disparities elimination programs -- Aligning use of resources with accomplishment of health disparities elimination goals *(GPRA) **( PART) ***(KPI) Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

13. CDC’s OMH, 1988-1998 Major Goals Assuring that policies direct activities toward minority health Enhancing research to reduce the disproportionate disease burden in minority groups Developing effective internal and external communication networks CDC’s OMH, 1988-1998 Major Goals Assuring that policies direct activities toward minority health Enhancing research to reduce the disproportionate disease burden in minority groups Developing effective internal and external communication networks Major goals of the CDC’s OMH during 1988-1998 are shown here. CDC’s OMH, 1988-1998 Major Goals Assuring that policies direct activities toward minority health Enhancing research to reduce the disproportionate disease burden in minority groups Developing effective internal and external communication networks Major goals of the CDC’s OMH during 1988-1998 are shown here.

14. Strategic Redirection of OMH, 1998 Executive retreat, agency-wide deliberations on draft paper on new vision/policy/strategy/action (1998) Senior Staff reviews, briefings & deliberations (1999-2001) Policy/Action items approved (Oct 2001) Strategic Redirection of OMH, 1998 Executive retreat, agency-wide deliberations on draft paper on new vision/policy/strategy/action (1998) Senior Staff reviews, briefings & deliberations (1999-2001) Policy/Action items approved (Oct 2001) New OMH Leadership appointed in 1998. In addition, the President had committed the Nation to eliminating health disparities, and Secretary Shalala and Surgeon General/ASH David Satcher were drawing national attention to the Healthy People 2010 health disparity elimination goal and leading the effort to develop an HHS response. A strategic planning process was initiated starting with an Executive retreat and agency-wide deliberations on draft paper describing a new, unified minority health vision/policy/strategy/action agenda (1998). Senior staff reviews, briefings, and deliberations occurred during 1999 -2001 (CIO Directors; Minority Health Coordinators (1999-2000), Senior Staff briefings & deliberations (Jan – Aug 2001)). Policy/Action items approved (Oct 2001). Strategic Redirection of OMH, 1998 Executive retreat, agency-wide deliberations on draft paper on new vision/policy/strategy/action (1998) Senior Staff reviews, briefings & deliberations (1999-2001) Policy/Action items approved (Oct 2001) New OMH Leadership appointed in 1998. In addition, the President had committed the Nation to eliminating health disparities, and Secretary Shalala and Surgeon General/ASH David Satcher were drawing national attention to the Healthy People 2010 health disparity elimination goal and leading the effort to develop an HHS response. A strategic planning process was initiated starting with an Executive retreat and agency-wide deliberations on draft paper describing a new, unified minority health vision/policy/strategy/action agenda (1998). Senior staff reviews, briefings, and deliberations occurred during 1999 -2001 (CIO Directors; Minority Health Coordinators (1999-2000), Senior Staff briefings & deliberations (Jan – Aug 2001)). Policy/Action items approved (Oct 2001).

15. Action Items for Improving Minority Health: 2000 - 2005 Cross- Cutting Actions: Activities each CIO should undertake Infrastructure: Mobilizing people, information systems, and resources Program Development and Implementation: Improving programs Monitoring and Accountability: Tracking and assuring quality Action Items for Improving Minority Health: 2000 – 2005 Cross- Cutting Actions: Activities each CIO should undertake Infrastructure: Mobilizing people, information systems, and resources Program Development and Implementation: Improving programs Monitoring and Accountability: Tracking and assuring quality Action Items for Improving Minority Health: 2000 – 2005 Cross- Cutting Actions: Activities each CIO should undertake Infrastructure: Mobilizing people, information systems, and resources Program Development and Implementation: Improving programs Monitoring and Accountability: Tracking and assuring quality

16. OMH Functions/Priorities 2001-2004 Strategic planning (minority health priorities) Policy initiatives (analysis, development) Leadership/coordination of minority health initiatives and Executive Branch activities Support for minority-serving institutions of higher learning Cooperative agreements to conduct research, prevention activities, student/faculty development Student traineeships Epidemiologic studies External partnerships (technical assistance/symposia) Direct support to CDC/ATSDR programs (SME) OMH Functions/Priorities 2001-2004 Strategic planning (minority health priorities) Policy initiatives (analysis, development) Leadership/coordination of minority health initiatives and Executive Branch activities Support for minority-serving institutions of higher learning Cooperative agreements to conduct research, prevention activities, student/faculty development Student traineeships Epidemiologic studies External partnerships (technical assistance/symposia) Direct support to CDC/ATSDR programs (SME) Note: Futures activities began, June 2003. Establishing a Strategic Vision/Effective Execution Major functions and operations Supporting evidence - based policy and action Providing leadership for Special Initiatives and Policy Enhancing effective internal and external partnerships Enhancing internship/fellowship opportunities Undertaking research targeting key populations Support to CDC programs Seeking resources to support activities OMH Functions/Priorities 2001-2004 Strategic planning (minority health priorities) Policy initiatives (analysis, development) Leadership/coordination of minority health initiatives and Executive Branch activities Support for minority-serving institutions of higher learning Cooperative agreements to conduct research, prevention activities, student/faculty development Student traineeships Epidemiologic studies External partnerships (technical assistance/symposia) Direct support to CDC/ATSDR programs (SME) Note: Futures activities began, June 2003. Establishing a Strategic Vision/Effective Execution Major functions and operations Supporting evidence - based policy and action Providing leadership for Special Initiatives and Policy Enhancing effective internal and external partnerships Enhancing internship/fellowship opportunities Undertaking research targeting key populations Support to CDC programs Seeking resources to support activities

17. Despite these significant successes, we want to make health disparities a much bigger focus for our entire agency The Futures Initiative provides an opportunity for CDC’s OMH, its partners, and the rest of CDC to do more, faster, to eliminate health disparities in the United States. I know there has been concern about how Futures will impact the Office of Minority Health. CDC’s executive leadership teams is examining ideas to strengthen – not weaken – its current efforts and activities. We want to place the Office of Minority Health where it can have optimal impact and this summer we held a conference call with over 30 external partners to get their input. One visible manifestation of this expanded effort: At each senior staff meeting, we go center by center, highlighting one particular program a month that is addressing health disparities in a direct way and identifying what lessons can we can learn from that and how we can utilize those lessons to improve our programs across the board. This spring CDC held a media conference on Racial/Ethnic Health Disparities Focusing on Heart Disease and HIV/AIDS First Conference on Increasing the Number of American Indian, Alaska Native, & Native Hawaiian Professionals in public health careers. (July 20 in Atlanta) Source: Improving Health, Eliminating Disparities, Oct. 27, 2004 – GerberdingMorehousePrimaryCareConference2b Despite these significant successes, we want to make health disparities a much bigger focus for our entire agency The Futures Initiative provides an opportunity for CDC’s OMH, its partners, and the rest of CDC to do more, faster, to eliminate health disparities in the United States. I know there has been concern about how Futures will impact the Office of Minority Health. CDC’s executive leadership teams is examining ideas to strengthen – not weaken – its current efforts and activities. We want to place the Office of Minority Health where it can have optimal impact and this summer we held a conference call with over 30 external partners to get their input. One visible manifestation of this expanded effort: At each senior staff meeting, we go center by center, highlighting one particular program a month that is addressing health disparities in a direct way and identifying what lessons can we can learn from that and how we can utilize those lessons to improve our programs across the board. This spring CDC held a media conference on Racial/Ethnic Health Disparities Focusing on Heart Disease and HIV/AIDS First Conference on Increasing the Number of American Indian, Alaska Native, & Native Hawaiian Professionals in public health careers. (July 20 in Atlanta) Source: Improving Health, Eliminating Disparities, Oct. 27, 2004 – GerberdingMorehousePrimaryCareConference2b

20. Population Data and Representative Mortality and Case Rates Population Data and Representative Mortality and Case Rates Added per Walter’s suggestionPopulation Data and Representative Mortality and Case Rates Added per Walter’s suggestion

21. Population by Race & Hispanic Origin United States, 2000 & Projected 2050 In 2000, non-Hispanic whites made up more than two-thirds of the total population, according to the 2000 US. Census. By the year 2050, the Census Bureau predicts the proportion of the population that is non-Hispanic white will diminish to just over half the total population. The largest increase is expected in the Asian American/Pacific Islander (AAPI) population, which is expected to almost triple it’s current size by 2050. The Hispanic/Latino population is expected to almost double by 2050. African American and American Indian/Alaska Native (AI/AN) populations are also expected to increase. (JW) The anticipated demographic changes magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population; therefore, the future health of America as a whole will be influenced substantially by improving the health of these racial and ethnic minorities. A national focus on disparities in health status is particularly important as major changes unfold in the way in which health care is delivered and financed. (1) A combination of three factors contribute to this shift in population distribution: differential fertility, differential net immigration, and differential age distributions among the race and Hispanic origin groups. Higher fertility rates and net immigration levels would elevate the increased proportions of of the expanding groups. At the same time, the non-Hispanic population would experience an increase in the number of deaths as more and more of this population enters old age groups where the risk of mortality is the highest. (2) Slide sources (3-5)Population by Race & Hispanic Origin United States, 2000 & Projected 2050 In 2000, non-Hispanic whites made up more than two-thirds of the total population, according to the 2000 US. Census. By the year 2050, the Census Bureau predicts the proportion of the population that is non-Hispanic white will diminish to just over half the total population. The largest increase is expected in the Asian American/Pacific Islander (AAPI) population, which is expected to almost triple it’s current size by 2050. The Hispanic/Latino population is expected to almost double by 2050. African American and American Indian/Alaska Native (AI/AN) populations are also expected to increase. (JW) The anticipated demographic changes magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population; therefore, the future health of America as a whole will be influenced substantially by improving the health of these racial and ethnic minorities. A national focus on disparities in health status is particularly important as major changes unfold in the way in which health care is delivered and financed. (1) A combination of three factors contribute to this shift in population distribution: differential fertility, differential net immigration, and differential age distributions among the race and Hispanic origin groups. Higher fertility rates and net immigration levels would elevate the increased proportions of of the expanding groups. At the same time, the non-Hispanic population would experience an increase in the number of deaths as more and more of this population enters old age groups where the risk of mortality is the highest. (2) Slide sources (3-5)

22. Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2002 Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2002 Overall, infant mortality is much higher for African Americans and American Indians/Alaska Natives (AI/ANs) when compared with other groups (13.8 and 8.6 per 1,000 live births, respectively). However, this slide shows that infant mortality rates also vary widely within racial/ethnic groups. For example, Asian Americans and Pacific Islanders (AAPIs) have the lowest overall infant mortality rate (4.8), but the rate for Native Hawaiians (9.6) is more than three times the rate for Chinese Americans (3.0), and higher than the rate for AI/ANs (8.6). Similarly, the rate for Puerto Ricans (8.2) is more than twice as high as for Cubans (3.7), both subgroups of the Hispanic/Latino population. (JW) Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6): All populations: 55.5 American Indian: 124.2 Non-Hispanic white: 50.4 Asian/Pacific Islander: 15.5 African American: 122.9 Hispanic/Latino: 29.3 Another significant cause of disparities in infant mortality is disorders related to short gestation and low birthweight. Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6): All populations: 109.5 American Indian: 71.6 Non-Hispanic white: 76.2 Asian/Pacific Islander: 46.9 African American: 302.7 Hispanic/Latino: 78.9 Slide source (7)Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2002 Overall, infant mortality is much higher for African Americans and American Indians/Alaska Natives (AI/ANs) when compared with other groups (13.8 and 8.6 per 1,000 live births, respectively). However, this slide shows that infant mortality rates also vary widely within racial/ethnic groups. For example, Asian Americans and Pacific Islanders (AAPIs) have the lowest overall infant mortality rate (4.8), but the rate for Native Hawaiians (9.6) is more than three times the rate for Chinese Americans (3.0), and higher than the rate for AI/ANs (8.6). Similarly, the rate for Puerto Ricans (8.2) is more than twice as high as for Cubans (3.7), both subgroups of the Hispanic/Latino population. (JW) Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6): All populations: 55.5 American Indian: 124.2 Non-Hispanic white: 50.4 Asian/Pacific Islander: 15.5 African American: 122.9 Hispanic/Latino: 29.3 Another significant cause of disparities in infant mortality is disorders related to short gestation and low birthweight. Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6): All populations: 109.5 American Indian: 71.6 Non-Hispanic white: 76.2 Asian/Pacific Islander: 46.9 African American: 302.7 Hispanic/Latino: 78.9 Slide source (7)

23. Updated 5/8/07 Infant mortality is much higher for African Americans and American Indians when compared with other groups. This slide demonstrates that infant mortality can vary widely within racial/ethnic groups. For example, Cuban Americans have the lowest rate of infant mortality for any subgroup, but Puerto Ricans have one of the highest rates. Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in the US for 2001 are as follow: All populations: 56 per 1,000 Non-Hispanic white: 50 per 1,000 African American: 123 per 1,000 American Indian: 124 per 1,000 Asian/Pacific Islander: 16 per 1,000 Hispanic/Latino29 per 1,000 Source: National Vital Statistics Report Nov. 7, 2003, 52(9): 69-77 http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_09.pdf Updated 5/8/07 Infant mortality is much higher for African Americans and American Indians when compared with other groups. This slide demonstrates that infant mortality can vary widely within racial/ethnic groups. For example, Cuban Americans have the lowest rate of infant mortality for any subgroup, but Puerto Ricans have one of the highest rates. Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in the US for 2001 are as follow: All populations: 56 per 1,000 Non-Hispanic white: 50 per 1,000 African American: 123 per 1,000 American Indian: 124 per 1,000 Asian/Pacific Islander: 16 per 1,000 Hispanic/Latino29 per 1,000 Source: National Vital Statistics Report Nov. 7, 2003, 52(9): 69-77 http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_09.pdf

24. Sudden Infant Death Syndrome Rates per 1,000 Live Births by Race and Hispanic Origin: U.S., 2001 Though American Indians/Alaska Natives (AI/ANs) have an infant mortality rate that is significantly lower than African Americans, the rate of Sudden Infant Death Syndrome (SIDS) is slightly higher among AI/ANs than African Americans, and significantly higher than among other populations – 2.2 times higher than among all populations combined. (JW) Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6): All populations: 55.5 American Indian: 124.2 Non-Hispanic white: 50.4 Asian/Pacific Islander: 15.5 African American: 122.9 Hispanic/Latino: 29.3 Another significant cause of disparities in infant mortality is short gestation and low birthweight. Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6): All populations: 16.0 American Indian: 8.0 Non-Hispanic white: 13.3 Asian/Pacific Islander: 12.7 African American: 21.6 Hispanic/Latino: 14.4 Slide source (6)Sudden Infant Death Syndrome Rates per 1,000 Live Births by Race and Hispanic Origin: U.S., 2001 Though American Indians/Alaska Natives (AI/ANs) have an infant mortality rate that is significantly lower than African Americans, the rate of Sudden Infant Death Syndrome (SIDS) is slightly higher among AI/ANs than African Americans, and significantly higher than among other populations – 2.2 times higher than among all populations combined. (JW) Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS). The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6): All populations: 55.5 American Indian: 124.2 Non-Hispanic white: 50.4 Asian/Pacific Islander: 15.5 African American: 122.9 Hispanic/Latino: 29.3 Another significant cause of disparities in infant mortality is short gestation and low birthweight. Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6): All populations: 16.0 American Indian: 8.0 Non-Hispanic white: 13.3 Asian/Pacific Islander: 12.7 African American: 21.6 Hispanic/Latino: 14.4 Slide source (6)

26. Age-Adjusted Mortality Rates per 100,000 Persons by Race/Ethnicity for 3 Health Focus Areas: U.S., 2003 Age-Adjusted Mortality Rates per 100,000 Persons by Race/Ethnicity for 3 Health Focus Areas (Heart Disease, Cancer, Stroke): U.S., 2002 African Americans have the highest all-cause death rate (1083.3 per 100,000), and as this slide shows, the highest death rate for three of the leading causes of death. They also lead in deaths from diabetes (49.5, vs. 25.4 per 100,000 for all populations); homicide (21.0, vs. 6.1 per 100,000 for all populations); influenza and pneumonia (24.0, vs. 22.6 per 100,000 for all populations); and breast (34.0), prostate (62.0), and lung cancer (61.9). (All populations cancer death rates, Breast: 25.6, Prostate: 27.9, Lung: 54.9.). (9) African Americans have a higher cancer death rate than white Americans, even though white Americans have a higher prevalence of cancer -- 7.8% for whites, compared to 3.4% for African Americans. This suggests some racial disparity in cancer screening and/or treatment. (10) Slide source (9)Age-Adjusted Mortality Rates per 100,000 Persons by Race/Ethnicity for 3 Health Focus Areas (Heart Disease, Cancer, Stroke): U.S., 2002 African Americans have the highest all-cause death rate (1083.3 per 100,000), and as this slide shows, the highest death rate for three of the leading causes of death. They also lead in deaths from diabetes (49.5, vs. 25.4 per 100,000 for all populations); homicide (21.0, vs. 6.1 per 100,000 for all populations); influenza and pneumonia (24.0, vs. 22.6 per 100,000 for all populations); and breast (34.0), prostate (62.0), and lung cancer (61.9). (All populations cancer death rates, Breast: 25.6, Prostate: 27.9, Lung: 54.9.). (9) African Americans have a higher cancer death rate than white Americans, even though white Americans have a higher prevalence of cancer -- 7.8% for whites, compared to 3.4% for African Americans. This suggests some racial disparity in cancer screening and/or treatment. (10) Slide source (9)

27. Age-Adjusted Death Rates per 100,000 Persons by Race, & Hispanic Origin for Diabetes Mellitus: U.S., 2004 Age-Adjusted Death Rates per 100,000 Persons by Race, & Hispanic Origin for Diabetes Mellitus: U.S., 2002 Though African Americans have the highest diabetes death rate, data from 2000 show that American Indians and Alaska Natives (AI/ANs) were 2.6 times more likely to have diagnosed diabetes compared with non-Hispanic whites, African Americans were 2.0 times more likely, and Hispanics were 1.9 times more likely. (11) Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world (12): 50% of Pima Indians in Arizona who are between the ages of 30 and 64 have type 2 diabetes. (13) A new study by the Centers for Disease Control and Prevention (CDC) and the Indian Health Service (IHS) reveals dramatic increases among young American Indians and Alaska Natives and raises concerns about the impact of diabetes on future generations of Native Americans. Most cases of diabetes among Native Americans are type 2, the most common form of the disease, and is associated with modifiable risk factors such as obesity and inactivity. (12) Slide source (9)Age-Adjusted Death Rates per 100,000 Persons by Race, & Hispanic Origin for Diabetes Mellitus: U.S., 2002 Though African Americans have the highest diabetes death rate, data from 2000 show that American Indians and Alaska Natives (AI/ANs) were 2.6 times more likely to have diagnosed diabetes compared with non-Hispanic whites, African Americans were 2.0 times more likely, and Hispanics were 1.9 times more likely. (11) Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world (12): 50% of Pima Indians in Arizona who are between the ages of 30 and 64 have type 2 diabetes. (13) A new study by the Centers for Disease Control and Prevention (CDC) and the Indian Health Service (IHS) reveals dramatic increases among young American Indians and Alaska Natives and raises concerns about the impact of diabetes on future generations of Native Americans. Most cases of diabetes among Native Americans are type 2, the most common form of the disease, and is associated with modifiable risk factors such as obesity and inactivity. (12) Slide source (9)

28. Age-Adjusted Case Rates Per 100,000 Persons by Race/Ethnicity for Tuberculosis (TB): U.S., 2001 Asian Americans and Pacific Islanders (AAPIs) are 2.4 times as likely to have Tuberculosis (TB) as African Americans, and 5.8 times as likely as all races. (JW) Several important factors likely contribute to the disproportionate burden of TB in minorities.  In foreign-born persons from countries where TB is common, TB disease may result from infection acquired in the country of origin.  In racial and ethnic minorities, unequal distribution of TB risk factors, such as HIV infection, may also contribute to increased exposure to TB or to an increased risk of developing TB once infected with M. tuberculosis.  However, much of the increased risk of TB in minorities has been linked to lower socioeconomic status and the effects of crowding, particularly among U.S.-born persons. (14) Slide source (15) Age-Adjusted Case Rates Per 100,000 Persons by Race/Ethnicity for Tuberculosis (TB): U.S., 2001 Asian Americans and Pacific Islanders (AAPIs) are 2.4 times as likely to have Tuberculosis (TB) as African Americans, and 5.8 times as likely as all races. (JW) Several important factors likely contribute to the disproportionate burden of TB in minorities.  In foreign-born persons from countries where TB is common, TB disease may result from infection acquired in the country of origin.  In racial and ethnic minorities, unequal distribution of TB risk factors, such as HIV infection, may also contribute to increased exposure to TB or to an increased risk of developing TB once infected with M. tuberculosis.  However, much of the increased risk of TB in minorities has been linked to lower socioeconomic status and the effects of crowding, particularly among U.S.-born persons. (14) Slide source (15)

31. Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Chronic Liver Disease & Cirrhosis: U.S., 2004 Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Chronic Liver Disease & Cirrhosis: U.S., 2002 Analysis shows a strong correlation between death rates from liver cirrhosis, regardless of cause, and drinking levels nationwide. Consistent with this association, deaths from chronic liver disease and cirrhosis are about 4 times more prevalent among American Indians/Alaska Natives (AI/ANs) than among the general US population. However Hispanics/Latinos are approximately twice as likely as whites to die from cirrhosis or liver disease, despite a lower prevalence of drinking and heavy drinking. (19) The reason for this discrepancy is unclear. Evidence exists that Hispanics/Latinos tend to consume alcohol in higher quantities per drinking occasion than do whites, resulting in a higher cumulative dose of alcohol. Data from nationwide surveys of adults show that both current drinking (defined as consumption of 12 or more drinks in the past year) and heavy drinking are most prevalent among AI/ANs and Native Hawaiians and lowest among AAPIs. (19) Slide source (9)Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Chronic Liver Disease & Cirrhosis: U.S., 2002 Analysis shows a strong correlation between death rates from liver cirrhosis, regardless of cause, and drinking levels nationwide. Consistent with this association, deaths from chronic liver disease and cirrhosis are about 4 times more prevalent among American Indians/Alaska Natives (AI/ANs) than among the general US population. However Hispanics/Latinos are approximately twice as likely as whites to die from cirrhosis or liver disease, despite a lower prevalence of drinking and heavy drinking. (19) The reason for this discrepancy is unclear. Evidence exists that Hispanics/Latinos tend to consume alcohol in higher quantities per drinking occasion than do whites, resulting in a higher cumulative dose of alcohol. Data from nationwide surveys of adults show that both current drinking (defined as consumption of 12 or more drinks in the past year) and heavy drinking are most prevalent among AI/ANs and Native Hawaiians and lowest among AAPIs. (19) Slide source (9)

35. Extra Data Slides

36. Updated 5/8/07Updated 5/8/07

37. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR MALIGNANT NEOPLASMS: U.S., 2004. Updated 5/8/07Updated 5/8/07

38. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR ISCHEMIC HEART DISEASE: U.S., 2004. Updated 5/8/07Updated 5/8/07

39. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR CEREBROVASCULAR DISEASES: U.S., 2004. Updated 5/8/07Updated 5/8/07

40. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR PROSTATE CANCER: U.S., 2004. Updated 5/8/07Updated 5/8/07

41. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR TRACHEA, BRONCHUS, & LUNG CANCER: U.S., 2004. Updated 5/8/07Updated 5/8/07

42. AGE-ADJUSTED DEATH RATES PER 100,000 PERSONS BY RACE & HISPANIC ORIGIN FOR UNINTENTIONAL INJURIES: U.S., 2004. Updated 5/8/07Updated 5/8/07

43. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR CHRONIC LOWER RESPIRITORY DISEASE: U.S., 2004. Updated 5/8/07Updated 5/8/07

44. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR BREAST CANCER: U.S., 2004. Updated 5/8/07Updated 5/8/07

45. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR COLON, RECTUM, & ANUS CANCER: U.S., 2004. Updated 5/8/07Updated 5/8/07

46. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR INFLUENZA & PNEUMONIA: U.S., 2004. Updated 5/8/07Updated 5/8/07

47. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR SUICIDE: U.S., 2004. Updated 5/8/07Updated 5/8/07

48. AGE-ADJUSTED MORTALITY RATES PER 100,000 PERSONS BY RACE/ETHNICITY FOR HOMICIDE: U.S., 2004. Updated 5/8/07Updated 5/8/07