BIOMEDICAL POLITICS: Democrats Blast a Sunny-Side
Look at U.S. Health Disparities
Jocelyn Kaiser - Science 2004 303(5657): p.
451a also on-line at "SCIENCE NOW" (Science's
On-line website)  - 16 January 2004

A Rosy Look at Health Disparities

When Congress ordered up a report on racial and
socioeconomic disparities in the health of U.S.
citizens, it wasn't expecting a smiley face. But
that's what it got, according to Representative
Henry Waxman (D-CA), who this week accused the
Bush Administration of whitewashing federal
researchers' conclusions. Administration
officials deny that they softened the December
report; they say editors emphasized "successes"
in the summary only because that is the best way
to encourage improvements in health care.

Half-full of gloss? Critics say this report
paints an overly rosy picture of health
disparities.

At issue is the 196-page National Healthcare
Disparities Report, authored by three researchers
at the Agency for Healthcare Research and Quality
(AHRQ). It is packed with data on health care
treatment and outcomes for many diseases
affecting minority groups and the poor. Waxman's
Democratic staff on the Government Reform
Committee compared the final version with a June
2003 draft and concluded that Health and Human
Services (HHS) officials scrubbed the executive
summary.

The draft stated, for example, that "racial,
ethnic, and socioeconomic disparities are
national problems." The final version simply says
that "some socioeconomic, racial, ethnic, and
geographic differences exist." The final summary
omits statements saying inequalities are
"significant" and "pervasive" and also drops some
striking examples of inequalities such as higher
rates of deaths from AIDS and incidence of
late-stage cancer among minorities. New wording,
however, notes that "some 'priority populations'
do as well or better than the general population
in some aspects of health care."

AHRQ spokesperson Karen Migdail says that
"revisions were done to use successes ... as a
catalyst for change," which she describes as a
"glass half-full approach." She says that "this
Administration has made reducing health
disparities a major priority." She adds that "not
a number was changed" in the body of the report.

Some health policy experts agree with Waxman that
the final summary gives a distorted view. Donald
Steinwachs of the Johns Hopkins Bloomberg School
of Public Health, who served on an Institute of
Medicine panel on health inequities, says that
panel's 2002 report was "very similar in tone" to
the draft HHS report, emphasizing that
disparities "have to be a national priority." The
U.S. Surgeon General during the Clinton
Administration agrees: "I'm concerned that the
report [has lost] a sense of urgency," says David
Satcher, now at the Morehouse College of Medicine
in Atlanta.

--JOCELYN KAISER

Related sites:
Waxman's analysis:
http://www.house.gov/reform/min/politicsandscience/example_disparities.htm
The National Healthcare Disparities 2004 report
(PDF, labeled "prepublication copy" ):

http://qualitytools.ahrq.gov/disparitiesreport/documents/NHDR.pdf
Institute of Medicine 2002 report on health
disparities: http://www.iom.edu/report.asp?id=4475