Eliminating Health Disparities Requires Community Involvement

March 20, 2002

(Center for the Advancement of Health) -- Successful programs to lessen racial and ethnic health disparities share common traits of establishing strong ties between health providers and the community members they serve, according to a group of studies just published.

Areas in which innovative programs are having a positive effect are: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS and immunization, reports the journal Health Promotion Practice in the April issue, devoted to the subject of eliminating racial and ethnic health disparities.

"Based on this collection of articles, the most successful interventions to narrow the gap in health disparities build community involvement and trust," says Kathleen Roe, Dr.PH, professor at San Jose State University and co-editor of the theme issue. "It is essential to enlist the help of community representatives, involve community members in prioritizing issues and address fundamental policy changes at the neighborhood, organizational and institutional levels."

The articles describe innovative methods occurring in local health departments, community-based organizations, clinics, churches, prisons, barber and beauty shops, neighborhoods and professional organizations all over the United States.

"This theme issue addresses critical factors related to health disparities -- socioeconomics, historical mistrust of research and medical institutions, lack of culturally relevant interventions, inaccurate individual health beliefs, and racism and discrimination within communities and institutions," says Stephen Thomas, Ph.D., professor of minority health at the University of Pittsburgh and co-editor of the issue.

Among the programs studied were those aimed at Asian and Pacific Islander women, Latinas and African American girls.

Asian and Pacific Islander (AAPI) women have the lowest cancer screening rates compared to other ethnic groups, and breast cancer is the number one killer among AAPI females. A study of seven AAPI communities conducted by Sonja Park Tajasiri, Dr.PH, MPH, and colleagues in Los Angeles and Orange Counties, Calif., found low levels of baseline breast and cervical cancer screening were due to high un-insurance rates, severe language barriers to accessing even publicly funded care facilities, strong cultural taboos against men and women jointly discussing female examinations, long waits at doctors' offices and reliance on traditional remedies. Other screening barriers included lack of time off from work, lack of transportation, lack of child care and lack of female doctors. Because certain barriers are more pronounced than others among the seven different subpopulations of AAPI women, the researchers caution against using a "one-size-fits-all" approach.

Despite nationwide progress in reducing HIV/AIDS, Latinas have a six-fold higher case rate than non-Hispanic white women and are twice as likely than whites to die from AIDS by age 29. Hortensia Amaro and colleagues studied changes in Latinas' HIV knowledge, attitudes and behaviors from baseline to 12 weeks, 3-month follow-up, and 15 months later in both control and intervention groups. While Latinas who attended the educational sessions in Boston showed gains in knowledge at the 3-month post-intervention session compared to controls, these changes were not evident at 15 months. The authors stressed the need for periodic booster sessions as well as engaging Latino males in prevention efforts and changing community norms regarding the acceptability of condom use.