Bridging the Divide: A Call to Action By the Congressional Black Caucus to Eliminate Racial Health Disparities

Floor Speech

BREAK IN TRANSCRIPT

Mrs. BEATTY. Mr. Speaker, I rise this evening, along with my colleague, Congressman Hakeem Jeffries of the Eighth Congressional District of New York, for tonight's Congressional Black Caucus Special Order hour, Bridging the Divide: A Call to Action By the Congressional Black Caucus to Eliminate Racial Health Disparities.

Mr. Speaker, tonight, the Congressional Black Caucus comes to the House floor to discuss our overarching goal of promoting equality for African Americans across the healthcare spectrum.

Mr. Speaker, it is well known that poverty, socioeconomic status, and health disparities are closely linked and latched together. For example, individuals with low incomes tend to have more restricted access to medical care and face greater financial barriers to affordable health care, oftentimes contributing to health disparities.

Last week, Mr. Speaker, the House Republicans released their Conference's poverty plan called A Better Way. Unfortunately, but not unexpectedly, this Republican antipoverty proposal isn't a better way, Mr. Speaker. It isn't even a new way. Quite frankly, Mr. Speaker, it is the wrong way. It uses the same trickle-down, discredited policies that House Republicans have put forth in the past.

The House Republicans' poverty elimination proposal would repeal the Affordable Care Act and undermine affordable, quality health coverage that millions of Americans are now enjoying. It would also cut Medicaid, the Children's Health Insurance Program that we refer to as CHIP, and it would end the Medicare guarantee--programs with proven successes, Mr. Speaker, in reducing health disparities. So this is, in part, why we are here tonight.

We know that health coverage is the first step in securing better healthcare outcomes, and Medicaid and CHIP play a vital role in opening the doorway to the needed health care, especially for our children.

As we address the most pressing challenges in achieving health equity and equality for African Americans, I want hardworking American families to know that they have voices in Congress that aim to protect their safety, invest in their future, and provide affordable health care for all.

With the Affordable Care Act, which every member of the Congressional Black Caucus supported when it passed, we have improved access. We have improved affordability and quality of health care.

So tonight, Mr. Speaker, I want to thank President Obama for moving the needle forward in helping American families and African American families across this great country and Nation to have the financial and health security that comes with health care.

Mr. Speaker, we cannot repeal the ACA. We must continue to improve and strengthen it, and we will still have more work to do.

The Congressional Black Caucus, from its very inception, has long been the voice for bridging the divide on racial healthcare disparities. No, Mr. Speaker; we have been the voice for standing up for American people, and especially individuals who are African American, against all disparities. We will not only come to this floor tonight. We will continue our fight and we will continue to come to this floor.

Tonight, you are going to hear a lot of our members weave together our poverty plan. You are going to have members talk about gun violence. You are going to have members talk about all lives matter. If we don't end the gun violence, then we are not going to have a healthy nation.

Tonight, I want to applaud my good friend and colleague, Congresswoman Robin Kelly of the Second District of Illinois, chair of our Congressional Black Caucus Health Braintrust. I want to commend her for her report, the 2015 Kelly Report on Health Disparities in America, the official congressional analysis of the state of African Americans' health in the United States, and her work on the 40 Under 40 Leaders in Health Awards, leaders under 40 who are physicians and medical professionals. And lastly, let me just thank her for her courage and her leadership for recognizing that all lives matter.

We cannot come to this House floor and talk about poverty programs and health care and education and about finance if we do not bridge the gap with gun violence. I salute her for no longer standing up until we make a difference.

So tonight, we are coming, Mr. Speaker, with a strong call to action for us to keep this wonderful America healthy. You will hear from Congresswoman Kelly momentarily.

He is a chairman who has been a longtime advocate and voice for not only the Congressional Black Caucus, but for his constituents in his congressional district in North Carolina. Tonight, he speaks for us. Tonight, he speaks for the call of action of us to bridge the gap.

BREAK IN TRANSCRIPT

Mrs. BEATTY. I thank Congressman Butterfield for making us aware of 136 mass shootings in 164 days of this year. Certainly, that is relevant to tonight's topic, because whether it is death by guns or death by healthcare disparities, there are too many deaths.

I think you said it so well when you provided the data and the statistics of African American men and their mortality rates and what is happening to them. And yes, African Americans lag behind, and that is why we stand with you bridging the gap and for this call of action.

Kelly) from the Second Congressional District, my colleague, my confidant, and my friend. She is a champion of expanding health care. She is a champion, Mr. Speaker, of making sure that we understand that healthcare disparities must end.

She is the chair of the powerful and most prestigious Congressional Black Caucus Health Braintrust. She strives to increase healthcare opportunities for all: for our children, for our senior citizens, and for residents of the underserved communities. It is my honor to ask her to provide some information on today's topic.

BREAK IN TRANSCRIPT

Mrs. BEATTY. I thank the gentlewoman from Illinois, (Ms. Kelly). And how appropriate for tonight for the gentlewoman to remind us, as I ask her to constantly do, about why we must, to put it in her words, come together. We must do something.

Madam Speaker, tonight we say to you and to our Republican colleagues: Come together and do something.

I say to the gentlewoman, Congresswoman Kelly: Let today serve as a turning point in our Nation's ongoing struggle to stamp out hate of all forms. We must mourn those who lost their family members, but we must do more than mourn. We must have action. If we are going to have a hope for a better America, hate has no place in this great Nation.

So I thank the gentlewoman, and I will continue to remind others that we know firsthand what it does to our community.

But, Madam Speaker, we stand here tonight speaking to all communities. But here is what we know. The NAACP has shared with us that African American children and teens accounted for 45 percent of all child and teen gun deaths in 2008 and 2009, but were only 15 percent of the total child population.

The FBI says that approximately 47 percent of victims of the 165,000 homicides from 2000 to 2010, including over 111,000 gun-related homicides, were Black.

The Children's Defense Fund, Madam Speaker, says that in 2010, Black males between the ages of 15 and 19 were nearly 30 times more likely to die in a gun homicide than White males of the same age, and more than three times more likely to die in a gun homicide than Hispanic males of the same age.

So, Madam Speaker, tonight you will hear us repeatedly make a call for action. You will hear us repeatedly quote great leaders. And I think it is worth quoting again what Congresswoman Kelly said, in the words of Dr. Martin Luther King: ``Of all the forms of inequality, injustice in health care is the most shocking and inhumane'' of all inequalities, of all injustices.

As we speak of great leaders, it is, indeed, my honor and my privilege to ask my colleague, the gentleman from the 10th Congressional District of New Jersey (Mr. Payne), a man who has made a name for himself, a man who understands firsthand as a father of triplets, as a spouse, as a ranking member on Homeland Security's Subcommittee on Emergency Preparedness, Response, and Communications, a man who has been at the forefront in his community, a man who served before coming here as an elected official, but, more importantly, a person who understands health disparities and the call for action--it gives me great honor to yield to the gentleman from New Jersey (Mr. Payne) to share some wisdom with us tonight.

BREAK IN TRANSCRIPT

Mrs. BEATTY. I thank Congressman Payne so much for giving us such compelling information and data and reminding us that the time is now for us to enact those programs that work, and the time is now for us to understand what is at risk. Also, let me thank the gentleman for his role on the Congressional Men's Health Caucus.

At this time, I yield to the gentlewoman from the State of Texas (Ms. Jackson Lee). The gentlewoman from the 18th Congressional District of Texas is someone who I am always amazed when she comes to the mic, someone who is well researched, and someone who delivers an oratorical message that makes us take pause and pay attention.

Tonight, I would like to say that Congresswoman Sheila Jackson Lee is a movement. Earlier, I heard her use that word in talk about how we, Madam Speaker, must be the movement against violence, that we must be leading that movement against these disparities in health care.

BREAK IN TRANSCRIPT

Mrs. BEATTY. Madam Speaker, I thank Congresswoman Sheila Jackson Lee for reminding us that we should be done with guns like the assault weapons. I thank the gentlewoman for reminding us of the impact that health disparities have on our communities in this Nation.

Madam Speaker, I have two documents that will be entered into the Record.

The first document is from Congresswoman Eddie Bernice Johnson. I would like to state for the Record that she was the first nurse to serve in this United States Congress. And the second is a portion of the Special Feature on Racial and Ethnic Health Disparities: 30 Years After the Heckler Report. Special Feature on Racial and Ethnic Health Disparities: 30 Years After the Heckler Report Introduction

The 1985 Report of the Secretary's Task Force on Black and Minority Health, released by then Secretary of Health and Human Services Margaret Heckler, documented significant disparities in the burden of illness and mortality experienced by blacks and other minority groups in the U.S. population compared with whites (41). The report laid out an ambitious agenda, including improving minority access to high-quality health care, expanding health promotion and health education outreach activities, increasing the number of minority health care providers, and enhancing federal and state data collection activities to better report on minority health issues. In the 30 years since the Heckler Report, national efforts to improve minority health through outreach, programming, and monitoring have included the formation of the Department of Health and Human Services (HHS) Office of Minority Health in 1986 (42); the annual National Healthcare Quality and Disparities Reports first issued in 2003 (43); the adoption of disparities elimination as an overarching goal of Healthy People 2010 (44); and most recently, an HHS Action Plan to Reduce Racial and Ethnic Health Disparities--a comprehensive federal commitment to reduce and eventually eliminate disparities in health and health care (45).

Race is a social construct influenced by a complex set of factors (46,47). Because of the complexity and difficulty in conceptualizing and defining race, as well as the increasing representation of racial and ethnic subgroups in the United States, racial classification and data collection systems continue to evolve and expand. In 1977, the Office of Management and Budget (OMB) required that all federal data collection efforts collect data on a minimum of four race groups (American Indian or Alaskan Native, black, Asian or Pacific Islander, and white) and did not allow the reporting of more than one race (48). In 1997, in response to growing interest in more detailed reporting on race and ethnicity, OMB mandated data collection for a minimum of five race groups, splitting Asian or Pacific Islander into two categories (Asian, and Native Hawaiian or Other Pacific Islander) (49). In addition, the 1997 standards allowed respondents to report more than one race. A minimum of two categories for data collection on ethnicity, ``Hispanic or Latino'' and ``Not Hispanic or Latino,'' were also required under the 1997 OMB standards. Consequently, whereas the Heckler Report primarily documented black-white differences in health and mortality due to data limitations, this Special Feature is able to report on more detailed racial and ethnic groups. For example, Figures 19-21 display trends in infant mortality and low-risk cesarean section deliveries, and the current data on preterm births for five Hispanic-origin groups.

At the time of the Heckler Report, 22.3% of the population were considered racial or ethnic minorities (Table 1). Current Census (2014) estimates identify 37.9% of the population as racial or ethnic minorities (50). In 2014, Hispanic persons, who may be of any race, comprised 17.4% of the U.S. population. Non-Hispanic multiple race persons were 2.0% of the population. For the single race groups, non- Hispanic American Indian or Alaska Native persons were 0.7%, non-Hispanic Asian persons were 5.3%, non-Hispanic black persons were 12.4%, non-Hispanic Native Hawaiian or Other Pacific Islander persons were 0.2%, and non-Hispanic white persons were 62.1% of the U.S. population in 2014 (50).

Understanding the demographic and socioeconomic composition of U.S. racial and ethnic groups is important because these characteristics are associated with health risk factors, disease prevalence, and access to care, which in turn drive health care utilization and expenditures. Non-Hispanic white persons are, on average, older than those in other racial and ethnic groups, with a median age of 43.1 years, and Hispanic individuals are the youngest, with a median age of 28.5 years in 2014 (50). About one-quarter of black only persons (26.2%) and Hispanic persons (23.6%) lived in poverty compared with 10.1% of non-Hispanic white only persons and 12.0% of Asian only persons in 2014 (51). Non-Hispanic black only children and Hispanic children were particularly likely to live in poverty (37.3% and 31.9%, respectively, in 2014) (52). However, Hispanic individuals are often found to have quite favorable health and mortality patterns in comparison with non-Hispanic white persons and particularly with non-Hispanic black persons, despite having a disadvantaged socioeconomic profile--a pattern termed the epidemiologic paradox (53).

HHS defines a racial or ethnic health disparity as ``a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group'' (54). There are many different ways to measure racial and ethnic differences in health and mortality, which can lead to different conclusions (55-58). This Special Feature on Racial and Ethnic Health Disparities (Special Feature) uses the maximal rate difference, one of three overall measures used in Healthy People 2020 to measure differences among groups of people (see Technical Notes). The maximal rate difference is an overall measure of health disparities calculated as the absolute difference between the highest and lowest group rates in the population for a given characteristic (59). The identification of groups that experience the highest and lowest rates in this Special Feature was based on observed rates and was not tested for a statistically significant difference against other rates. Ties in highest or lowest rates were resolved by examining decimal places. With respect to changes in health disparities over time, tracking the maximal rate difference over time enables one to determine whether the absolute difference between the highest and lowest group rates is increasing, decreasing, or stable.

The Special Feature charts that follow provide detailed comparisons of key measures of mortality, natality, health conditions, health behaviors, and health care access and utilization, by race, race and ethnicity, or by detailed Hispanic origin, depending on data availability. A majority of the 10 graphs in this year's Special Feature present trends in health from 1999-2014. Results indicate that trends in health were generally positive for the overall population and several graphs illustrate success in narrowing gaps in health by racial and ethnic group. Differences in life expectancy, infant mortality, cigarette smoking among women, influenza vaccinations among those aged 65 and over, and health insurance coverage narrowed among the racial and ethnic groups. For example, the absolute difference in infant mortality rates between infants born to non-Hispanic black mothers (highest rate) and infants born to non-Hispanic Asian or Pacific Islander mothers (lowest rate) narrowed between 1999-2014. Differences by racial and ethnic group in the prevalence of high blood pressure and smoking among adult men remained stable throughout the study period, with non- Hispanic black adults more likely to have high blood pressure than adults in other racial and ethnic groups throughout the period, and non-Hispanic black and non-Hispanic white males more likely to be current smokers than Hispanic and non- Hispanic Asian men. For low-risk cesarean sections, influenza vaccinations among adults aged 18-64, and unmet dental care needs, the gap widened among the racial and ethnic groups between 1999-2014.

Despite improvements over time in many of the health measures presented in this Special Feature, disparities by race and ethnicity were found in the most recent year for all 10 measures, indicating that although progress has been made in the 30 years since the Heckler Report, elimination of disparities in health and access to health care has yet to be achieved. Life Expectancy at Birth

In 2014, life expectancy was longer for Hispanic men and women than for non-Hispanic white or non-Hispanic black men and women.

Life expectancy is a measure often used to gauge the overall health of a population. Life expectancy at birth represents the average number of years that a group of infants would live if the group were to experience the age- specific death rates present in the year of birth. Differences in life expectancy among various demographic subpopulations, including racial and ethnic groups, may reflect subpopulation differences in a range of factors such as socioeconomic status, access to medical care, and the prevalence of specific risk factors in a particular subpopulation (60,61).

During 1980-2014, life expectancy at birth in the United States increased from 70.0 to 76.4 years for males and from 77.4 to 81.2 years for females (Table 15, and data table for Figure 18). During this period, life expectancy at birth for males and females was longest for white persons and shortest for black persons. For both males and females, racial differences in life expectancy at birth narrowed, but persisted during 1980-2014. Life expectancy at birth was 6.9 years longer for white males than for black males in 1980, and this difference narrowed to 4.2 years in 2014. In 1980, life expectancy at birth was 5.6 years longer for white females than for black females, and this difference narrowed to 3.0 years in 2014.

In 2014, Hispanic males and females had the longest life expectancy at birth, and non-Hispanic black males and females had the shortest. In 2014, life expectancy at birth was 7.2 years longer for Hispanic males than for non-Hispanic black males and 5.9 years longer for Hispanic females than for non- Hispanic black females. Infant Mortality

During 1999-2013, infant mortality rates were highest among infants born to non-Hispanic black women (11.11 infant deaths per 1,000 live births in 2013).

Infant mortality, the death of a baby before his or her first birthday, is an important indicator of the health and wellbeing of a country. It not only measures the risk of infant death but it is used as an indicator of maternal health, community health status, and availability of quality health services and medical technology (62,63).

The infant mortality rate in the United States decreased from 7.04 infant deaths per 1,000 live births in 1999 to 6.75 in 2007, and then decreased at a faster rate to 5.96 in 2013. Trends in infant mortality rates during 1999-2013 varied among the five racial and ethnic groups. During 1999-2013, infants born to non-Hispanic black mothers experienced the highest rates of infant mortality (11.11 in 2013) and infants born to non-Hispanic Asian or Pacific Islander mothers experienced the lowest rates (3.90 in 2013). The difference between the highest and lowest infant mortality rates among the five racial and ethnic groups was stable from 1999 to 2006 and then narrowed from 2006 to 2013. The difference between the highest (non-Hispanic black) and lowest (non- Hispanic Asian or Pacific Islander) infant mortality rates was 9.41 deaths per 1,000 live births in 1999, compared with 7.21 in 2013.

For infants born to Hispanic mothers, the infant mortality rate remained stable during 1999-2008 (5.71 infant deaths per 1,000 live births in 1999) and then decreased to 5.00 in 2013. During 1999-2013, the infant mortality rate for Hispanic infants varied by the mother's Hispanic-origin group. Throughout this period, infants born to Puerto Rican mothers experienced the highest mortality rates. In all years except 2009, infants born to Cuban mothers and those born to Central and South American mothers experienced the lowest mortality rates at alternate times throughout 1999-2013. The difference between the highest (Puerto Rican) and lowest (Cuban) infant mortality rates among Hispanic-origin groups narrowed from 3.71 deaths per 1,000 live births in 1999 to 2.88 in 2013. During 1999-2013, the difference in infant mortality rates was narrower for mothers in the Hispanic- origin groups than for mothers in the five racial and ethnic groups. Preterm Births

In 2014, non-Hispanic black mothers had the highest percentage of preterm births of the five racial and ethnic groups, and Puerto Rican mothers had the highest percentage of preterm births of the five Hispanic-origin groups.

An infant's gestational age is an important predictor of his or her survival and subsequent health (64-70). Preterm birth prior to 37 weeks gestation affects infant mortality rates and racial and ethnic disparities in infant mortality (Figure 19) (71). The degree of prematurity matters--infants born prior to 32 weeks gestation are at greatest risk of death during infancy, with the risk of infant death decreasing as gestational age increases (72).

In 2014, 7.7% of singleton births occurred before 37 weeks of gestation; 5.7% at 34-36 weeks; 0.8% at 32-33 weeks gestation; and 1.2% before 32 weeks (data table for Figure 20). In 2014, among the five racial and ethnic groups, non- Hispanic black women had the highest percentage of singleton births before 37 weeks (11.1%) and non-Hispanic Asian or Pacific Islander women had the lowest percentage (6.8%). Non- Hispanic black women also had the highest percentage of singleton preterm births at each preterm gestational age. The difference between the highest (non-Hispanic black) and lowest (non-Hispanic Asian or Pacific Islander) percentages of singleton preterm births among the five racial and ethnic groups was 4.3 percentage points (before 37 weeks), 2.0 percentage points (34-36 weeks), 0.6 percentage points (32-33 weeks), and 1.7 percentage points (before 32 weeks).

Among Hispanic-origin groups in 2014, Puerto Rican mothers had the highest percentage of singleton births before 37 weeks (9.1%) and Cuban mothers had the lowest percentage (7.2%). The difference between the highest (Puerto Rican) and lowest (Cuban) percentages of singleton preterm births among the Hispanic-origin groups was 1.9 percentage points (before 37 weeks) and 1.3 percentage points (34-36 weeks). Central and South American mothers had the lowest percentage of singleton births before 34 weeks. For preterm births before 34 weeks, the difference between the highest (Puerto Rican) and lowest (Central and South American) percentages was 0.2 percentage points (32-33 weeks) and 0.6 percentage points (before 32 weeks). Low-risk Births Delivered by Cesarean Section

During 1999-2014 non-Hispanic black mothers experienced the highest percentage of low-risk cesarean deliveries among the five racial and ethnic groups (29.9% in 2014); Cuban mothers experienced the highest percentage of low-risk cesarean deliveries among the five Hispanic-origin groups (41.49-6 in 2014).

Cesarean deliveries comprise approximately one-third of all births in the United States (32.2% in 2014) and can place mothers and infants at increased risk for poor health outcomes (74). Over the past decade, professional medical groups have attempted to reduce low-risk cesarean deliveries defined as cesarean deliveries among full term (37 or more completed weeks of gestation), singleton, vertex (head first) births to women giving birth for the first time (75,76).

The percentage of low-risk births that were delivered by cesarean section increased from 19.5% to 26.6% during 1999- 2005, stabilized during 2005-2009, and then decreased to 26.0% in 2014 (data table for Figure 21). Throughout the period 1999-2014, non-Hispanic black mothers experienced the highest percentage of low-risk cesarean deliveries (29.9% in 2014) among the five racial and ethnic groups, while non- Hispanic American Indian or Alaska Native mothers experienced the lowest percentage (21.5% in 2014). The difference between the highest (non-Hispanic black) and lowest (non-Hispanic American Indian or Alaska Native) percentages widened from 4.8 percentage points in 1999 to 8.4 percentage points in 2014.

Among Hispanic mothers, the percentage of low-risk births that were delivered by cesarean section increased from 18.7% to 24.6% during 1999-2004, increased at a slower rate from 2004-2009, and then remained stable during 2009-2014 (data table for Figure 21). Throughout the period 1999-2014 Cuban mothers experienced the highest percentage of low-risk cesarean deliveries (41.4% in 2014), while Mexican mothers experienced the lowest percentage (24.1% in 2014). Among Hispanic-origin groups, the difference between the highest and lowest percentages of low-risk cesarean deliveries was stable during 1999-2002, widened sharply during 2002-2006, and then narrowed during 2006-2014. The difference between the highest (Cuban) and lowest (Mexican) percentages was 11.7 percentage points in 1999, 21.5 percentage points in 2006, and 17.3 percentage points in 2014. Children and Adolescents With Obesity

In 2011-2014 for children and adolescents aged 2-19 years, Hispanic children and adolescents had the highest prevalence of obesity and non-Hispanic Asian children had the lowest prevalence.

Childhood obesity is a serious public health challenge in the United States and many other industrialized nations in the world (Figure 8) (19,77,78). Excess body weight in children is associated with excess morbidity in childhood and excess body weight in adulthood (13,14). Obesity among children and adolescents is defined as a body mass index at or above the sex- and age-specific 95th percentile of the CDC growth charts (15). Between 1999-2000 and 2013-2014, the percentage of children and adolescents aged 2-19 with obesity increased from 13.9% to 17.2% (79). However, among youth aged 2-19, the prevalence of obesity did not change from 2003-2004 through 2013-2014 (79).

In 2011-2014 for children and adolescents aged 2-19, the percentage with obesity was highest for Hispanic children and adolescents and lowest for non-Hispanic Asian children and adolescents. For those aged 2-19, the difference between the highest (Hispanic) and lowest (non-Hispanic Asian) percentages was 13.3 percentage points.

For children aged 2-5, the percentage with obesity was highest for Hispanic children and lowest for non-Hispanic white children. (The estimate for non-Hispanic Asian children aged 2-5 was not stable and is not shown.) The difference between the highest (Hispanic) and lowest (non-Hispanic white) percentages was 10.4 percentage points for children aged 2-5. For children aged 6-11, the percentage with obesity was highest for Hispanic children and lowest for non-Hispanic Asian children. For children aged 6-11, the difference between the highest (Hispanic) and lowest (non-Hispanic Asian) percentages was 15.2 percentage points.

In 2011-2014 for adolescents aged 12-19, the percentage with obesity was highest for Hispanic adolescents and lowest for non-Hispanic Asian adolescents. The difference between the highest (Hispanic) and lowest (non-Hispanic Asian) percentages was 13.4 percentage points for adolescents aged 12-19 years. Hypertension

In 2011-2014, non-Hispanic black men and women were the most likely to have hypertension compared with adults in the other racial and ethnic groups.

Hypertension is an important risk factor for cardiovascular disease, stroke, kidney failure, and other health conditions (80,81). In 2011-2014, 84.1% of adults with hypertension were aware of their status, and 76.1% were taking medication to lower their blood pressure (82). Despite improvement in increasing the awareness, treatment, and control of hypertension, diagnosis and treatment of hypertension among minority groups remains a challenge (83).

Hypertension is defined as reporting taking antihypertensive medication and/or having a measured systolic blood pressure of at least 140 mm Hg or a measured diastolic blood pressure of at least 90 mm Hg. The age-adjusted percentage of adults aged 20 and over with hypertension was stable during 1999-2014 (30.8% in 2013-2014) (data table for Figure 23). During 1999-2014, non-Hispanic black adults had the highest percentage with hypertension among the three racial and ethnic groups (42.7%, age-adjusted in 2013-2014), while with the exception of 1999- 2000, adults of Mexican origin had the lowest percentage with hypertension (28.8%, age-adjusted in 2013-2014). The difference between the highest and lowest age-adjusted percentages of adults with hypertension among the three racial and ethnic groups was stable during 1999-2014; in 2013-2014, the difference between the highest (non-Hispanic black) and lowest (Mexican-origin) percentages was 13.9 percentage points.

In 2011-2014, the age-adjusted percentage of adult men and women with hypertension was similar (31.0% and 29.7%, respectively, data table for Figure 23). The difference between the highest (non-Hispanic black) and lowest (Hispanic) age-adjusted percentages of men with hypertension among the four racial and ethnic groups was 14.7 percentage points; for women, the difference between the highest (non- Hispanic black) and lowest (non-Hispanic Asian) was 19.0 percentage points in 2011-2014. Current Cigarette Smoking

During 1999-2014, differences in cigarette smoking between racial and ethnic groups were larger for women than for men.

Smoking causes more than 480,000 deaths each year, accounting for about one in five deaths in the United States (84). Smokers are more likely to develop heart disease, stroke, and cancer. Smoking also increases the risk for diabetes, cataracts, rheumatoid arthritis, and stillbirth (85).

During 1999-2014, the age-adjusted percentage of adults aged 18 and over who were current cigarette smokers decreased from 25.2% to 19.0% for men and from 21.6% to 15.1% for women (data table for Figure 24). Within each of the four racial and ethnic groups, men were more likely to be current cigarette smokers than women.

In 2014 for men, the age-adjusted percentage of current cigarette smokers was highest for non-Hispanic black men (22.0%) and lowest for Hispanic men (13.8%). The difference between the highest and lowest age-adjusted percentages of current cigarette smokers among the four racial and ethnic groups remained stable during 1999-2014 because levels for men in all racial and ethnic groups declined similarly during this period. The difference between the highest (non-Hispanic black) and lowest (Hispanic) percentages for men was 8.2 percentage points in 2014.

For women, non-Hispanic white women consistently had the highest age-adjusted percentage of current cigarette smokers among the four racial and ethnic groups throughout 1999-2014 (18.3% in 2014), while non-Hispanic Asian women had the lowest age-adjusted percentage (5.1% in 2014). For women, the difference between the highest (non-Hispanic white) and lowest (non-Hispanic Asian) percentages narrowed from 17.5 percentage points in 1999 to 13.2 in 2014. During 1999-2014, racial and ethnic differences in cigarette smoking prevalence were larger for women than for men. Influenza Vaccination

During 1999-2014, influenza vaccination was highest for those aged 65 and over and lowest for those aged 18-64, for all racial and ethnic groups.

Influenza is a serious illness that can lead to hospitalization and sometimes death. Influenza vaccination is especially important for people who are at risk of getting seriously ill from influenza, including those with chronic conditions, older adults, and young children.

The percentage of adults aged 18-64 who received an influenza vaccination in the past 12 months remained stable during 1999-2006 and then increased to 35.8% in 2014 (data table for Figure 25). This pattern was present for all racial and ethnic groups. Decreases in influenza vaccination coverage in 2005 were related to a vaccine shortage (86). For those aged 18-64, no racial and ethnic group was consistently the most likely to receive influenza vaccination during 1999- 2014. In 2014, non-Hispanic Asian adults had the highest percentage for influenza vaccination receipt (41.3%) and Hispanic adults had the lowest percentage (27.9%). For adults aged 18-64, the difference between the highest and lowest percentages of adults receiving an influenza vaccination among the four racial and ethnic groups widened from 6.9 percentage points in 1999 (non-Hispanic white compared with Hispanic) to 13.4 in 2014 (non-Hispanic Asian compared with Hispanic).

For adults aged 65 and over, the percentage who received an influenza vaccination in the past 12 months increased from 65.7% to 70.1% during 1999-2014. During this period, trends in influenza vaccination coverage varied by racial and ethnic group, and no racial and ethnic group was consistently the most or least likely to receive influenza vaccination. In 2014, non-Hispanic Asian adults had the highest percentage for receipt of influenza vaccination (72.7%) and non-Hispanic black adults had the lowest (57.4%). For adults age 65 and over, the difference between the highest (non-Hispanic Asian) and lowest (non-Hispanic black) percentages of older adults receiving an influenza vaccination among the four racial and ethnic groups was stable during 1999-2003 and then narrowed to 15.3 percentage points in 2014. Health Insurance Coverage

During 1999 through the first 6 months of 2015 among adults aged 18-64, lack of health insurance coverage was highest among Hispanic adults.

Health insurance is a major determinant of access to health care. Children are less likely to be uninsured than adults aged 18-64 because they are more likely to qualify for public coverage, primarily Medicaid and the Children's Health Insurance Program (CHIP) (see data table for Figure 26 for estimates for children) (26,87). Passage of the Affordable Care Act (ACA) in 2010 (38) authorized states to expand Medicaid eligibility (88) and to establish the health insurance marketplace in 2014.

For adults aged 18-64, the percentage without coverage increased from 17.9% to 20.5% during 1999-2013, and then decreased to 12.7% in the first 6 months of 2015 (36). During this period, the trend for lack of coverage varied by racial and ethnic group.

During 1999-June 2015, Hispanic adults aged 18-64 had the highest percentage without coverage (27.2% in the first 6 months of 2015), and non-Hispanic white adults aged 18-64 had the lowest, except in the first 6 months of 2015, when non- Hispanic Asian adults had the lowest percentage without coverage.

The difference between the highest and lowest percentages of adults aged 18-64 without health insurance among the four racial and ethnic groups narrowed from 1999-June 2015. This difference was 24.9 percentage points in 1999 (Hispanic adults compared with non-Hispanic white adults) and 19.9 percentage points in the first 6 months of 2015 (Hispanic adults compared with non-Hispanic Asian adults). Difficulty Accessing Needed Dental Care Due to Cost

During 1999-2014 among adults aged 18-64, nonreceipt of needed dental care due to cost was lowest among non-Hispanic Asian adults.

Oral health is integral to general health and wellbeing, and forgoing needed dental health care can have serious health effects (89). In general, fewer adults have dental coverage than medical coverage, and dental coverage tends to be less comprehensive (90-92). In 2012, 44% of dental expenditures among adults aged 18-64 were paid out of pocket, a higher out-of-pocket percentage than for any other type of personal health care expenditure (93).

The percentage of adults aged 18-64 who did not receive needed dental care in the past 12 months due to cost increased from 9.3% to 17.3% during 1999-2010, and then decreased to 12.6% in 2014 (data table for Figure 27).

During 1999-2014, non-Hispanic Asian adults aged 18-64 had the lowest percentage of not receiving needed dental care due to cost (6.3% in 2014) among the four racial and ethnic groups. No racial and ethnic group consistently had the highest percentage of not receiving needed dental care due to cost during 1999-2014. The difference between the highest and lowest percentages of adults not receiving needed dental care due to cost among the four racial and ethnic groups widened during 1999-2010, and then remained stable from 2010-2014 for those aged 18-64. This difference was 5.9 percentage points in 1999 (non-Hispanic black compared with non-Hispanic Asian) and 9.4 percentage points in 2014 (Hispanic compared with non-Hispanic Asian).

BREAK IN TRANSCRIPT

Mrs. BEATTY. Madam Speaker, we have heard a lot tonight. We have heard the call to action by Members. We have heard the relationship to poverty in health disparities, to the socioeconomic conditions of African Americans to health disparities. We have heard the relationship to death by guns to health disparities. We have heard the data and the statistics about the mortality rates from diseases like cardiovascular disease, the leading killer for women and African American women and men. We have heard about the effect of untreated diabetes and how that affects African Americans.

The list goes on and on, Madam Speaker. I could tell you whether it is obesity, whether it is stroke--and certainly as a stroke survivor, I understand firsthand the value and the importance of quality, affordable health care--that there are some Federal programs that actually work and bridge the gap. I could say wonderful things about the United States Health and Human Services Office of Minority Affairs that provides data and research and services for us.

But before I ask my colleague, Madam Speaker, to say a few words, I ran across something that was said, in my opinion, by one of the most powerful individuals that will go down in current history. And 20 years from now, Madam Speaker, if I were standing here talking about his legacy, health care would be one of them. Let me conclude my part with these brief words that he quoted on April 1 of this year:

``Our Nation was built on an enduring belief that we are all created equal--regardless of the color of our skin or the station into which we were born. From the ambitions we hold for ourselves to the way we take care of our health, this founding premise serves as the guidepost of our national life.''

Yet, to this day, Madam Speaker, minorities continue to experience the healthcare gaps that leave their communities our communities.

I will add this to his ending that, Madam Speaker, tonight, the Congressional Black Caucus asks that we recommit to taking action to overcome these disparities. And that person who will leave a great legacy for these words is no other than our President of these United States, President Barack Obama.

And now as we begin to close our hour, I yield to the gentleman from New York (Mr. Jeffries). I could not think of a better colleague, a better coanchor, to come and share with us our call to action.

My colleague and classmate, Congressman Jeffries, is a scholar, someone who sits back, listens, and then comes with resolve. He is someone who is no stranger to this process of telling it like it is. He is someone who has spent a lot of time and years with his experience to speak for the individuals of his district. But tonight, Madam Speaker, I asked him to speak for the Congressional Black Caucus. I asked him to close us out on our call for action as we talk about the health disparities in our African American communities.

BREAK IN TRANSCRIPT

Mrs. BEATTY. Madam Speaker, I thank Congressman Jeffries.

Madam Speaker, as we close out tonight, I can't think of a better way to take my last 30 seconds than to speak to you and to speak to America and to ask that we take these last seconds in silence as a call to action to prevent the guns being on the street, as a call to action to reduce the health disparities. But in honor of the families in Orlando, we give them our commitment that we stand with them and that I stand with all of my friends and constituents and supporters who belong to the LGBT community.

I yield back the balance of my time.

BREAK IN TRANSCRIPT

Source