[Pages H3737-H3747]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

{time} 1945
BRIDGING THE DIVIDE: A CALL TO ACTION BY THE CONGRESSIONAL BLACK CAUCUS
TO ELIMINATE RACIAL HEALTH DISPARITIES

The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 2015, the gentlewoman from Ohio (Mrs. Beatty) is recognized
for 60 minutes as the designee of the minority leader.

General Leave

Mrs. BEATTY. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days to revise and extend their remarks and add
any extraneous materials relevant to the subject matter of this Special
Order.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Ohio?
There was no objection.
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.

[[Page H3738]]

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.
Mr. Speaker, I yield to the gentleman from North Carolina (Mr.
Butterfield), chairman of the Congressional Black Caucus. 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.
Mr. BUTTERFIELD. I thank Congresswoman Beatty for yielding to me this
evening.
This is such a sad evening for all of us because of the events in
Orlando. I thank her so very much for having the strength to come to
the floor tonight to manage the important topic that we are all so
concerned about.

I thank Congresswoman Robin Kelly for her incredible work chairing
the CBC Health Braintrust and all the work she does related to health
disparities in this country. I thank all of my colleagues for their
tireless work.
Before I begin my remarks, let me just say that I sat on the floor a
moment ago and listened to Congresswoman Corrine Brown. It was an
incredible 1-minute speech she gave. I want to share in her sentiments
this evening and align myself with the pain that she and her
constituents are facing in Orlando. The mass shootings were absolutely
horrific and unthinkable, under any definition. They are just
unthinkable.
My prayers go out to the families in Orlando for their pain and for
all that they are having to endure because of these mass shootings.
As someone said a few moments ago, a moment of silence is not enough.
It is time for this Congress to act. It is time for this body, Mr.
Speaker, to have a serious debate about gun violence and to pass
legislation that will deprive people the right to own a high-capacity
assault weapon and high-caliber bullets and use them to kill innocent
people. Now is the time.
136 mass shootings have taken place during the first 164 days of this
year. It is a sad statistic that we must address. The United States is
5 percent of the world's population, yet we are 31 percent of the mass
shootings in the world. It is time to act.
Let me talk about the topic tonight, very briefly.
The Congressional Black Caucus has been committed to advancing access
to affordable health care for all Americans so that we can eliminate
racially based health disparities. That has been our mission for many
years.
Eliminating health disparities means addressing inequities in
environmental, social, and economic conditions in all of our
communities. By all measurable statistics, from health outcomes to
participation in health professions, African Americans lag so far
behind.
For example, more than 40 percent of African Americans have high
blood pressure--a rate that is one of the highest in the world. African
Americans are more likely to develop hypertension at a younger age and
are at higher risk of stroke, heart failure, end-stage renal disease,
and death from heart disease.
Stroke, Mr. Speaker, is the third leading cause of death in the
United States. African Americans are 50 percent more likely to
experience a stroke than White Americans. That is a fact.
According to the Federal Centers for Disease Control and Prevention,
African American children are twice as likely to have asthma as White
children, and Black children are 10 times more likely than White
children to die of complications from asthma.
African Americans were, on average, 6 years younger than Whites when
they suffered sudden cardiac arrest. Cardiac arrest incidence among
African American men was 175 per 100,000; whereas, the incidence for
White males was just 84 per 100,000. Cardiac arrest in African American
women was 90 per 100,000, as opposed to 40 per 100,000 for Caucasian
women.
Another illness which disparately impacts the African American
community is that of prostate cancer. In June of last year, I
introduced the National Prostate Cancer Plan Act, a bipartisan bill
which seeks to establish the National Prostate Cancer Council on
Screening, Early Detection and Assessment and Monitoring of Prostate
Cancer.
Prostate cancer impacts one in seven American men and is the second
leading cause of cancer-related deaths among men in the U.S., with
nearly 30,000 deaths anticipated just this year. African American men
are particularly vulnerable, as they are twice as likely to be
diagnosed with prostate cancer and 2.5 times more likely to die from
the disease than their White counterparts.
Just last week, House Republicans released their A Better Way agenda
to address poverty, but that proposal, like others they have released,
will not lift Americans out of poverty. In some cases, these types of
proposals can actually push low-income Americans even deeper into
poverty, further limiting their access to health care and exacerbating
health disparities.
So, Mr. Speaker, it is time for us to continue our efforts to address
the health disparities and barriers. That is what the Congressional
Black Caucus is advocating the evening. We are going to continue this
work until every disparity is removed.
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.
Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. 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.

{time} 2000

Ms. KELLY of Illinois. Mr. Speaker, I want to thank my colleagues and
my classmates, the gentlewoman from Ohio (Mrs. Beatty), my friend, and
the distinguished gentleman from New

[[Page H3739]]

York (Mr. Jeffries), for leading this important conversation about
bridging the divide to eliminate racial health disparities.
But I can't weigh in on that topic until I first address the horrific
events of yesterday in Orlando, Florida. Our Nation is horrified and
heartbroken by the tragedy in Orlando. We are disgusted by this brutal
attack. We will not tolerate terrorism or hate in any form against any
group of people because this is just not our way.
These ideas of hate will not endure because there is not strength to
them. We will win the battle against terrorism and intolerance.
We will hold leaders accountable who put their NRA score ahead of the
need to keep guns out of the hands of terrorists. We will stand with
the LGBTQ community and value their lives, their health, and their
security from the threat of violence and hate. And we will work to see
that all Americans enjoy the very same freedoms and protections.
We have done a lot of moments of silence, but I believe in showing
respect through action, not silence, and that is why we are here this
evening to discuss what divides us as a country in a health sense.
For 45 years, the Congressional Black Caucus has been out front in
Congress in fighting for these freedoms and protections. And when it
comes to the matter of health equity, I have worked to champion the
health policy concerns of vulnerable communities as my predecessors in
the Congressional Black Caucus Health Braintrust, the Honorable Louis
Stokes and Dr. Christensen, have done.
Some of my colleagues here know this, but I want to repeat it for
anyone who doesn't. Before he was killed, Martin Luther King, Jr., was
quoted as saying: ``Of all the forms of inequality, injustice in health
care is the most shocking and inhumane.''
I couldn't agree more, and as the chair of the Health Braintrust, I
have worked with many of the people in this room to focus on advancing
this critical phase of the human rights and civil rights struggle:
health equity.
When Benjamin Franklin created the Nation's first public hospital,
The Pennsylvania Hospital, he did so in order to establish the
promotion of public health as a core American value. He did so to care
for our Nation's diseased and sick poor.
Nearly 300 years later, the Affordable Care Act cemented health care
as a fundamental right for all Americans. Yet, today, we find ourselves
at a crossroads in health care. Health disparities in communities of
color continue to be intractable hurdles in the quest to achieve health
equity in America.
African Americans are infected with HIV at a rate that is 8 times
that of White Americans.
While White women are more likely to have breast cancer, African
American women are 40 percent more likely to die from the disease.
African Americans, Latinos, Asians, and Pacific Islanders, as well as
Native Americans, are diagnosed with lupus two to three times more
frequently than Caucasians.
More than 13 percent of African Americans aged 20 or older have
diagnosed diabetes. And people of color are two to four times more
likely than Whites to reach end-stage renal disease.
This grim snapshot illustrates that, despite the gains we have made
since the days of Ben Franklin and the ACA, there is still much ground
to cover in closing the health equity gap.
Last year, I drafted a comprehensive report, The Kelly Report on
Health Disparities, an official Congressional analysis of the state of
minority health in the U.S. that offers a blueprint for reversing
negative health trends in communities of color.
The Kelly Report brought Members of Congress together, medical
professionals, and public health thought leaders to examine the root
causes and impact of health disparities in America, and provide a
comprehensive set of legislative and policy recommendations to address
them.
The whole can only ever be as healthy as its parts. For America to
achieve true health equity, lawmakers, community leaders, and industry
stakeholders must come together and aggressively work to reduce
disparities nationwide. We all have a part to play in creating a
healthier America.
We must take heed of Dr. King's words: ``Of all the forms of
inequality, injustice in health care is the most shocking and
inhumane.'' And we can and we must fix that.
Again, because of what happened in Orlando, and I want to say it is
the mass shooting that we are talking about, and it is tragic, but the
night before, one person was shot. And I often liken this to a 747
crash as we talk about that, but we don't talk about the two-seater.
And that two-seater, the person that died alone in that club after she
sung Friday night has a brother, a mother, a father, and their pain is
just as harsh. So let's not forget that young lady that lost her life.
And she did not lose her life to someone that was Muslim or someone
that believed in ISIS. She lost her life to an American young man, a
Caucasian.
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.
Mr. PAYNE. Madam Speaker, I first want to start by thanking
Congresswoman Beatty for that very kind and generous introduction. We,
in our class, are very proud of our colleagues, and we support each
other in times of need.
I just would like to also congratulate and acknowledge Congressman
Hakeem Jeffries, the gentleman from New York, who is also host of this
Special Order. I appreciate the opportunity to discuss an issue that is
very personal to me.
Before I begin, I just want to say that my heart goes out to the
families and friends of the victims of the horrible

[[Page H3740]]

tragedy in Orlando, and I can only imagine what they are going through.
The other thing that is illuminating to me is that, as we came here
and stood up for a moment of silence, after that moment of silence, I
believe Members were given a 1-minute opportunity to speak on any topic
that they would like to on the floor, as is customary, and not one
person from the other side of the aisle mentioned what happened in
Orlando.
So not only was it a moment of silence for the leadership in this
House, but it appears that it is going to be a moment that remains
silent or a topic that remains silent from the other side of the aisle.
Madam Speaker, eliminating racial-based health disparities depends on
our ability to advance access to affordable health care for all. Even
in the 21st century, health disparities are stark, especially in the
African American communities, where life expectancies are lower and
infant mortality rates are higher than among Whites.
Today, despite improvement in overall health in the United States,
African Americans and other minority populations lag behind in numerous
health areas, including access to quality care, timelines of care, and
health outcomes.
For years, the Congressional Black Caucus has called on Republicans
to join us and other House Democrats in developing a plan to eliminate
racial health disparities, a plan that addresses the causes of health
disparities, such as inequities in environmental, social, and economic
conditions in our communities.
Instead, we get from them proposals like their so-called A Better Way
poverty proposal, a stale, repackaging of failed policies presented
under the guise of concern about Americans trapped in poverty.
Cutting job training programs, food assistance, and Head Start will
push low-income Americans further into poverty, making it even more
difficult for them to access the affordable and quality health care
needed to secure their well-being and the well-being of their families.
We need to, instead, use the government as a source of good.
Every American deserves to live in a safe and healthy environment.
Yet, low-income and minority communities are much more exposed to high
levels of pollution, resulting in serious health problems such as
asthma, heart problems, and cancer.
This is a very real problem across America, a very real problem in my
district. Thirteen million people, including 3.5 million children, are
concentrated in the vicinity of transportation facilities and are
exposed to unhealthy levels of air pollution.

{time} 2015

My district is home to the Port Newark-Elizabeth Marine Terminal,
part of the Port of New York and New Jersey, the third largest port in
the country. According to the EPA, 25 percent of children in Newark
suffer from asthma--three times the State average.
What we need are additional Federal actions to reduce harmful air
pollution from ports and congested components of the national freight
transportation system. The issue is critical to the low-income and
minority community who suffer the disproportionately adverse health
effects of these environmental hazards.
Now, since I am on the topic of environmental justice, I just want to
remind everyone that the Republicans continue to block any action to
help the thousands of children facing lifelong damage from drinking
poisoned water in Flint, including a vote to block the Families of
Flint Act emergency supplemental. Their radical refusal to address this
health issue will have tragic consequences for American families, and,
I think it is representative of their overall inadequate approach to
health disparities in minority communities.
The way to eliminate racial health disparities is neither to downplay
them nor to cut programs that will assist the most vulnerable. It is to
address the environmental, social, and economic conditions that
exacerbate those disparities. It is to expand access to quality health
care that could eliminate or reduce the onset of many of these chronic
illnesses and disproportionate health outcomes. It is to maintain and
strengthen our investments in healthcare access and resources for
disadvantaged populations.
In closing, Madam Speaker, I also want to stress that health
education must also be a focus in any efforts to eliminate racial-based
health disparities. African Americans and other communities are
disproportionately affected by poor provider-patient communication and
health literacy issues. Consequently, they often do not have access to
information that enables them to make the appropriate health decisions.
We have a responsibility to work with our healthcare institutions and
community health centers to make it easier for people to find,
understand, and use the information and services.
As co-chair of the Congressional Men's Health Caucus, I have hosted
and participated in a number of outreach events in my district to
engage directly with constituents about the importance of making
positive health decisions and staying proactive about their health and
well-being. So I encourage everyone watching at home to get the
information you need to make smart health decisions, to get the
security you and your family deserve, and to get the health care that
we all need.
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.
Ms. JACKSON LEE. Madam Speaker, there is no doubt how much I
appreciate the Congressional Black Caucus and Congresswoman Beatty and
Congressman Jeffries for always being timely in allowing us to give a
message to our colleagues. We hope maybe the American people will hear
us, but we accept that this body is the body to which and to whom we
speak. So I am thankful for that.
I want to pay tribute, overall, to the Congressional Black Caucus
because we are actually here speaking of health disparities, because it
was the caucus that triggered this debate through the years that we
have been trying to get universal access to health care and was the
moving force in the 2009, 2008, and 2010 passage, ultimately, of the
Affordable Care Act, where the work that we did, joining Congresswoman
Donna Christian-Christiansen, at that time, and Frank Pallone on the
Congressional Health Caucus, but on the CBC we had the health
disparities task to ensure that the language in the Affordable Care Act
addressed the issue of health disparities.
There was a large section on that that built on some of the work that
some of us had already done creating the Office of Minority Health that
I had worked on in years past. So it was the lightning bolt of the
caucus, and then working with the Congressional Asian Pacific American
Caucus and then the Congressional Hispanic Caucus that we raised the
issue that no one was talking about.
I remember debating on the floor of the House on the issues of
dealing with senior citizen African American men and how they access
health care, how do women access health care, and how do women impacted
by diabetes access health care. These are some of the diseases that
have a proclivity to the African American population.
We were finding out that we even had an issue where medical
professionals didn't know how to ask the questions. How do you address
someone who needs to be diagnosed for prostate cancer or may be
diagnosed for prostate cancer and is an African American male, a senior
citizen? My father ultimately died from cancer that metastasized from
the prostate to the lungs and the brain, so we knew we had a serious
issue.

[[Page H3741]]

So today, I want to mention four points, but I am going to focus on
the last one, obesity--a question of access to health care and physical
fitness.
Many times we live in areas where there is no access to a pool or a
tennis court. Mental health--if you lived your life in a segregated
America, if you were called ``Boy'' and ``Girl,'' it is a different
mental health situation than maybe others may have faced. If you live
in a situation of poverty, of a single household, maybe--this is not
across the board--these issues will be impacted. If you lived around
gun violence, if you saw your 15-year-old friend being shot dead in the
street, there is a question of mental health that we need access to
that care for us to be able to reach out or maybe counselors to be able
to provide for children.

HIV/AIDS is something that we have lived through. I remember going to
funerals of friends in the 1980s and into the 1990s, particularly with
HIV/AIDS. So we have worked in the Congressional Black Caucus to
massively talk about testing.
Let me get to this point that I want to dwell just for a moment on,
and that is gun violence. I was here on the floor earlier with my head
held down and my heart heavy as my district, today, had a memorial.
They had one yesterday. We will have one tomorrow and have one on
Wednesday. I mourn with Congresswoman Corinne Brown of Florida.
We are offering legislation dealing with the assault weapons and to
complement legislation already passed or already in place. But it is
important to note that this is a health issue, because the Centers for
Disease Control can assess and study every health issue that faces
America today, but they are legislatively, by law, prohibited by my
friends on other side of the aisle, by Republicans, disallowed every
year to give them permission to study gun violence.
Gun violence is killing our children and killing our families. In
Orlando, it killed Latinos who happened to be the attendees at the
Pulse Club. The LGBTQ community was the dominant community, and a
hateful terroristic act using AR-15s and Glock guns killed them.
The incident was the deadliest mass shooting. The next deadliest
incidents in recent history were April 16, 2007, Virginia Tech, 32
killed, 17 injured; December 14, 2012, Sandy Hook, 26 killed, 1
injured; October 16, 1991, Killeen, Texas, 23 killed, 27 injured.
According to Everytown index of mass shootings where four or more
people are shot and killed, the incident was the ninth mass shooting in
the United States in 2016, and the 150th mass shooting in United States
since January 1, 2009.
The mass shooting with guns impacts both the mental health, the
sanctity, and the minority community. It is shameful that we are not
allowed to engage in the kind of research that a Harvard professor
talked about, and that is the assessing of violence and the assessing
of violence with guns.
The materials I have before me make it very clear that most of these
violent acts are done with guns--done with guns. San Bernardino,
Chattanooga, Charleston, Garland, Oak Creek, and Fort Hood were all
done with guns.
So I stand here today to challenge this issue of health disparities
to say that the heavy brunt of killings, singular killings, are
impacted by poverty, lack of access to health care, the proliferation
of guns in our inner city communities, and the failure of the United
States Congress to put real gun safety legislation, closing the
loophole, the Jim Clyburn rule that says that, if you don't get the
review and approval by ATF, you do not get the gun. You have to wait
until you get the approval from ATF, which may be trying to determine
whether this person with multiple problems, mental health or background
issues, doesn't need to get a gun and then ultimately go kill their
spouse, their children, their neighbors, their family members or
strangers.
So it is my belief today that this health disparities debate is
crucial, and we should come away from here recognizing that obesity,
the issues of mental health and HIV/AIDS can be, with great investment,
researched for cures, or cancer that proliferates in our community,
triple negative breast cancer, legislation that I have put forward and
have gotten passed about that impact. But it is the gun violence that
we are doing absolutely nothing about. The disparities and the impact
on minority communities is atrocious.
I want to close simply by saying the word or the acronym LGBTQ
community. I want to say it over and over again, because I think it is
shameful that, in our debate, in our recognition of the tragedy of
Orlando, that we don't acknowledge the horrific hate crime and the
hatefulness against that community. As I stand here, that community is
diverse, and there are African Americans who are LGBTQ.
So I would ask that, as we move forward this week, we will be
reminded of this hatefulness and we will have a cure. We will be
reminded of this violence, and we will have a cure. That cure, first of
all, will be to restrain the use of assault weapons and these weapons
of war-type bullets that men and women in the United States military
say have no business on the streets of America.
I believe, Congresswoman, that health disparities are an important
wall and division to overcome. I thank the gentlewoman for having this
Special Order to ensure that we will confront these issues and try to
save lives.
Racial disparities refer to the variation in rates of disease
occurrence and disabilities between socioeconomic and/or geographically
defined population groups.
I want to focus on four areas of racial disparities in health that
impact African Americans that we can do something about: 1. Obesity; 2.
Mental Health; 3. HIV/AIDS; and 4. Gun Violence.
African Americans, based on 2015 Census data, comprise 13.2 percent
of the U.S. population, or about 42 million people.
Socioeconomic status, in turn, is linked to mental health: People who
are impoverished, homeless, incarcerated or have substance abuse
problems are at higher risk for poor mental health.
As the founder and chair of the Congressional Children's Caucus, I am
especially concerned about the childhood obesity epidemic among
African-American youth.
More than 40 percent of African American teenagers are overweight,
and nearly 25 percent are obese.
The percentage of children aged 6-11 years in the United States who
were obese increased from 7 percent in 1980 to nearly 18 percent in
2012.
African American youth are consuming less nutritious foods such as
fruits and vegetables and are not getting enough physical exercise.
This combination has led to an epidemic of obesity, which directly
contributes to numerous deadly or life-threatening diseases or
conditions, including the following: Hypertension; Dyslipidemia (High
Cholesterol or High Triglyceride Levels); Type 2 Diabetes; Coronary
Heart Disease; Stroke; Gallbladder Disease; Osteoarthritis; Asthma,
bronchitis, sleep apnea, and other respiratory problems; Cancer
(Breast, Colon, and Endometrial).
When ethnicity and income are considered, the picture is even more
troubling.
African American youngsters from low-income families have a higher
risk for obesity than those from higher-income families.
Efforts such as the Let's Move! Campaign by the First Lady are
pivotal to ensuring that communities are able to provide healthy snacks
and food and encourage healthier decisions.
Since the mid-1970s, the prevalence of overweight and obesity has
increased sharply for both adults and children.
Non-Hispanic blacks have the highest age-adjusted rates of obesity at
47.8 percent.
According to the CDC, 37.6 percent of men and 56.9 percent of women
twenty years and over are obese.
Every year, more than 40 million Americans struggle with mental
illness.
African American men are as likely as anyone else to have mental
illness, but they are less likely to get help.
Racism continues to have an impact on the mental health of African
Americans.
Negative stereotypes and attitudes of rejection have decreased, but
continue to occur with measurable, adverse consequences.
Historical and contemporary instances of negative treatment have led
to a mistrust of authorities, many of whom are not seen as having the
best interests of African Americans in mind.
According to the Department of Health and Human Services Office of
Minority Health:
Adult blacks are 20 percent more likely to report serious
psychological distress than adult whites.
Adult blacks living below poverty are two to three times more likely
to report serious psychological distress than those living above
poverty.
Adult blacks are more likely to have feelings of sadness,
hopelessness, and worthlessness than are adult whites.
How African Americans view mental health over generations is a major
barrier to accessing mental health services and treatment.

[[Page H3742]]

In 1996, MHA commissioned a national survey on clinical depression.
The survey explored the barriers preventing Americans seeking
treatment and gauged overall knowledge of and attitudes toward
depression.
This survey revealed that:
63 percent of African Americans believe that depression is a personal
weakness.
This is significantly higher than the overall survey average of 54
percent.
Only 31 percent of African Americans believed that depression was a
``health problem.''
African Americans were more likely to believe that depression was
``normal'' than the overall survey average.
56 percent believed that depression was a normal part of aging.
45 percent believed it was normal for a mother to feel depressed for
at least two weeks after giving birth.
40 percent believed it was normal for a husband or wife to feel
depressed for more than a year after the death of a spouse.
Many of these problems persist to this day. As Doctor William Lawson
of Howard University (and MHA's District of Columbia affiliate) pointed
out in an NPR interview in 2012, ``Many African-Americans have a lot of
negative feelings about, or not even aware of mental health services.
The ``Mental Health: Culture, Race and Ethnicity Supplement'' to the
1999 U.S. Surgeon General's Report on Mental Health, states the
following:
African-American physicians are five times more likely than white
physicians to treat African-American patients.
African-American patients who see African-American physicians rate
their physicians' styles of interaction as more participatory.
African Americans seeking help for a mental health problem would have
trouble finding African American mental health professionals: In 1998,
only 2 percent of psychiatrists, 2 percent of psychologists and 4
percent of social workers said they were African Americans.
The public mental health safety net of hospitals, community health
centers, and local health departments are vital to many African
Americans, especially to those in high-need populations.
African Americans of all ages are underrepresented in outpatient
treatment but over-represented in inpatient treatment.
Few African-American children receive treatment in privately funded
psychiatric hospitals, but many receive treatment in publicly funded
residential treatment centers for emotionally disturbed youth.
In 2012, there were an estimated 356,268 inmates with severe mental
illnesses in U.S. prisons and jails.
There were only 35,000 mentally ill individuals in state psychiatric
hospitals.
The report, ``The Treatment of Persons With Mental Illness in Prisons
and Jails,'' jails ``in 44 of the 50 states and the District of
Columbia, a prison or jail in that state holds more individuals with
serious mental illness than the largest remaining state psychiatric
hospital.'' the report said.
African Americans today are overrepresented in our jails and prisons.
People of color account for 60 percent of the prison population.
The Stanford Law School Three Strikes Project's report stated that,
``over the past 15 years, the number of mentally ill people in prison
in California has almost doubled.''
In California, 45 percent of state prison inmates have been treated
for severe mental illness within the past year.
African Americans also account for 14 percent of regular drug users,
but for 37 percent of drug arrests.
Illicit drug use is frequently associated with self-medication among
people with mental illnesses.
In January 2014, the Texas Observer reported that, of the 9,000
inmates in Harris County Jail more than 25 percent take medication for
mental illness, which means that the jail treats more psychiatric
patients than all 10 of Texas' state-run public mental hospitals
combined.
The passage of the Affordable Care Act created access to health care
for those who purchase health insurance and for the poor living in
states that are participating in the Medicaid component of the ACA.
Disparities can occur, if physicians do not refer patients with signs
of mental illness for proper treatment or if referred patients do not
seek out treatment.
Disparities in access to care and treatment for mental illnesses have
also persisted over time.
As noted by the Office of Minority Health:
Only 8.7 percent of adult blacks, versus 16 percent of adult whites,
received treatment for mental health concerns in 2007-2008.
Only 6.2 percent of adult blacks, versus 13.9 percent of adult
whites, received medications for mental health concerns during 2008.
While 68.7 percent of adult whites with a major depressive episode in
2009 received treatment, only 53.2 percent of adult blacks did.
The Affordable Care Act will have an impact on this gap by 2016.
Depression and other mental illness can be deadly if left untreated.
Suicide is the third leading cause of death among African Americans
15 to 24 years old.
Untreated mental illness can also make African American men more
vulnerable to substance abuse, homelessness, incarceration, and
homicide.
African Americas are the racial/ethnic group most affected by HIV in
the United States.
According to the CDC, 44 percent (19,540) of estimated new HIV
Diagnoses in the United States were among African Americans, who
comprise 12 percent of the US population.
HIV/AIDs are now the leading cause of death among African Americans
ages 25 to 44--ahead of heart disease, accidents, cancer, and homicide.
At the end of 2012, an estimated 496,500 African Americans were
living with HIV, representing 41 percent of all Americans living with
the Virus.
Of African Americans living with HIV, around 14 percent do not know
they are infected.
African Americans accounted for an estimated 44 percent of all new
HIV infections among adults and adolescents (aged 13 years or older) in
2010, despite representing only 12 percent of the U.S. population.
HIV is a sexually transmitted disease or STD; it is also spread
through intravenous drug use.
HIV infections spread through sharing of needles has declined with
needle programs, while the STD rates of infection among African
Americans has increased at rate higher than any other ethnic group.
Have their HIV status checked--not once but annually.
Know the HIV status of sexual partner.
If HIV positive: Know how to get on antiviral medication, 2 small
pills taken each day, and stay on them.
Where to go for information if you or your partner is HIV positive.
In 2010, men accounted for 70 percent (14,700) of the estimated
20,900 new HIV infections among all adult and adolescent African
Americans.
The estimated rate of new HIV infections for African American men
(103.6/100,000 population) was 7 times that of white men, twice that of
Latino men, and nearly 3 times that of African American women.
In 2010, African American gay, bisexual, and other men who have sex
with men represented an estimated 72 percent (10,600) of new infections
among all African American men and 36 percent of an estimated 29,800
new HIV infections among all gay and bisexual men.
Of those gay and bisexual men, 39 percent (4,321) were young men aged
13 to 24.
According to the CDC, the numbers of new HIV diagnoses among African
American women fell 42 percent between 2005 to 2014, but it is still
high compared to women of other races/ethnicities.
Most new HIV infections among African American women (87 percent;
5,300) are attributed to heterosexual contact.
In 2012, there were 72,010 Texans living with HIV/AIDS.
Texas has the 10th highest number of HIV diagnoses in 2013 and ranks
18th for deaths from HIV.
Currently 14 percent of the people living with HIV are undiagnosed
and only 30 percent of the people with HIV are virally suppressed,
which means that 70 percent of the people who are ill are not on
medication that can help limit their ability to infect others.
HIV is an unnecessarily disproportionate burden on the African
American and Latino community.
There is a wall of misinformation about the illness and an
uncomfortable silence regarding the need to speak about the illness not
only to the young, but also the older persons.
When treatments were first developed in the 1990s they had lots of
side effects that made patients very ill.
Few talk about the advances in HIV treatment that now involve taking
2 small pills a day with the result leaving patients feeling healthy
and able to engage in life's normal activities.
The virus count for those who take their medication is so low that it
often does not register in tests.
This does not mean that people are cured, but it does mean that there
is no reason not to get tested so that you know if you are in need of
treatment.
Anyone can become infected--so it is up to all of us to educate our
families, neighbors, co-workers and friends about getting tested.
There are some insurance company practices that have a detrimental
impact on the ability of people with HIV to enroll in qualified health
insurance plans.
In states like Texas that are not fully participating in the
Affordable Care Act's Medicaid

[[Page H3743]]

expansion this is especially problematic for HIV patients who are poor.
Some states allow insurance carriers to post misleading or
intentionally vague formularies on market place websites or excluding
essential HIV medications from drug formularies and impressing high
cost sharing.
Out of pocket medication cost each month should be capped.
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.

{time} 2030

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.

[[Page H3744]]

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

[[Page H3745]]

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).

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

[[Page H3746]]

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.
Mr. JEFFRIES. Madam Speaker, I thank my good friend, the
distinguished gentlewoman from Ohio, and our phenomenal anchor for this
CBC Special Order hour today and throughout the second session of the
114th Congress. It has been an honor and a privilege to work closely
with her. She has done such a phenomenal job, not just on behalf of the
people she represents in the great city of Columbus, Ohio, but all
throughout the Nation in her various roles, and certainly in her
leadership in the Congressional Black Caucus.
It is with a heavy heart that I stand on the floor of the House of
Representatives today and, with great sadness, acknowledge the pain and
the suffering and extend my condolences to those who have suffered this
great tragedy in Orlando, Florida, the worst mass shooting in the
history of the United States of America.
It is a complicated shooting. We understand that it most likely is an
act of terror, a hate crime of unspeakable proportions. There are
indications that the shooter may have some degree of mental illness and
a history of domestic abuse. The shooter appeared to have been, in some
measure, on the FBI's radar.
But you can add all those things up and there is still something that
is missing that we here in Congress have the capacity to deal with, and
that is the fact that one individual was able to purchase a weapon of
mass destruction--which should be reserved for war, not the hunting of
human beings in this great democratic Republic--and inflict death on 49
individuals and maim in ways that are inhumane to more than 50 others.
Martin Luther King, Jr., once said: ``In the end, we will remember
not the words of our enemies, but the silence of our friends.''
During the 114th Congress, there have been more than 100 mass
shootings. We often come to the floor of the House of Representatives
and the Speaker or one of his designees stands at the rostrum and asks
us, as Members of the House, to stand in a moment of silence. And then
we go on with business as usual, having done nothing about the
tremendous gun violence problem that we have in America.
The rest of the world is looking around and saying: What are they
doing in the United States of America? Five percent of the world's
population, 50 percent of the world's guns. It is estimated that there
are more than 300 million guns circulating throughout this great land.
The FBI and local law enforcement can't tell you where the overwhelming
majority of them are because of legislative silence and malpractice.
This is an issue, of course, that has great impact on the African
American community. Homicides are the leading cause of death through
guns of younger African American men. So we in the CBC view it as a
public health crisis certainly for our community. I think it is one
that all Americans should view as a health crisis for the entire
country.
But the thing that is also troubling--and we will have time to deal
with this tragedy--is hopefully we will be able to take some
commonsense steps in the right direction, including making sure that
individuals who are on the terrorist watch list can't purchase weapons
of mass destruction. How complicated is that to do?
But the thing that is striking for many of us in the African American
community is that, when you look at some of the leading causes of
death--heart disease being number one, and then, of course, diabetes
and childhood obesity being problematic, certain forms of cancer, HIV/
AIDS infection--many of these illnesses, these ailments that plague the
neighborhoods that I represent in central Brooklyn, in Bedford-
Stuyvesant, in East New York, in Ocean Hill-Brownsville, in Canarsie,
and in the west end of Coney Island, are preventable, preventable by
better exercise, preventable by dealing with some of the environmental
racism that many low-income communities of color have been subjected
to, resulting in incredibly high rates of asthma and other forms of
respiratory illness, preventable by better diet.
Senator Booker recently said to many of us--and this has stuck with
me--that more African Americans in the United States of America die as
a result of drive-throughs, not drive-bys. That is because the diet,
the access to healthy food, is limited. The food deserts within which
many African Americans, particularly at the lowest socioeconomic level,
are forced to reside in are scandalous.
So we in the Congressional Black Caucus believe that we have to deal
with these issues in a more meaningful, comprehensive fashion.
I am thankful that back at home in the west end of Coney Island,
Coney Island Cathedral, one of the most important religious
institutions in Brooklyn, is actively engaged in a public health
campaign to deal with diabetes and heart disease and many of the other
ailments that result from a poor diet that exists, a lack of access to
healthy food in the Black community. It is a campaign that we want to
take across the Nation.
We are thankful for the work that has been done by the Congressional
Black Caucus and by President Obama through his leadership of the
Affordable Care Act. We now know that over 20 million previously
uninsured Americans now have access to quality, affordable health
care--disproportionately African American.
That is a positive step in the right direction. But instead of trying
to dismantle this monumental step forward, as House Republicans have
attempted to do more than 60 times over the last few years, they have a
clinical obsession with a law that has been declared constitutional--
not once, but twice--by the United States Supreme Court.
Let's figure out ways to come together as a nation, despite our
racial, religious, and ethnic differences, to deal with the disparities
that exist in the African American community and beyond. And let us
come together as a Congress and as a nation to deal with the scourge of
hate, in its most recent form, directed at the LGBT community down in
Orlando in such a horrific and invidious fashion.
We are better than this. We can do much better here in the United
States Congress. The Congressional Black Caucus is here to lead the way
on issues, worked in partnership hand in hand with our colleagues on
the other side of the aisle, if they are just willing to meet us some
of the way, to deal with the issues of health disparities in the
African American community and deal with the scourge of gun violence
that takes our young boys and girls in shocking numbers and also
impacts people all across the country.
I thank the distinguished gentlewoman for her leadership and for once
again yielding to me and anchoring this Special Order in such a
phenomenal way.
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.

[[Page H3747]]

I yield back the balance of my time.
Ms. EDDIE BERNICE JOHNSON of Texas. Madam Speaker, I rise in honor of
the special order hour titled ``Bridging the Divide: A Call to Action
by the Congressional Black Caucus to Eliminate Racial Health
Disparities.'' I would like to thank my colleagues Congressman Hakeem
Jeffries and Congresswoman Joyce Beatty for hosting this timely special
order.
Historically, racial and ethnic minorities are likely to have the
highest uninsured rates and are less likely to receive preventive and
quality health care. While the Affordable Care Act has helped
minorities afford health insurance and access quality care, there is
still a need to eliminate existing disparities. For example, the
Department of Health and Human Services is currently working to expand
access, end racial and ethnic discrimination, perform outreach to
underserved communities, improve workforce diversity, and expand data
collection and reporting.
While this is an ambitious plan, it is one that is extremely
necessary. Unfortunately, coverage, access, and outreach may not be the
only keys to eliminating disparities. Demographic characteristics
contribute heavily to racial and ethnic health status. For example,
research shows that privately insured African American and Hispanic
adults fare worse than privately insured white adults along measures to
access and use of care. Unfortunately, African Americans and Hispanics
are less likely to have a regular provider than their white
counterparts. The same research also showed that privately insured
African Americans and Hispanics had less confidence in their ability to
pay for medical costs.
Since social determinants like economic stability, education, and
environment play such a large role in how we each view and access
health care, many of the changes necessary to eliminate racial and
ethnic disparities require a much larger plan than just a focus on
health-related programs. Reducing disparities in health truly entails
addressing racial and ethnic social determinants such as availability
of safe housing, affordable food, access to education, job
opportunities, community-based resources, public safety, public
transportation, and more.
Our society must make many changes before we can truly eliminate
racial and ethnic health disparities because that also means
eliminating disparities in many other sectors. I thank Congressman
Jeffries and Congresswoman Beatty for hosting this poignant special
order.

____________________