Foreword

Thomas R. Frieden, MD, MPH

Director, CDC

CDC works 24 hours a day, seven days a week protecting people in the United States from health threats in order to save lives, promote health, and reduce costs. Achieving health equity, eliminating health disparities, and improving health in the United States are overarching goals to improve and protect our nation's health.

Over the past 50 years, the United States has made significant progress toward these important goals. Life expectancy increased from just under 70 years in 1960 to approximately 79 years in 2011 (1,2). People are living longer, healthier, and more productive lives. However, this upward trend is neither as rapid as it should be — we lag behind dozens of other nations (3) – nor is it uniformly experienced by people in the United States.

In fact, these two shortcomings of our health system are distinct but related. Our overall health status does not achieve our potential. An important part of this — even though preventable illness, injury, disability, and death affect all segments of society — is that life expectancy and other key health outcomes vary greatly by race, sex, socioeconomic status, and geographic location. In the United States, whites have a longer healthy life expectancy than blacks, and women live longer than men (4). There are also marked regional differences, with much lower life expectancy among both white and black Americans who live in the Southeast (4).

CDC Health Disparities and Inequalities Report — United States, 2013 is the second agency report examining some of the key factors that affect health and lead to health disparities in the United States. Four findings bring home the enormous personal tragedy of health disparities:

• Cardiovascular disease is the leading cause of death in the United States. Non-Hispanic black adults are at least 50% more likely to die of heart disease or stroke prematurely (i.e., before age 75 years) than their non-Hispanic white counterparts (5).
• The prevalence of adult diabetes is higher among Hispanics, non-Hispanic blacks, and those of other or mixed races than among Asians and non-Hispanic whites. Prevalence is also higher among adults without college degrees and those with lower household incomes (6).
• The infant mortality rate for non-Hispanic blacks is more than double the rate for non-Hispanic whites. Rates also vary geographically, with higher rates in the South and Midwest than in other parts of the country (7).
• Men are far more likely to commit suicide than women, regardless of age or race/ethnicity, with overall rates nearly four times those of women. For both men and women, suicide rates are highest among American Indians/Alaska Natives and non-Hispanic whites (8).

CDC and its partners work to identify and address the factors that lead to health disparities among racial, ethnic, geographic, socioeconomic, and other groups so that barriers to health equity can be removed. The first step in this process is to shine a bright light on the problem to be solved. Providing accurate, useful data on the leading causes of illness and death in the United States and across the world is a foundation of CDC's mission and work.

In 1966, Martin Luther King said that "Of all the forms of inequality, injustice in health care is the most shocking and inhumane" (9). Nearly a half century after Reverend King made this observation, we have made some but not nearly enough progress in reducing the barriers to equitable health care and to health equity. We should work with what he called "the fierce urgency of now" to eliminate this form of inequality wherever and whoever it affects.

As Secretary of Health and Human Services Kathleen G. Sebelius has said, "Health equity benefits everyone" (10). Every person who dies young, is avoidably disabled, or is unable to function at their optimal level represents not only a personal and family tragedy but also impoverishes our communities and our country. We are all deprived of the creativity, contributions, and participation that result from disparities in health status.

Eliminating the burden of racial and ethnic health disparities is not easy, but it can be done. For example, 20 years ago the Vaccines for Children (VFC) program was created to provide vaccines at no cost to eligible children. It is now one of our country's most successful public health initiatives (11). By removing cost barriers associated with vaccines, the VFC program has protected millions of children from diseases — both those who participated directly in the program and others — and has helped to virtually eliminate disparities in childhood vaccination rates. More recently, the Affordable Care Act (12), with its provisions to require insurer coverage of preventive services without cost to patients and to increase health insurance access for millions of previously uninsured Americans (13,14), provides a powerful opportunity to further reduce health disparities.

Achieving health equity requires the hard work of many people and organizations. CDC's many partners can use the information in this report to stimulate action to further reduce health disparities. The future health of our nation will be determined, to a large extent, by how effectively federal, state, and local agencies and private organizations work with communities to eliminate health disparities among populations that continue to experience a disproportionate burden of disease, disability, injury, and death.

References

1. Arias E. United States life tables, 2008. Natl Vital Stat Rep 2012;61(3).
2. Hoyert DL, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep 2012;61(6).
3. World Health Organization. World health statistics 2013. Geneva, Switzerland: World Health Organization; 2013.
4. CDC. State-specific healthy life expectancy at age 65 years—United States, 2007–2009. MMWR 2013;62:561–6.
5. CDC. Coronary heart disease and stroke deaths—United States, 2009. In: CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3):155-8.
6. CDC. Diabetes—United States, 2006 and 2010. In: CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3):97-102.
7. CDC. Infant deaths—United States, 2005-2008. In: CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3):169-72.
8. CDC. Suicides—United States, 2005-2009. In: CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3):177-81.
9. Families USA. Martin Luther King Jr.: A civil rights icon's thoughts on health care. Available at http://www.standupforhealthcare.org/blog/martin-luther-king-jr-a-civil-rights-icon-s-thoughts-on-health-care.
10. U.S. Department of Health and Human Services. HHS action plan to reduce racial and ethnic health disparities. Washington, DC: US Department of Health and Human Services; 2012. Available at http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf.
11. CDC. Vaccines for children program (VFC). Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/vaccines/programs/vfc/index.html.
12. US Department of Health and Human Services. Read the Law: The Affordable Care Act, Section by Section. Washington, DC: US Department of Health and Human Services; 2012. Available at http://www.hhs.gov/healthcare/rights/law/index.html.
13. Congressional Budget Office.  CBO's February 2013 estimate of the effects of the Affordable Care Act on health insurance coverage. Washington, DC: Congressional Budget Office; 2013. http://cbo.gov/sites/default/files/cbofiles/attachments/43900_ACAInsuranceCoverageEffects.pdf.
14. US Centers for Medicare and Medicaid Services. How does the health-care law protect me? Baltimore, MD: US Centers for Medicare and Medicaid Services; 2012. Available at https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part8=undefined/part=1.