Just a couple of months ago, I was honored to attend the 17th World Conference on Tobacco or Health in Cape Town, South Africa. This once-every-three-years international event comprises a massive call for a collective resolution to fight tobacco by working together and integrating tobacco control into our health and development goals.
I was inspired by the assembly of researchers, academicians, non-governmental organizations, scientists, health professionals, and public officials from more than 100 countries, all of them working on various aspects of tobacco control.
One of the most interesting tracks was titled “Social justice, the underserved, and vulnerable populations.” This struck a chord with me because it highlighted the issues that we also have here at home regarding tobacco use.
Tobacco use in the United States has fallen overall—from 42.4 percent of U.S. adults using tobacco in 1965 to 15.5 percent in 2016. This means that the multi-generational anti-smoking campaign has been working, and that’s a success to be celebrated. But among certain minority populations, tobacco use remains stubbornly high: 31.8 percent for American Indians/Alaska Natives, 25.2 percent for multiple-race Americans.
I point this out because health disparities in the United States are persistent. As tracked by the federal Agency for Healthcare Research and Quality, some disparities have shrunk between 2000 and 2015, but they haven’t disappeared. For instance, one-fifth of performance measures show disparities getting smaller for Blacks and Hispanics, but most disparities have not changed for any racial or ethnic groups.
Why is this? The simple answer is, we don’t know. There are some explanations—such as health insurance, access to a usual source of care, and the like—but these are incomplete. As our colleagues at the American Association for Cancer Research point out, we need tailored strategies for tobacco control to target different populations.
It’s not just tobacco. It’s preventable emergency department visits. It’s receiving potentially inappropriate prescription medications. It’s asthma and mental health care. It’s a whole host of issues, and it demands our attention.
This is clearly something that is recognized at the highest levels of the health care policy world. The Department of Health and Human Services has an Action Plan to Reduce Racial and Ethnic Health Disparities, and its Office of Minority Health is leading the charge to put the plan into practice.
I support this effort and encourage you to do the same. But what I took out of the international tobacco conference isn’t just an American problem—this is in fact an international problem. It will require solutions at every level. I look forward to working within our local community here in Rockville, statewide in Maryland, and at the national level to address disparities.