A major American tragedy is that we spend more money per year on health care than other major industrialized nations, but rank lower than many other countries in health outcomes. The United States has the highest health care spending per capital in the world, at $4,887, compared for example with Japan who spends $2,131 per capita and has far better health outcomes. (In 2003, the United States spent 15.3% of its gross domestic product on health care and projected that the percentage would reach 18.7% in 10 years.1 )
We must also keep in mind that America leads the world in science and that Americans have been awarded almost 50% of the Nobel Prizes in Medicine. We invest more in research, publicly and privately, than any other country in the world. In spite of this, there are tremendous gaps here between what we know and what we do. Major issues facing the health care system in America are that health care is treated as a privilege rather than a right, which means health is treated as a commodity to be traded in the marketplace, available to the highest bidder, and that we invest far too little in preventing diseases and their complications.
The structures wrought by this uneven system and their effects on people are evident in the significant disparities in this country in health between different racial and ethnic minority groups compared with Whites. Major barriers to access to quality health care, including being uninsured, underinsured, and underserved have been identified as areas that must be addressed if our goals, as stated in Healthy People 2010,2 to increase years and quality of healthy life and eliminate racial and ethnic health disparities, are to be realized.
Initiatives such as the W.K. Kellogg Foundation's Community Voices Initiative are challenging the status quo by focusing on policy changes that can lead to the elimination of health disparities. At the local level, the eight Community Voices sites are working on sustainable improvements in healthcare for the undeserved through policy innovation and systems changes. The national program office of Community Voices, housed at the National Center for Primary Care at Morehouse School of Medicine, works to assure that the voices and experiences of underserved communities are heard and acknowledged in national dialogue about health disparities and health reform, Community Voice's efforts have already led to innovative approaches to finding solutions to some of our most common and daunting health-outcomes-related problems. Further, these projects are sources of [End Page xii] useful models that can be replicated in other communities to provide access to care and promotion of disease prevention.
I had the opportunity to visit the Ingham Community Voices Program in Michigan and was impressed by their focus on oral health. Concerned dentists volunteered a small percentage of their time to provide services to children on Medicaid. They were able to treat one half of the uninsured children in the area. This is an example of a program that demonstrates that it cares enough, which is the first resource needed to eliminate health disparities.
Other projects demonstrate a quest to know enough to find answers to questions about what works and does not work. The Denver Health Community Voices Program has a community outreach program whose purpose is to facilitate the enrollment of eligible people into health programs. The program demonstrates that culturally sensitive community outreach to underserved populations not only improves the enrollment of eligible individuals into health plans, but also empowers communities to assume greater responsibility for their own members' health. Notable here is that this program has the benefit of a culturally diverse steering committee that provides input on the best ways to interact with the targeted communities. Culture counts and we must know enough if we are to eliminate health disparities.
Community Voices has provided a wake-up call to the plight of African American men who bear a disproportionate burden of disparate health outcomes in this country. For example, African American men are more likely to die from lung, prostate, and oral cancers and to be uninsured than their White counterparts. Life expectancy...