Preventing disparities at forefront of health care reform

Contra Costa Times December 14, 2009

Federally funded security guards at dangerous neighborhood parks. Federal grants to poor neighborhoods to build grocery stores or to keep school gyms open after hours.

These are the types of unprecedented - yet uncontroversial - disease prevention initiatives whose inclusion has been lost in the rancorous debate over health care reform legislation working its way through Congress.

The prevention provisions mark a victory for advocates and federal lawmakers who for years have unsuccessfully sought more federal funding to close the gap in health disparities and life expectancies between richer and poorer Americans.

In Alameda and Contra Costa counties, for example, there's a 16-year life-expectancy difference between those living in a comfortable Walnut Creek area and an East Oakland neighborhood just 12 miles away, where one-fifth of the residents live in poverty.

An adult raised in West Oakland, where 41 percent of residents live in poverty, is also five times more likely to be hospitalized for diabetes than someone raised in the affluent Oakland hills, and is twice as likely to die of cancer.

The House health care reform bill, passed last month, sets aside $33.9 billion over five years for a prevention and health promotion strategy. Democratic lawmakers are pushing for a vote by Christmas on the Senate version, which includes $15 billion over 10 years for similar prevention and health promotion programs.

In both House and Senate bills, a grant request to open a grocery store in an area without one would qualify as a health program, said Rich Hamburg, deputy director of Trust for America's Health. So would a request for money to hire security guards to watch over a park that residents have come to fear because of crime, he said, or money to keep a school playground open after hours. Nutritionists could be hired to teach students healthful food preparation techniques at home, or how to make good choices when eating out.

The Senate bill authorizes "community transformation" grants that would have a similar aim as the House Prevention and Wellness Trust, Hamburg said.

Seven in 10 Americans support the prevention provisions in the nearly $1 trillion health care reform bills, according to a November survey by the Trust for America's Health and the Robert Wood Johnson Foundation.

"Support for wellness, prevention and health promotion is strong across parties, across regions, and all age groups," Hamburg said. "Every which way, it has strong support."