that the programs have not been adequately supported. This is especially true for government initiatives such as those at the National Institutes of Health (NIH) and the CDC. As long as those programs are not adequately supported, he said, we cannot be fully confident that we are collecting all of the quality data that we need. The World Health Organization (WHO) believes that health inequities in the world can be eliminated in the next generation. The country in the best position to lead, Satcher said, is the United States. We have the resources and the constitutional backing, and we can lead the world by starting with our own country, but we need support and commitment.

Two of the overarching goals of Healthy People 2010 are to increase years and quality of life and to eliminate racial and ethnic health disparities, although Satcher noted that it will take a few more decades beyond 2010 to fully realize these goals. Satcher concurred with Maupin that children’s health is the most important investment we can make. Infant mortality is one of the most dramatic examples of disparities in health. African American babies are nearly two and half times as likely to die in their first year of life, and American Indian babies almost twice as likely to die, as the majority population. Interestingly, the United States trails other countries such as Cuba and Costa Rica in this regard, who although they have fewer resources than the United States, have lower overall infant mortality rates. Because we have failed to seriously make a commitment to eliminate disparities in health, we have pulled our whole health system down, and will continue to do so, Satcher said.

Worldwide, mortality of children under 5 years of age is about 80 per 1,000 live births. In the United States the rate is about 8 per 1,000 live births. Sweden has the lowest rate on record of about 3 babies per thousand who die before their 5th birthday. Sub-Saharan Africa, however, has an under-5 mortality rate of 172 per 1,000. The world cannot be stable and exist in peace, Satcher said, as long as such health inequities exist.

A study done at the Graham Center in Washington, DC, modeled what could have happened in the United States if disparities in health had been eliminated in the last century, assessing mortality ratios for African Americans and whites back to 1960 (Satcher et al., 2005). In 1900, the life expectancy in the United States was 47 years (49 for whites and 44 for blacks). Analysis of the data suggests that if disparities in health had been eliminated in the United States by the year 2000, there would have been 83,500 fewer deaths among African Americans. If infant mortality had been equal between both populations, 4,700 African American infants who died in the year 2000 would not have died. In terms of insurance coverage, there would have been 2.5 million fewer blacks uninsured, including over 600,000 children. In reality, in the year 2000 there were around 39 million



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement