MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. The U.S. is on track to be a majority minority country within three decades. Compared to their white neighbors, African-Americans, Latinos, Asians and Native Americans have higher rates of illness and death from treatable conditions.

MR. KOJO NNAMDIIt's a problem without an obvious solution. Martin Luther King once said that, quoting here, "Of all of the forms of inequality, injustice in healthcare is the most shocking and inhumane." So what do we do about it? Healthcare reform passed last year and that should help, but the underlying social problems that feed the gap in quality care need to be tackled as well.

MR. KOJO NNAMDIHere to talk about some initiatives to do that is Garth Graham. He is the deputy assistant secretary for Minority Health and director of the Office of Minority Health with the Department of Health and Human Service. Dr. Graham still practices as a clinical practitioner in Internal Medicine when he is not working of the Office of Minority Health. Dr. Graham, thank you for joining us.

DR. GARTH GRAHAMThank you for having me.

NNAMDIAlso in studio with us is Claudia Baquet. She is the associate dean for Policy and Planning and the director of The Center for Health Disparities at the University of Maryland School of Medicine. Dr. Baquet served as deputy assistant secretary for Minority Health between the years 1992 and 1994. Claudia Baquet, thank you for joining us.

DR. CLAUDIA BAQUETThank you for having me.

NNAMDIWell, the government has known about this problem for decades. The Office of Minority Health, which you head, was created 25 years ago. I'd like to hear from both of you on this, but first you, Dr. Graham. From where you sit, has there been progress over these past 25 years?

GRAHAMYes, there's certainly been a progress, but what we've seen is that health disparities still continue to persist, still exist. The last National Health Disparities Report, which is an annual report released by the government, show that health disparities have persisted in a number of areas.

GRAHAMCertainly we see that in certain cancers that disproportionably affect minority communities. Certain markers of access to care, certain things like even communicating between a physician and a patient that we see, particularly in Hispanic communities, and we see certain issues with a language access.

GRAHAMSo we've seen some improvement over the past two decades since the government has been tracking these issues. But what we certainly see is a persistent nature to health disparities.

NNAMDIDr. Baquet?

BAQUETI have a perspective, having served also as a senior scientist at the National Cancer Institute for about eight years. During the time when the secretary's task force on Black and Minority Health was released in the mid-80's, which was an exercise to initially start defining what we call disparities now, yes, disparities continue to exist.

BAQUETThe differences that I see, having this perspective of being in the federal government when they were first studied and then now, is that with the release of the secretary's plan for elimination of ratio ethnic disparities last week with a wonderful CDC report on inequalities in health, we're finally moving beyond just simply characterizing or describing the disparities and coming up with solutions and systems change to try to reduce and ultimately eliminate them.

NNAMDIIf you'd like to this conversation you can call us at 800-433-8850. What do you see as the top health threat to minority communities? 800-433-8850, you can also e-mail us at kojo@wamu.org or go to our website, kojoshow.org. Join the conversation there.

NNAMDINumbers vary, but some reports show that lack of insurance accounts for maybe 20 percent of what we see in health disparities. What is the rest? Is the problem access to care, ongoing bias or are these initiatives going to help us to better understand? And we will talk about the initiatives specifically very shortly.

GRAHAMSure. So a number of different factors. In fact, one of the vexing things about health disparities, there's no simple solution. Certainly health insurance is a factor. The Institute of Medicine has articulated again and again and again that health insurance and how that affects access to care is a major factor in terms of the existing health disparities.

GRAHAMBut there's some things that have, when I say they're not specifically health, in terms of certainly jobs and certainly in terms of other factors, education as well as other markers that we call social determinates of health that also affect health disparities. So it's truly multi-factorial.

GRAHAMWhat I would also say, and I know Dr. Baquet can speak this, because she's done wonderful work, certainly at the Maryland state level in terms of moving things and making sure that Maryland legislatures pay attention to the issue of health disparities, is that there are different ways to tackle it.

GRAHAMCertainly there's a role for the federal government, there's a role for state, there's a role for businesses, there's a role for community organizations. Because of the multi-factorial nature of this, it's the kind of problem where we all have a responsibility in terms of fighting against health disparities.

NNAMDIDr. Baquet?

BAQUETI agree. Understanding health disparities, it's a very complex matter. In addition to access issues in terms of having insurance, simply having an insurance card doesn't mean a person will obtain or be able to find the type of healthcare in a very nurturing, culturally competent environment even with language specific to what their primary language is.

BAQUETAnd so understanding the range of factors that contribute to health disparities would be volumes and volumes of papers and a radio show much longer than we have time for. But if you can imagine that individuals and their families and communities behaviors can predispose to certain disparities, that could be of course using tobacco, a diet high in fat, less physical activity, not seeking care in terms of prevention strategies, but only going to seek care when you're very ill and going to an emergency room rather than health maintenance examinations.

BAQUETAnd then, of course, we know that there is growing diversity in cultures in our nation and not a healthcare work force that is prepared to deal with fostering the delivery of culturally competent care. So all of these factors often do not occur in isolation. A person may smoke, eat a high saturated fat diet, not have health insurance, work during the day when the health clinic is open instead of a clinic that may not open on Saturdays and evenings is very complex.

NNAMDIThe Affordable Care Act, healthcare reform, which passed last year, should help address our nation's health disparity, but critics say it falls short on the social aspects of the problem.

NNAMDIThe two initiatives I'd like to talk about are the National Stakeholders' strategy for achieving health equity in the HHS action plan to reduce health disparities, both of them announced by Secretary Kathleen Sebelius. Are those initiatives -- do those new initiatives get at that issue?

GRAHAMCertainly, it's a start in terms of getting at the issues so our department last -- two weeks ago announced these initiatives. And part of these initiatives are certainly partnering with other federal agencies to address other issues outside of just the strictly healthcare realm, so certainly partnering with folks over education, folks over at labor, the Department of Labor, folks over at housing and so it's a start to certainly broaden the sphere in terms of how we look at health disparities.

NNAMDITalk about the difference between the two. It's my understanding that the National Stakeholders' Strategy for achieving health equity is directed more at community groups and what those community groups can do for themselves and that the action plan to reduce health disparity has to do with what the government itself can do.

GRAHAMYes, exactly. And so what it really is showing is that there's a role for the federal government and the federal government needs to take visible leadership on our reducing disparities but the government can't solve it all. There's a role for communities, there's a role for businesses, there's a role for folks who are working at the state level.

GRAHAMFolks who do great work such as what Dr. Baquet does and so there's a role for all kinds of individuals. And so what we try to do here is to lean in a specific role for the federal government. Certainly a series of actions that will allow us to keep ourselves accountable and have the public keep us accountable but also understand that there is a role in terms of strategies that community organizations, individuals, folks working at all different tiers in terms of the system.

GRAHAMAnd I think, Kojo, that's the point that we're trying to get at, is that health disparities is not just one person's domain. It truly is a national problem and there are all different folks at all different tiers in terms of folks who should be involved in the national debate if not the ultimate solution of health disparities.

NNAMDIDr. Baquet, should be we be A, hopeful or B, skeptical of these new initiatives if others don't seem to have worked?

BAQUETHopeful, because having been a former federal employee both at NIH and then at HHS and then now at a major academic health center in Baltimore, I've seen the evolution so that finally you have the federal government recognizing that the partnerships and engagement of the communities affected by health disparities and investment in enhancing their capacity to address their own health issues using federal resources when appropriate and then using local resources when appropriate.

BAQUETThis is very revolutionary compared to where we were in the '80s around the time of the secretary's task force. So this is wonderful.

NNAMDIIn case you're just joining us, we're talking about new initiatives to attempt to eliminate health disparities. We're talking with Garth Graham. He is the deputy assistant secretary for Minority Health and director of the Office of Minority Health with the Department of Health and Human Services.

NNAMDIAnd Claudio Baquet is the associate dean for Policy and Planning and director of the Center for Health Disparities at the University of Maryland School of Medicine. Onto the telephones, here is Patricia in Shepherd's Town, W.Va. Patricia, your turn.

PATRICIAHi, I think the point I wanted to bring up, as far as disparity is concerned, that it's not -- I understand that, say, minority gives you an opportunity to isolate into a specific area, but I think it's more of a monitory thing. I had cancer for over 15 years and at the time I was going to graduate school and I didn't have insurance. And since then, it's been a long, hard struggle for me to get hospitalization, to get doctors, to get competent, good quality doctors that would treat me.

PATRICIASo I think it goes back to more that it's an issue of funding and money as I'm finally old enough that I have Medicare that I'm finding out that doctors don't want to take Medicare. So I just feel like once you get caught in here, you can't ever get out again.

NNAMDIPatricia, I'm glad you brought that up.

BAQUETThere are a host of different categories of disparities. Of course, there are racial ethnic disparities, which deal with the racial ethnic communities and communities of colors that we discussed. There are geographical disparities, which occur marginally in rural and frontier areas.

BAQUETI believe the caller was from West Virginia and the socio-economic disparities, again, as Dr. Graham mentioned, the social determinates of health, one's educational level, how much education they have, where they live, place matters, is there a safe environment in their home and in their community where they're not exposed to substances that can increase their occurrence of many preventable diseases. So, yes, rural and socio-economic disparities are also continuing to get additional attention.

NNAMDIIf I am black and middle-class, does my health future look brighter than someone who is poor and black or poor and white, Dr. Graham? I'm trying to isolate the extent to which financial circumstances affect this because I know Patricia, Patricia is no longer on the line, but it's probably all of the above and then some.

GRAHAMRight, it is all of the above. I think folks like Patricia articulate many of the challenges that working -- for average working folks, if not working poor, as well as other individuals face when interacting with a complex health system. I mean, that's we're trying to certainly deal with, with the many aspects of the Affordable Care Act.

GRAHAMBut, you know, you can look at it different ways because certainly what we see, if we look at infant mortality in African-American woman, we see where African-American woman who have a graduate degree and higher, in terms of a measure of socioeconomic status. Still, in many places, have a higher infant mortality rate, which is the rate at which that baby will live. Her baby will live past the first year of life, have a higher infant mortality rate compared to Caucasian women who have not graduated high school.

GRAHAMSo that's one proxy in terms of that statistics. That being said and done, going back to Patricia's point, we see also the converse, in terms of many areas where we see socioeconomic status certainly play a very prominent and vital role in terms of marginalizing folks from getting access to care. So, it's not simple. It's complicated. But the bottom line, I think, is regardless of whether we're talking about Patricia, whether we're talking about young African-American mother or whether we're talking about, you know, African-American men who have some degree of college or anything above that. All of those folks represent a population that deserve access to care and that we should strive for in terms of making sure they have adequate access to care.

NNAMDIGot to take a short break. If you have already called, stay on the line, we will get to your call. We still have a few lines open. The number is 800-433-8850. If you're a minority working in health care, we'd love to hear what inspired you on that path. Do you see a role for your business, church or community group in trying to close the disparity gap? 800-433-8850 or simply go to our website, kojoshow.org, ask a question or make a comment there. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation on eliminating health disparity. We're talking with Dr. Claudia Baquet, associate dean for policy and planning and director of the Center for Health Disparities at the University of Maryland School of Medicine. She served as deputy assistant secretary for minority health from 1992 to 1994. Also in studio with us is Dr. Garth Graham, deputy assistant secretary for minority health currently and director of the Office of Minority Health with the Department of Health and Human Services. We're taking your calls at 800-433-8850.

NNAMDIOne of the phrases you used a couple of times in the first part of this discussion that may need explanation, Dr. Baquet, is culturally competent care. What does that mean?

BAQUETCultural competent in the delivery of culturally competent care means that the type of medical attention, public health care or delivery of health care services is tailored to be responsive to the cultural influences a person may have. So, for example, this goes beyond just simply having language specific health care services. For example, if a Latino female comes in for her annual female check for, say, a pap smear, culturally competent care means that the health care professional understands that that woman wants a female physician to do her pap test rather than a male and will often bring in her significant other, her spouse in the room during the procedure. So that's one example. It's tailoring health care to get the best outcomes for cultural influences on health care delivery.

NNAMDIThe American Medical Association found that many physicians are unaware of minority-specific health concerns. What training do medical schools provide students with to make them mindful of this that you are aware of, Dr. Graham?

GRAHAMSo, cultural competency training has become a part of many curricula in medical schools. There are a lot of medical schools across the country who are starting to teach this as something -- something certainly even from the ACG and the graduate medical education perspective. There is a more -- there's a higher influence now on just not knowing the lab values of a patient, but understanding the patient as attached to those lab values and understanding the culture of that patient. So we're seeing that moving forward at a very advanced pace within the American medical school system and it's all part of I think of also providing more patient-oriented patient center care.

NNAMDIHere is Laura in Rockville, Md. Laura, you're on the air. Go ahead, please.

LAURAHi, Kojo. Thank you so much for this discussion. You all have actually addressed some of my concerns already about culturally competent care. But sort of related to that, do you all have any statistics on the demographics of the professional medical community? Because if we're seeing more representation of certain groups in the medical field, we might see more people from minority groups comfortable in receiving services.

NNAMDIThere is indeed a big focus on training members of minority communities to be health care providers.

GRAHAMYeah. So I think your caller and Dr. Baquet alluded to this earlier, one of the vexing challenges that we'll face is the number of minority physicians in not only physician training but nursing as well as other allied health professions. Certainly when we look at Hispanic physicians, we're seeing numbers that are still in the single digits in terms of the percentage of Hispanic physicians and certainly similar low numbers with African-American physicians, Native-American physicians across the board.

GRAHAMSo, your caller -- and this has persisted for many years. Your caller identified one of the challenges that has been, not only identified by what HHS is going to be doing, but something that has been a concern for a number of years, which is increasing not only the number of physicians we have currently, but the pipeline of students and trainees that are coming behind those physicians so that we have an adequate percentage of minority physicians in the workforce.

NNAMDIAfrican-Americans comprise 13 percent of the nation's population, but 4 percent of U.S. physicians. Why is this important? Well, it's my understanding, Dr. Baquet, that research has shown that having providers from the same racial or ethnic background as patients, especially in low income communities tends to produce better health results and this is something I know anecdotally but apparently there are studies that show that many minority medical students report a desire to return to the community they came from after graduation.

BAQUETYes, there's evidence, strong evidence, that shows that minority physicians will often -- the majority of them will go back to the communities from whence they came to practice medicine. We know that the importance of having the same culture or cultural background by the health care professional, it's been documented in any number of studies that there's greater satisfaction with health care if there's what we call racial concordance. That is the race of the patient is the same as the race of the physician. And so, having these shortages we know directly impacts both health outcomes, health care seeking behaviors and patients reported satisfaction with whether or not they felt discriminated against in the clinic encounter when they went to the doctor or not.

NNAMDIOn to the telephones again. Here is Conrad in Silver Spring, Md. Conrad, you're on the air. Go ahead, please.

CONRADYes. Thank you, Kojo. I just wanted to first thank Dr. Graham and Dr. Baquet for their leadership over the years in this area and specifically the question with regards health IT, health information technology. The National Medical Association and the National Association of Black-owned Broadcasters had been exploring strategies with using broad catheters to connect with broadband, to engage in power and educate underserved communities and I was wondering what Dr. Graham and Dr. Baquet's thoughts on the use of telemedicine and mobile health to reach underserved communities.

NNAMDIDr. Graham?

GRAHAMSo that's a key part of our plan in a number of different areas. In fact, it's on page 27 or something along those lines if I remember specifically.

NNAMDIHe remembers the page numbers.

GRAHAMIt took us a long time to get it. So a part of that specifically is making sure a number of things certainly. Right now, the federal government is investing in electronic health records and trying to make sure that doctors offices have electronic health records, that electronic health records that doctors have meet certain criteria to make sure that they are something called meaningful users, make sure that there are certainly quality electronic health records.

GRAHAMSo we're working to try to make sure that minority physicians understand what needs to be done in terms of the adoption of electronic health records and also make sure that minority physicians take advantage of financial incentive that goes along with the adoption of electronic health records. That's one component, but there's much more to the health information and technology and its ability to help reduce health disparities. And your caller touched on, I thank you for your comments because they certainly show a lot of insight into some of the potential things that we can use to help reduce health disparities. Telemedicine is amazing once you've seen it in practice.

GRAHAMI was in Mississippi a couple of years ago and saw an example of where there was a young child who had fractured his leg, basically, and was taken care of not by a physician, but by someone who was many, many miles away, who was in contact with a physician, who was instructing that person how to help reduce that fracture appropriately and then transport the child. So basically what that allowed the child to do was to get medical care tens and tens and tens of miles away with expert input without having to drive the four hours to make it to the medical center to get that care. So, that just improved his quality of life significantly right there.

NNAMDIDr. Baquet?

BAQUETYes, I appreciate very much Conrad's comments about telemedicine. After working in the field at the University of Maryland Medical School in Baltimore for about eight years, we have perfected a number of telemedicine methods. Our V.A. hospital has filmless radiology, we do tele-dermetology between Baltimore and some of the rural communities in the state and I'm pleased to have funding from the National Institute of Minority Health and Health Disparities to study whether or not providing home based telemedicine for patients with heart disease and lung disease will reduce their emergency room visits and enhance their quality of life.

BAQUETAnd this study is going on now in Garrett County, which is headed towards West Virginia the western part of the state, part of Appalachia and in southern Maryland. So I'm very thrilled to hear the emphasis in this report on telemedicine. One of the biggest barriers is lack of reimbursement for the service, but it appears with the plan that will eventually be addressed. So we're very pleased.

NNAMDIConrad, thank you very much for your call. You too can call us. Do you have questions about how healthcare reform can impact your life? Call us, 800-433-8850, or go to our website, kojoshow.org join the conversation there. Dr. Graham, your office has studied the impact that violence and trauma can have on the health of African-American men in particular. If you're born into a neighborhood in which there is a great deal of violence, does that mean you have an immediate handicap? How is that piece of the problem dealt with in this instance?

GRAHAMYeah, that's an interesting other piece of activity that we're undertaking with. I was being led by a fellow by the name of Dr. John Rich who received one of those MacArthur Genius Awards not many years ago for this specific work. And basically what his work has shown is that many times the exposure and re-exposure to violence that African-American males have in urban communities is literally trauma and re-trauma. They get re-traumatized again and again and again as they're continually exposed to violence.

GRAHAMSo in many cases, we've looked -- and I want to say we. I think, overall, the system has looked at violence in African-American men as merely just a penal issue, something to be dealt with the legal system. But in many contexts, it really is a public health issue as well because of the way in which these -- the way in which many young men are introduced to violence and then the way they're re-exposed to it again and again and again is truly a public health issue.

NNAMDIOn to Kevin in Gaithersburg, Md. Kevin, your turn.

KEVINHi, I'm a Caucasian and I received a -- I had a medical condition. I received care from a number of doctors in the last few years. And one the doctors that I've been seeing have been all different races and ethnicities, and I've never along that way stopped and thought what questions the quality of my care because of who it was from. What I was hearing you say was some minorities and races and ethnicities might respond better to having the same race as their doctor. I wonder if the response to that should be to promote more minority doctors or should it be to educate that, you know, people receiving care can trust people of all ethnicities. They don't need to live in a, you know, "Cosby Show" kind of world where they're all within that same ethnicity.

NNAMDIOkay, here's Dr. Baquet for more explanation on that.

BAQUETThank you, Kevin, for that comment. The reason that I mentioned the matching of the races between the patients and the provider is because of the wealth of studies done. Some by Kaiser Family Foundation available on their website that document that if the race isn't the same you have a greater chance of less satisfaction with care. You have a greater chance for the communities of color, the racial ethnic minorities not feeling that they received the type of care they should and a higher proportion of them also report that they felt discriminated against and then therefore won't return to that physician or health care system again, which then leads to other problems in persistence and the reason they came in the first place. So, yes...

NNAMDIWhich, Kevin, is not to say that people of different races are incapable of providing appropriate care.

BAQUETExactly.

NNAMDIIt is, however, to say that if you happen to be of a different race, a level of cultural competence is helpful if not required.

BAQUETYes, yes. And for those who aren't of the same race as the patient, this is why we have these emerging standards and new curricula to train those in undergraduate medical education on how to be culturally competent regardless of their race ethnicity.

NNAMDIThank you very much for your call, Kevin. Any other questions?

KEVINNo, thank you.

NNAMDIAll right, then we can move on to Ben in Washington, D.C. Hi, Ben.

BENHi, Kojo. Thank you very much for having me on. My question is pretty simple. I read yesterday, or it was actually last week, about how Sigmet did a pilot program for the ACO model and they said that for them it was profitable and also reduced the cost for the hospital as well. So I'm wondering how this is going to impact the political position between Democrats and Republicans, because the Republicans are kind of promoting a business as is motto but this new ACO motto is benefiting private enterprise and also benefiting most importantly the health care recipients, does this actually change the game?

NNAMDIDr. Graham.

GRAHAMOh, that's an excellent question, Ben. And you obviously know a little bit about what's going on. This is our educated -- sort of educated caller. So the new census for Medicare and Medicaid innovation has been working on how we look at the benefit of these ACO models. They're kind of a cure organization models and there are a number of academic institutions, especially the larger academic institutions, that are already gearing up, if not shifting towards, looking at a variety of different ACO models overall.

GRAHAMBut Ben is right, you know, that we do see evidence that certainly there are ingredients of the ACO model that can be successful at improving care. And we want to make sure as we move forward that we look at all of the things that can be helpful. And I think what Ben is alluding to is some of the ongoing political debates around health reform and, you know, what to go with versus what not to go with. And what I would say is certainly what we should do is follow the signs and follow the evidence. And certainly if there are examples where the evidence shows that a particular model is beneficial for all communities, then I think, as Ben...

NNAMDIWhat's an ACO? What's an accountable care organization?

GRAHAMSo an accountable care organization is a way of making sure of kind of pooling physicians as well as pooling folks together to kind of work together in a better system and so it's really a way of creating, quite frankly, accountability amongst a group of caregivers and certainly having physicians more invested in not only the care that's given, but the way in which the practice, as well as the subsequent activities, are managed. So, it's another way of looking at things, another way of kind of pooling things together. And is one aspect, certainly from a departmental standpoint, that we are investing in to see -- to continue to look at the benefits of the accountable care organizations.

NNAMDIBen, thank you so much for your call. If you have already called, stay on the line. We'll be taking a short break, but when we come back, we'll be continuing our conversation on eliminating health disparity. You can call us at 800-433-8850. Where do you think access to health care fits into discussions about civil and human rights? 800-433-8850, or go to our website kojoshow.org, join the conversation there. I'm Kojo Nnamdi.

NNAMDIWe're discussing eliminating health disparity and new initiatives coming from the Department of Health and Human Services on that issue with Garth Graham, deputy assistant secretary for minority health, and director of the Office of Minority Health with the Department of Health Services, and Claudia Baquet, associate dean for policy and planning and the director the Center for Health Disparities at the University of Maryland School of Medicine. Dr. Baquet served at deputy assistant secretary for minority health between 1992 and 1994.

NNAMDIWe got this e-mail from Sonia in Miami Beach, Fl. "A lot of the latest medical research focuses on personalized medicine where the treatment is tailored to the specific molecular and/or genetic characteristics of a patient to treat their disease. This holds great promise for treating cancer and other diseases, but most of the patients who participated in research studies were white. As a physician and an African-American, I think we need to see a greater number of minorities participating in clinical trials. Can either of your guests address any new initiatives that will encourage minority patients to participate in medical research?" Dr. Graham?

GRAHAMI'll start out by saying a couple of things. One, the Food and Drug Administration has actually recently created a specific entity within FDA to deal with minority health and health disparity issues. And that is going to help catalyze a number of things that FDA works on in terms of looking at recruitment of minorities in clinical trials, drug effects on the differential impact that drugs can have on varied populations. And certainly a number of these things. So the issue of personalized medicine is -- holds great promise.

GRAHAMWe need to be able to look at this on a number of different tiers. Certainly there is a role for the individual in understanding the clinical dynamics between that single individual, but there are certain system issues we need to make sure we have in place so that everyone can still have access to care.

NNAMDIDr. Baquet, your experiences in this regard?

BAQUETYes. The -- I've spent a considerable amount of my research and community outreach work in this field. And just by way of very brief background, we know that clinical trials for example will produce new ways to prevent, diagnose, or treat illness. And for those who have certain illnesses, enhance -- can enhance their quality of life. If you take a disease such as cancer, which will have an estimated 1.4 million new cases this year, and over half a million deaths, yet only about four percent of cancer patients participate in trials.

BAQUETAnd of that four percent, way less than one percent of African-Americans for example participate in cancer trials. But we know that African-Americans, rural patients, and poor patients have the highest health disparities for a number of cancers. And so what we -- what we're seeing now is the rebirth of focus on fostering public trust and research, and in researchers that can move communities who has historically been under represented in medical research studies onto a more trusting relationship.

BAQUETA program that is supported by NIH to look at bioethics and ethical concerns of which personalized medicine will lead to a number of those new concerns for communities that have historically been underrepresented in trials and discriminated against. And this new bioethics initiative, of which I work in in Maryland, and now we're taking our models nationally, hopes to remove the stigma and mystery surrounding research in populations that are underserved, and also in the physicians that treat them, the community physicians.

BAQUETWe do that with a very novel program called Bioethics, Research Ethics, Clinical Trial Mini Medical School. Where the community attends medical school for four weeks, learns about the benefits, the potential risk associated with participating in trials, removes that mystery and stigma, and then can move forward in enhancing their willingness to even consider a trial for them or their loved one. We also learned that one of the biggest barriers to underserved patients and patients in general participating in trials is that their physicians don't discuss research with them.

BAQUETIn Maryland, 95 percent do not. Nationally, 95 percent do not, regardless of the color of the patient. And so now we're doing education of the physicians, the nurse practitioners, the social workers in Maryland and nationally to give them the tools to be able to discuss and refer patients to trials should they be interested.

NNAMDIHere is Phil in Bethesda, Md. Phil, your turn.

PHILHi. Thank you for taking my call. I feel really honored. I'm calling because I personally feel that the health care debate as it stands right now is being argued the wrong way. It seems to me like everybody's arguing whether health care is a universal human right, or it's not. And I think you can argue all day long, one way or the other, and there are very good arguments either way, but I think people need to step back and look at it from a personal interest perspective.

PHILI think it's pretty obvious that, for instance, if you have a school of children and everybody's vaccinated against a disease except for one kid, and that kid gets the disease and comes in and spreads the infection to other kids even though they are vaccinated, there might be a risk for them having the disease, everybody can be affected by that one child having the disease. And then there's another instance from a business perspective.

PHILI think it's, in a business interest, very good to have everybody with health care, because if you have your work force that is affected by a disease, and they're unable to come to work and produce business, then, I mean, it's just obvious that it would be much better to have everybody in their work -- work force covered by insurance.

NNAMDIPhil, I am sure that most people would agree with everything you say, but one of the factors in the ongoing debate about health care is whether or not people can be forced to purchase health insurance, and that's not a debate I'd like to get into during the course of this discussion when we're talking about health disparities. But you do make a good point. These new efforts, these new initiatives that we're talking about, Dr. Graham, grew out of community outreach.

NNAMDIWhen -- outreach. When will people who need services start seeing changes on the ground?

GRAHAMWell, we're hoping that people are seeing changes now, certainly with the implementation of the Affordable Care Act. A number of things are already happening. People can get -- who were previously denied coverage based on pre-existing conditions can get coverage through something called a pre-existing insurance plan. Right now as many of your listeners are probably aware, there are certain things that health insurance companies could do that no longer can do.

GRAHAMCan't discriminate in terms of insurance coverage for children lower than 19. So there are a number of changes with the health reform that we believe are beneficial to communities. They're certainly beneficial to all communities, but particularly those who have a higher burden of pre-existing conditions. Let me just jump back to something that Phil said. This issue of the impact that health care costs -- that health care is having on businesses, is extremely important.

GRAHAMThere are a lot of businesses that though their business might be producing cars, they're in the health care business, because a lot of their expenses go towards covering their employees in terms of health and health care. So Phil's exactly right that we need to be able to articulate the benefits of improving health in a number of different ways, and the interesting part it now looking at the health disparities component, is you have many businesses that employ a large number of minority populations. Certainly we see it in the hotel industry and a number of other service industries, et cetera.

GRAHAMSo we want to engage all those folks in this discussion, because it's not going to be one sector that solves this problem. It's gonna be a group of folks certainly coming together.

NNAMDIPhil, I'm sorry if I seemed to be dismissing the question you raised, because that's why Dr. Graham is the deputy assistant secretary for minority health. He saw the connection, and I did not. Here is Kimberly in Washington, D.C. Kimberly, you're on the air. Go ahead, please.

KIMBERLYHi. Thank you for taking my call. I've recently moved to the District and I'm really shocked by obesity, and wonder if people are being taught in schools or by their doctors about nutrition. My mother, who grew up in a very rural part of Colorado, was taught to eat a leafy green and yellow vegetable with every meal, and fish once a week, and so on. Whereas I see teenagers coming out of the local junior high and buying a bag of chips and a soda. And anyway, they have bad nutrition habits, and it's hard for to believe...

NNAMDIDr. Baquet, it seems to me that this is a part of the cultural competency conversation.

BAQUETYes, and so much more. The -- if you take the childhood obesity epidemic, it's tied to a number of factors, and it in itself is very complex. You have the lack of affordable or available food in many underserved communities, some urban areas.

NNAMDISo-called food deserts.

BAQUETAbsolutely. You have this increase in the sedentary lifestyle, lots of TV, lots of video games, and not moving, or even living in an environment -- you mentioned, intentional injury or violence. Not having a walking path or -- that you can safely walk to even move around after school. Then -- then you have issues with food preparation, what food is available for example in Baltimore are Oodles and Noodles. Tons of salt, very I would say limited nutrition, and -- but it's cheap.

BAQUETYou can go to McDonald's and feed family of four for $10. But you be able to find those -- that lean meat or those fresh beautiful vegetables in your community. Now, the nice thing about it, is there's the Let's Move initiative from the first lady that's brought attention to addressing this epidemic at multiple levels. So there will be systems change. The food system in a community has to change. Community gardening, taking out the vending machines with the sugar soda in the schools, and the potato chips that the caller mentioned.

BAQUETSo it is a complex historical issue, but it is being approached both in the reports that were recently released, but also with the first lady's let's move initiative.

NNAMDIThank you very much for your call, Kimberly. English may not be the first language for members of the minority groups you are reaching out to. How much of an obstacle are language barriers, Dr. Graham?

GRAHAMIt certainly is a significant obstacle. We have to make sure that people have access to care regardless of, as Claudia eluded to earlier, cultural or linguistic background. So certainly being able to reduce the language barrier and make sure that we provide services, translation interpreting services, in the property language and in the proper way. It's not just about translation. It's about making sure that the message is adequately interpreted.

GRAHAMSo all of those ingredients go into the multifactorial milieu where all the different mixtures of factors contribute to health disparities.

NNAMDIYou recently blogged about the translation widget on the Office of Minority Health website. How does that work?

GRAHAMSure. So if you go to our website, a shameless plug, minorityhealth.hhs.gov, you will see that there is a specific widget that you can download there that'll talk a little bit about the -- not just the importance of translation services, but help folks be able to understand a lot more about medical translation and the translation of -- certainly from English to Spanish and Spanish to English, but certainly looking at other venues in terms of translation as well.

NNAMDIHow about people who do not online access, people who don't have access to computers? It's -- a Kaiser Family Foundation poll found 20 percent of blacks and 28 percent of Hispanics are not online at all.

GRAHAMRight. So, you know, that's an interesting number, and I'm gonna say the one interesting thing that you see, is the rate of -- the utilization rate of broadband technology in minority communities right now is growing at a faster rate compared to the rest of the general population. So though the underlying number might be behind, minority populations are utilizing information technology at a very, very fast rate.

GRAHAMCertainly we're seeing that with cell phone technology, et cetera. That being said and done, we have to look at the gap that exists currently and try to make sure that we have services that are available in a number of different venues, not just online. So for those -- for those individuals, we always invite you to give us a call. Certainly try and reach out through -- that's another reason why we try and work with local community organizations as well, so that we can reach people in a variety of different mediums, not just electronically.

NNAMDIOn to Manuel in Chevy Chase, Md. Manuel, you're on the air, but we're running out of time very quickly, so please make your question or comment brief.

MANUELThank you very much, Kojo. I notice that there was minimal discussion of preventative care or about care after the illness occurs, care -- information -- about any information about diet and education, and educating children so they can educate their parents. Other point as relates to overweight people. You mentioned West Virginia where I frequent rural areas frequently, and note that the average overweightness is much greater than in urban areas, and this must have something to do with lower education.

NNAMDIRunning out of time very quickly. Allow me to have Dr. Baquet offer a brief response.

BAQUETYes. I agree completely. And prevention, primary care is the way to go rather than a person becoming very ill with a costly disease, costly in many, many ways to themselves as a person and to their families, and economically. So I do agree with your emphasis on prevention and primary care.

NNAMDIAnd I suspect the national stakeholder strategy for achieving health equity probably addresses that issue also.

GRAHAMIt sure does. We talk a lot about prevention. Thank you, Kojo.

NNAMDIThat's all the time we have. Garth Graham is the deputy assistant secretary for minority health, and director of the Office of Minority Health with the Department of Health and Human Services. Dr. Graham, thank you for joining us. Good luck to you.

GRAHAMThank you.

NNAMDIClaudia Baquet is the associate dean for policy and planning, and the director of the Center for Health Disparities at the University of Maryland School of Medicine. Dr. Baquet, thank you for joining us.

BAQUETThank you.

NNAMDIThank you all for listening. I'm Kojo Nnamdi.