Despite its resemblance to a reality TV show, one positive effect of this year’s presidential campaign is that the issue of inequality in our society has been brought to the forefront. In addition to economic polarization, there are persisting disparities in both health outcomes and the important determinants of health, especially for children and especially in urban areas like Milwaukee. The vision of the children in Wisconsin being the healthiest in the nation can seem unattainable in the face of such gaps. So I was especially heartened by a series of articles in the journal Pediatrics from the first few months of 2016, each providing a glimmer of hope that we may be inching closer to the goal of health equity for all children:
- The prevalence of asthma in the US, which doubled from 1980 to 1995 and continued to increase, with widening racial disparities, has flattened, and the racial difference stopped growing. Moreover, this is being driven primarily by a plateau in the rate of asthma among black children.
- A study of cigarette taxes over time across the US shows that higher cigarette taxes and prices are associated with a decline in infant mortality rates. This benefit was strongest among African-American infants. (Of note, Wisconsin has one of the highest cigarette taxes in the nation, 11th highest at $2.52 per pack. New York is the highest at $4.25, while the lowest is Missouri at $0.17.)
- Human papilloma virus (HPV), which causes genital warts and also accounts for the majority of cases of cervical cancer, is now preventable by a vaccine. Although there has been considerable controversy about the vaccine, there has been a 64% decrease in HPV prevalence in 14-19 year old girls following its introduction. Since HPV disproportionately affects men and women of color, this benefit will be especially great for minorities. (The HeLa cell line, now widely used in medical research, was obtained unknowingly from a black woman who was treated for and succumbed to cervical cancer at Johns Hopkins in the 1950s. The Immortal Life of Henrietta Lacks recounts her story and is a fascinating read.)
- The lasting consequences of adverse childhood events – ranging from poverty to violence to family instability – are increasingly recognized, but little is known about how to mitigate the effects. An intervention among poor minority middle school youth in Baltimore schools demonstrated that mindfulness-based stress reduction techniques led to significant improvements in psychological and behavioral outcomes: less depression, somatization, negative coping, and post-traumatic stress symptoms.
There’s still a lot of work to do to erase the pervasive disparities in our community, but it’s great to get some encouraging news from time to time.