Search for Better Health Care in the Black Community Louis Stokes Member of Congress 21st District Ohio
It is indeed an honor to have been invited to address you today at your conference that is focusing upon: "The Drug Mixup: Reactions and Interactions." I come to you as a legislator with a primary interest in all aspects of health care, particularly as they affect the black community. As a black congressman sitting on the House Appropriations Committee and the House Budget Committee, I am particularly distressed by the fact that the search for better health care in the black community is essentially a search for: 1. Greater accessibility to knowledge relative to health care, 2. More adequate facilities to provide care located in the communities where the problems are most prominent, 3. A more equitable distribution of the existing health manpower and, 4. Equal training opportunities for the development of minority health manpower. In essence, this nation has allowed me, and my brothers and sisters to become the victims of a dual health care system: One for the rich and one for the minorities and the poor. Presented to the conference, The Drug Mixup: Reactions and Interactions, sponsored by Region 11 of the National Medical Association and the Howard University School of Communications, Washington, DC, November 5, 1977. Requests for reprints should be addressed to The Honorable Louis Stokes, Congress of the United States, House of Representatives, 2455 Rayburn House Office Building, Washington, DC 20515.
I take this injustice very personally, because as a black American today, I have been shortchanged and do not receive my fair share of the federal health dollar. Therefore, when I speak on behalf of my constituents, in testimony before Congress, I speak with the sensitivity and commitment of a person who is familiar with the problems as a result of real life experience.
Factors Influencing the Health Status of the Black Community Consumer education should be a major part of the national effort to improve the health status of the black community. Fbr many years the black community has been the depository for products which at worst have negative effects on health and at best have no positive effects. Familiar to most blacks are the dumerous "tonics" and remedies produted locally or regionally for promotion to black and poor consumers. Patent medicine advertising on black-oriented radio stations, aided by consumer igtiorance and inaccessibility of physicians, has been so strong that it requires only a minor stretch of the imagination to position these stations as dispensers of medical advice to the community. For similar reasons the home remedy displays of neighborhood drugstores have been a principal source
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
for relief from health problems that other population segments routinely carry to professionals. The black community continues to be a fertile market for products in other categories which many regard as harmful. Cigarette advertising, now removed from television under federal and social pressure, has proliferated in the black community, where today smoking is intensely promoted by thousands of billboards. Much of the current growth of the tobacco industry in America may have come as a result of the industry's growth in the black community. The gap in health status between the black and white populations of the United States has been documented so frequently and so well that one is justified in asking why it remains so persistent. There are at least two reasons. First, factors other than medical care have a great influence in narrowing the gap, and secondly, there has not been the kind of commitment necessary in order to achieve desired results. In the search f0r better health care, the black community must reckon with both of these points. A widely used indicator of health conditions within a community is its infant mortality rate. At birth, the life expectancy of the black child is seven years less than that of the white child. By a reduction in infant mortality one can add significantly to life expectancy, but the infant mortality rate is influenced by a number of factors, including 749
but not limited to better health care. These include socioeconomic factors. It is also true that minority children who survive infancy also have a significantly shorter life expectancy than do nonminority children. Another major problem affecting the provision of health information and direct health care is the ratio of physicians to residents in low income vs other areas. For example, a 1967 study conducted in Cleveland to determine the availability of physicians to poverty populations showed that there was only one physician per 2,222 persons in poverty areas as compared to one physician per 885 persons in nonpoverty areas. Since 1967, the number of physicians providing health care to the poor has decreased further. A 1972 study by the Cleveland Health Department showed that in three social planning areas in the poverty area of the city there was only one physician per 3,548 residents. This led the Comptroller General who conducted this study that low-income to conclude people-Medicaid recipients and the medically indigent-are the primary users of the outpatient care system. This results to a great extent from the fact that many of the poverty areas are medically underserved due to insufficient numbers of physicians. The major killers among blacks are the same as those among whites, only more so. These are heart disease, cancer, and stroke. The incidence of hypertension is known to be higher among blacks, but we do not know enough about this disease to prevent it. Excess deaths from cancer probably relate to the inaccessibility of medical care, especially for those forms of cancer for which survival varies with early detection and treatment. Hypertension is known to increase the risk of cerebral hemorrhage, but mortality from stroke is also related to accessibility of medical care. This in turn relates to economic factors. The ultimate cause of much of the differential mortality is poverty and the real cure for poverty is wealth-not health. The fight for better health care and the fight against poverty must be
fought simultaneously, therefore, blacks who serve on the appropriations and budget committees in Congress are uniquely situated to help in the solution of health care problems in the black community. 750
In most urban environments, there are two overiding factors that compound all the health problems of the community: the rising demand for health services and the declining revenue available to meet that demand.
Federal Health Care Programs The rising demands from health services have followed implementation of Medicare and Medicaid for a nation that is beginning to understand that health care is both a need and a right. The local revenue dilemma can be attributed to the exodus of the more affluent taxpayers from the inner city to suburbia and to the decay and demolition of taxable real estate with delayed urban renewal. Most large cities in recent years have had a relative increase in the poor, the young, and the elderly, who are unable to contribute to professional expertise in a united health effort to combat these most serious health problems facing the black community. The Medicaid and Medicare programs are by far the largest federal health care efforts affecting racial differentials. These programs pay for care provided eligible persons by the public and private sectors. Together, they made up about 80 percent of the $33.1 billion health budget administered by HEW in 1976. Medicaid, the primary means of financing health care to the poor, served 24.4 million beneficiaries in 1976. It is a state-run program with federal guidelines and federal financial contributions. Because of varying state requirements, an estimated one third of the nation's poor are not covered and benefits vary greatly from state to state. Many of the states with the lowest coverage are in the South, where there are large black populations. In addition, benefits for those who do receive them are distributed quite unequally at state as well as national levels. In 1974, the national average expenditure per black beneficiary was $321 and per white beneficiary, $560-75 percent higher. Medicare, the federally funded and operated health insurance plan for the elderly and disabled, served about 24 million enrollees in 1976. Although, unlike those administered under Medicaid, eligibility and benefits are uniform throughout the nation, the benefits of Medicare are still distributed unequally among whites and blacks.
One reason for the disparity is that the program requires all beneficiaries, regardless of income, to contribute an identical proportion of the cost of the services they receive. This cost-sharing provision is a disproportionate burden and a greater deterrent to care for the poor, of whom a high percentage are black. Another major federal program that can directly affect the quality of health care in the black community is the Health Manpower Program. Federal involvement in health manpower development began in 1963 with special programs to aid both schools and students of health professions. For years, these efforts, dominated by the fear of a shortage of physicians, were concentrated on the training of more professionals. Although the supply of such professionals increased substantially, geographic maldistribution and overspecialization persisted. In fact, federal funding priorities probably increased the proportion of research-oriented physicians who would provide little or no community care. As a black congressman sitting on the most powerful financing committees in the US House of representatives, I am particularly distressed by the deficit in the number of black physicians available to cure some of the physical and social ills affecting black people. During 1975-1976, for the first time in five years, there was a decrease both in numbers and in the percentage of black Americans who were enrolled in the first-year class in US medical schools. Two years ago, there were 1,106 black American students in the first-year classes-they constituted 7.5 percent of all first-year students. Last year, there were only 1,036 black Americans in the first-year classes of America's medical schools-70 fewer blacks and a drop to 6.8 percent of the total first-year enrollment. If the black first-year students at Howard University College of Medicine (99) and at Meharry Medical College (98) were subtracted from the total, there would be only 839 black students in the 19751976 entering classes of the nation's other 112 medical schools. Excluding Howard and Meharry, this averages out to only eight black students per medical school first-year class. This decrease occurred at the same time that 2,934 new places have been created in the first-year classes of medical schools across the nation.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
Drug Abuse in the Black Community With regard to "The Drug Mixup," there are inequities in two other major federal programs. Some programs treat problems with a strong mental health component. They provide grants for community mental health centers serving specific geographic areas and alcoholism and drug-abuse projects serving target populations. In addition to direct federal funds, up to 30 percent of the costs of community mental health centers may be covered by payments made by patients or insurers, but such revenues are a negligible part of the financing of drug and alcohol programs. There are approximately 2.2 million beneficiaries of these mental health programs. The proportion of nonwhites served compares with some recognized indicators of need. Admissions to public inpatient psychiatric facilities occur nearly twice as frequently among nonwhites as among whites and 22 percent of all such admissions are for nonwhites. Yet community mental health centers, which are supposed to decrease institutionalization, serve a population that is only 12 percent nonwhite. This may be indicative of the location of the centers, lack of outreach and effective liaison with the community, or lack of racial sensitivity. Narcotic drug abuse is estimated to occur four times as frequently among nonwhites as among whites. Roughly 45 percent of all narcotic drug users referred to the Drug Abuse Warning Network were nonwhite. Drug abuse community programs serve a population that is 36 percent nonwhite. This may reflect a desire to balance the focus of projects between abusers of narcotics and abusers of other drugs, of whom a much smaller proportion are nonwhite. Drug abuse remains at unacceptably high levels throughout the United States. Because of the nature of illegal drug abuse, direct counts of the drug abusing population are difficult. However, on the basis of national surveys of drug use and analysis of other indicators of drug abuse trends, it is becoming increasingly less difficult to describe the extent and trends of drug use in the country. It is estimated that, in the past year, over 22 million Americans have used marijuana; seven million have used prescribed medication without medical
supervision; three to four million have used cocaine; and other one half million have used heroin. The spread of drug abuse in the black community continues to threaten the quality of our national life. It is destroying individual lives, dividing families, and disrupting the social structures of our cities and communities. The economic cost alone, in terms of lost productivity, narcotics-related crime, and drug abuse prevention programs, is estimated to be in excess of $10 billion a year. The toll of human suffering is beyond measure. In addition to street drug usage, a principal cause for the misuse of drugs on our society stems from the dependence of many prescribing physicians on the drug industry for their information about drugs. According to the latest figures, the prescription drug industry in 1971 spent more than $1 billion on advertising and promotion. Dr. Charles Edwards, former Assistant Secretary for Health in the US Department of Health, Education, and Welfare told the Pharmaceutical Manufacturers Association at their fourteenth Annual Meeting in 1972 that: Despite the contention that advertising is education, most of the drug promotion we see is designed to sell. . . to motivate the physician to prescribe and the consumer to buy. Are your current promotional efforts creating artificial needs? The answer to this question is unfortunately found in the very distressing story of the amphetamines, the tranquilizers, the barbiturates. . .all of which are part of one of the nation's most serious social problems. . . drug abuse." Some 50 percent of all narcoticdependent persons are concurrent abusers of depressants, with approximately 30 percent dependent on both
narcotics and depressants. Simultaneous abuse of barbiturates and amphetamines is becoming very common among drug abusers. The combination is said to produce more elevation of mood than either drug-type alone. This combination occurs in at least two other known abuse patterns. One is an alternating cycle of sedation and stimulation: using stimulants to overcome drowsy hangover, and by evening use of depressants to ward off insomnia. Barbiturates are also used by the "speed freak" to produce sleep after several days of continuous amphetamine injection. Most distressing is alcohol abuse (alcohol is still the most commonly abused drug) which is often
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
seen in combination with other prescribed or illegal drug abuse.
Role of the Congressional Black Caucus I would now like to turn my attention to the ways in which the Congressional Black Caucus members have helped to solve many of the problems that I have discussed. My remarks will address the three areas of drug abuse, health, and
communications:
Drug Abuse Charles Rangel serves on the Select Committee of Narcotics Abuse and was the major proponent in its creation. This committee will take a comprehensive view of problems and solutions in all aspects of narcotics abuse.
Health Ronald Dellums recently introduced the Health Services Act to provide comprehensive health protection. It is one of the major national health insurance proposals pending before the 95th
Congress. Under the leadership of Ralph Metcalfe and this writer, the first Health Brain Trust meeting of the Black Caucus was held in April 1977. The Health Brain Trust meets quarterly and brings together black health practitioners and other interested persons to discuss needs, problems, and solutions to the health care crisis now confronting the black community. During HEW hearings, Ralph Metcalfe and I requested a racial breakdown of all advisory councils to determine whether or not there is an adequate representation of blacks on the key councils that have a direct and indirect impact on the quality of health care among minorities and the poor. I opposed the Michel ammendment, that was introduced on the house floor June 16, 1977. The house defeated the amendment by a vote of 72 to 334-an outstanding victory for minorities, the poor, and the aged. I am vigorously opposing the Hyde amendment in the Labor-HEW appropriations bill. This discriminatory amendment prohibits the use of federal funds to perform, encourage, or promote abortions. This would directly affect Medicaid recipients, minorities, and the poor by denying to them the availability of safe abortions. Morehouse University was the 751
beneficiary of a $5 million appropriation to establish a school of medicine as a direct result of a Stokes amendment. A Stokes amendment to the educational assistance act to students from disadvantaged backgrounds would provide $14.5 million for assistance to disadvantaged students to support projects to motivate, recruit, and retain disadvantaged students in health profession training. I supported the earmarking of $2 million for financial distress grants under Title I. The funds are available to all types of health professional school students. Under educational assistance to disadvantaged individuals in allied health training, Congress provided $20 million for traineeships, improvement grants, and special projects in allied health. In the Health Professional Educational Assistance Act (PL 94-484), I supported $5 million for persons of low-income or disadvantaged backgrounds for scholarships to assist fulltime students with exceptional need in their first year of post-baccalaureate
study in the health professions. Also, I supported the inclusion of $144 million for capitation grants in the public law.
Communications The Congressional Black Caucus sponsored a reception on March 16, 1977 for 400 newspaper publishers and editors attending the mid-winter Workshop of the National Newspaper Publishers Association and the Business Meeting of Black Media. Following that meeting William Clay, Ralph Metcalfe, and Parren Mitchell met with 25 black owners of radio and television broadcast stations to determine what impediments existed to obstruct increased minority ownership opportunities. William Clay held hearings to investigate charges of discrimination in the employment practices and coverage of both the newspaper and broadcast industries. I actively monitor public broadcasting activities through my position as a member of the Labor-HEW subcommittee. As a result of my actions, last
Notiona ll
year the fiscal year 1977 appropriations act added language to convey its continuing concern for equal opportunity in the industry. I have recently introduced an amendment to the appropriation recommended for fiscal year 1980 for the Corporation for Public Broadcasting's EEO compliance activity. I have proposed that the Office of Education be directed to immediately increase its efforts to award public broadcasting facilities grants to eligible minority individuals and groups. In conclusion, ladies and gentlemen, I, as well as my colleagues of the Congressional Black Caucus, am actively involved in improving the quality of health for our people in the black community. As I look over this audience, my faith is renewed in the encouragement and endorsement you give those of us who have been elected to represent you. I pledge my continued efforts to the struggle and will tirelessly work on your behalf. Again, I thank you for inviting me.
1979 NMA Convention The 84th annual convention and scientific assembly of the National Medical Association will be held in Detroit, Michigan from July 29-August 2, 1979.
The scientific program will include Aerospace and Military Medicine, Anesthesiology, Basic Science, Community Medicine, Dermatology, Family Practice, Internal Medicine, Neurology and Psychiatry, Obstetrics and Gynecology,
Ophthalmology, Orthopedics, Otolaryngology, Pediatrics, Physical Medicine and Rehabilitation, Radiology, Surgery, and Urology.
SINCE
752
1895
JORA
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
It is indeed an honor to have been invited to address you today at your conference that is focusing upon: "The Drug Mixup: Reactions and Interactions." I come to you as a legislator with a primary interest in all aspects of health care, particularly as they affect the black community. As a black congressman sitting on the House Appropriations Committee and the House Budget Committee, I am particularly distressed by the fact that the search for better health care in the black community is essentially a search for: 1. Greater accessibility to knowledge relative to health care, 2. More adequate facilities to provide care located in the communities where the problems are most prominent, 3. A more equitable distribution of the existing health manpower and, 4. Equal training opportunities for the development of minority health manpower. In essence, this nation has allowed me, and my brothers and sisters to become the victims of a dual health care system: One for the rich and one for the minorities and the poor. Presented to the conference, The Drug Mixup: Reactions and Interactions, sponsored by Region 11 of the National Medical Association and the Howard University School of Communications, Washington, DC, November 5, 1977. Requests for reprints should be addressed to The Honorable Louis Stokes, Congress of the United States, House of Representatives, 2455 Rayburn House Office Building, Washington, DC 20515.
I take this injustice very personally, because as a black American today, I have been shortchanged and do not receive my fair share of the federal health dollar. Therefore, when I speak on behalf of my constituents, in testimony before Congress, I speak with the sensitivity and commitment of a person who is familiar with the problems as a result of real life experience.
Factors Influencing the Health Status of the Black Community Consumer education should be a major part of the national effort to improve the health status of the black community. Fbr many years the black community has been the depository for products which at worst have negative effects on health and at best have no positive effects. Familiar to most blacks are the dumerous "tonics" and remedies produted locally or regionally for promotion to black and poor consumers. Patent medicine advertising on black-oriented radio stations, aided by consumer igtiorance and inaccessibility of physicians, has been so strong that it requires only a minor stretch of the imagination to position these stations as dispensers of medical advice to the community. For similar reasons the home remedy displays of neighborhood drugstores have been a principal source
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
for relief from health problems that other population segments routinely carry to professionals. The black community continues to be a fertile market for products in other categories which many regard as harmful. Cigarette advertising, now removed from television under federal and social pressure, has proliferated in the black community, where today smoking is intensely promoted by thousands of billboards. Much of the current growth of the tobacco industry in America may have come as a result of the industry's growth in the black community. The gap in health status between the black and white populations of the United States has been documented so frequently and so well that one is justified in asking why it remains so persistent. There are at least two reasons. First, factors other than medical care have a great influence in narrowing the gap, and secondly, there has not been the kind of commitment necessary in order to achieve desired results. In the search f0r better health care, the black community must reckon with both of these points. A widely used indicator of health conditions within a community is its infant mortality rate. At birth, the life expectancy of the black child is seven years less than that of the white child. By a reduction in infant mortality one can add significantly to life expectancy, but the infant mortality rate is influenced by a number of factors, including 749
but not limited to better health care. These include socioeconomic factors. It is also true that minority children who survive infancy also have a significantly shorter life expectancy than do nonminority children. Another major problem affecting the provision of health information and direct health care is the ratio of physicians to residents in low income vs other areas. For example, a 1967 study conducted in Cleveland to determine the availability of physicians to poverty populations showed that there was only one physician per 2,222 persons in poverty areas as compared to one physician per 885 persons in nonpoverty areas. Since 1967, the number of physicians providing health care to the poor has decreased further. A 1972 study by the Cleveland Health Department showed that in three social planning areas in the poverty area of the city there was only one physician per 3,548 residents. This led the Comptroller General who conducted this study that low-income to conclude people-Medicaid recipients and the medically indigent-are the primary users of the outpatient care system. This results to a great extent from the fact that many of the poverty areas are medically underserved due to insufficient numbers of physicians. The major killers among blacks are the same as those among whites, only more so. These are heart disease, cancer, and stroke. The incidence of hypertension is known to be higher among blacks, but we do not know enough about this disease to prevent it. Excess deaths from cancer probably relate to the inaccessibility of medical care, especially for those forms of cancer for which survival varies with early detection and treatment. Hypertension is known to increase the risk of cerebral hemorrhage, but mortality from stroke is also related to accessibility of medical care. This in turn relates to economic factors. The ultimate cause of much of the differential mortality is poverty and the real cure for poverty is wealth-not health. The fight for better health care and the fight against poverty must be
fought simultaneously, therefore, blacks who serve on the appropriations and budget committees in Congress are uniquely situated to help in the solution of health care problems in the black community. 750
In most urban environments, there are two overiding factors that compound all the health problems of the community: the rising demand for health services and the declining revenue available to meet that demand.
Federal Health Care Programs The rising demands from health services have followed implementation of Medicare and Medicaid for a nation that is beginning to understand that health care is both a need and a right. The local revenue dilemma can be attributed to the exodus of the more affluent taxpayers from the inner city to suburbia and to the decay and demolition of taxable real estate with delayed urban renewal. Most large cities in recent years have had a relative increase in the poor, the young, and the elderly, who are unable to contribute to professional expertise in a united health effort to combat these most serious health problems facing the black community. The Medicaid and Medicare programs are by far the largest federal health care efforts affecting racial differentials. These programs pay for care provided eligible persons by the public and private sectors. Together, they made up about 80 percent of the $33.1 billion health budget administered by HEW in 1976. Medicaid, the primary means of financing health care to the poor, served 24.4 million beneficiaries in 1976. It is a state-run program with federal guidelines and federal financial contributions. Because of varying state requirements, an estimated one third of the nation's poor are not covered and benefits vary greatly from state to state. Many of the states with the lowest coverage are in the South, where there are large black populations. In addition, benefits for those who do receive them are distributed quite unequally at state as well as national levels. In 1974, the national average expenditure per black beneficiary was $321 and per white beneficiary, $560-75 percent higher. Medicare, the federally funded and operated health insurance plan for the elderly and disabled, served about 24 million enrollees in 1976. Although, unlike those administered under Medicaid, eligibility and benefits are uniform throughout the nation, the benefits of Medicare are still distributed unequally among whites and blacks.
One reason for the disparity is that the program requires all beneficiaries, regardless of income, to contribute an identical proportion of the cost of the services they receive. This cost-sharing provision is a disproportionate burden and a greater deterrent to care for the poor, of whom a high percentage are black. Another major federal program that can directly affect the quality of health care in the black community is the Health Manpower Program. Federal involvement in health manpower development began in 1963 with special programs to aid both schools and students of health professions. For years, these efforts, dominated by the fear of a shortage of physicians, were concentrated on the training of more professionals. Although the supply of such professionals increased substantially, geographic maldistribution and overspecialization persisted. In fact, federal funding priorities probably increased the proportion of research-oriented physicians who would provide little or no community care. As a black congressman sitting on the most powerful financing committees in the US House of representatives, I am particularly distressed by the deficit in the number of black physicians available to cure some of the physical and social ills affecting black people. During 1975-1976, for the first time in five years, there was a decrease both in numbers and in the percentage of black Americans who were enrolled in the first-year class in US medical schools. Two years ago, there were 1,106 black American students in the first-year classes-they constituted 7.5 percent of all first-year students. Last year, there were only 1,036 black Americans in the first-year classes of America's medical schools-70 fewer blacks and a drop to 6.8 percent of the total first-year enrollment. If the black first-year students at Howard University College of Medicine (99) and at Meharry Medical College (98) were subtracted from the total, there would be only 839 black students in the 19751976 entering classes of the nation's other 112 medical schools. Excluding Howard and Meharry, this averages out to only eight black students per medical school first-year class. This decrease occurred at the same time that 2,934 new places have been created in the first-year classes of medical schools across the nation.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
Drug Abuse in the Black Community With regard to "The Drug Mixup," there are inequities in two other major federal programs. Some programs treat problems with a strong mental health component. They provide grants for community mental health centers serving specific geographic areas and alcoholism and drug-abuse projects serving target populations. In addition to direct federal funds, up to 30 percent of the costs of community mental health centers may be covered by payments made by patients or insurers, but such revenues are a negligible part of the financing of drug and alcohol programs. There are approximately 2.2 million beneficiaries of these mental health programs. The proportion of nonwhites served compares with some recognized indicators of need. Admissions to public inpatient psychiatric facilities occur nearly twice as frequently among nonwhites as among whites and 22 percent of all such admissions are for nonwhites. Yet community mental health centers, which are supposed to decrease institutionalization, serve a population that is only 12 percent nonwhite. This may be indicative of the location of the centers, lack of outreach and effective liaison with the community, or lack of racial sensitivity. Narcotic drug abuse is estimated to occur four times as frequently among nonwhites as among whites. Roughly 45 percent of all narcotic drug users referred to the Drug Abuse Warning Network were nonwhite. Drug abuse community programs serve a population that is 36 percent nonwhite. This may reflect a desire to balance the focus of projects between abusers of narcotics and abusers of other drugs, of whom a much smaller proportion are nonwhite. Drug abuse remains at unacceptably high levels throughout the United States. Because of the nature of illegal drug abuse, direct counts of the drug abusing population are difficult. However, on the basis of national surveys of drug use and analysis of other indicators of drug abuse trends, it is becoming increasingly less difficult to describe the extent and trends of drug use in the country. It is estimated that, in the past year, over 22 million Americans have used marijuana; seven million have used prescribed medication without medical
supervision; three to four million have used cocaine; and other one half million have used heroin. The spread of drug abuse in the black community continues to threaten the quality of our national life. It is destroying individual lives, dividing families, and disrupting the social structures of our cities and communities. The economic cost alone, in terms of lost productivity, narcotics-related crime, and drug abuse prevention programs, is estimated to be in excess of $10 billion a year. The toll of human suffering is beyond measure. In addition to street drug usage, a principal cause for the misuse of drugs on our society stems from the dependence of many prescribing physicians on the drug industry for their information about drugs. According to the latest figures, the prescription drug industry in 1971 spent more than $1 billion on advertising and promotion. Dr. Charles Edwards, former Assistant Secretary for Health in the US Department of Health, Education, and Welfare told the Pharmaceutical Manufacturers Association at their fourteenth Annual Meeting in 1972 that: Despite the contention that advertising is education, most of the drug promotion we see is designed to sell. . . to motivate the physician to prescribe and the consumer to buy. Are your current promotional efforts creating artificial needs? The answer to this question is unfortunately found in the very distressing story of the amphetamines, the tranquilizers, the barbiturates. . .all of which are part of one of the nation's most serious social problems. . . drug abuse." Some 50 percent of all narcoticdependent persons are concurrent abusers of depressants, with approximately 30 percent dependent on both
narcotics and depressants. Simultaneous abuse of barbiturates and amphetamines is becoming very common among drug abusers. The combination is said to produce more elevation of mood than either drug-type alone. This combination occurs in at least two other known abuse patterns. One is an alternating cycle of sedation and stimulation: using stimulants to overcome drowsy hangover, and by evening use of depressants to ward off insomnia. Barbiturates are also used by the "speed freak" to produce sleep after several days of continuous amphetamine injection. Most distressing is alcohol abuse (alcohol is still the most commonly abused drug) which is often
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
seen in combination with other prescribed or illegal drug abuse.
Role of the Congressional Black Caucus I would now like to turn my attention to the ways in which the Congressional Black Caucus members have helped to solve many of the problems that I have discussed. My remarks will address the three areas of drug abuse, health, and
communications:
Drug Abuse Charles Rangel serves on the Select Committee of Narcotics Abuse and was the major proponent in its creation. This committee will take a comprehensive view of problems and solutions in all aspects of narcotics abuse.
Health Ronald Dellums recently introduced the Health Services Act to provide comprehensive health protection. It is one of the major national health insurance proposals pending before the 95th
Congress. Under the leadership of Ralph Metcalfe and this writer, the first Health Brain Trust meeting of the Black Caucus was held in April 1977. The Health Brain Trust meets quarterly and brings together black health practitioners and other interested persons to discuss needs, problems, and solutions to the health care crisis now confronting the black community. During HEW hearings, Ralph Metcalfe and I requested a racial breakdown of all advisory councils to determine whether or not there is an adequate representation of blacks on the key councils that have a direct and indirect impact on the quality of health care among minorities and the poor. I opposed the Michel ammendment, that was introduced on the house floor June 16, 1977. The house defeated the amendment by a vote of 72 to 334-an outstanding victory for minorities, the poor, and the aged. I am vigorously opposing the Hyde amendment in the Labor-HEW appropriations bill. This discriminatory amendment prohibits the use of federal funds to perform, encourage, or promote abortions. This would directly affect Medicaid recipients, minorities, and the poor by denying to them the availability of safe abortions. Morehouse University was the 751
beneficiary of a $5 million appropriation to establish a school of medicine as a direct result of a Stokes amendment. A Stokes amendment to the educational assistance act to students from disadvantaged backgrounds would provide $14.5 million for assistance to disadvantaged students to support projects to motivate, recruit, and retain disadvantaged students in health profession training. I supported the earmarking of $2 million for financial distress grants under Title I. The funds are available to all types of health professional school students. Under educational assistance to disadvantaged individuals in allied health training, Congress provided $20 million for traineeships, improvement grants, and special projects in allied health. In the Health Professional Educational Assistance Act (PL 94-484), I supported $5 million for persons of low-income or disadvantaged backgrounds for scholarships to assist fulltime students with exceptional need in their first year of post-baccalaureate
study in the health professions. Also, I supported the inclusion of $144 million for capitation grants in the public law.
Communications The Congressional Black Caucus sponsored a reception on March 16, 1977 for 400 newspaper publishers and editors attending the mid-winter Workshop of the National Newspaper Publishers Association and the Business Meeting of Black Media. Following that meeting William Clay, Ralph Metcalfe, and Parren Mitchell met with 25 black owners of radio and television broadcast stations to determine what impediments existed to obstruct increased minority ownership opportunities. William Clay held hearings to investigate charges of discrimination in the employment practices and coverage of both the newspaper and broadcast industries. I actively monitor public broadcasting activities through my position as a member of the Labor-HEW subcommittee. As a result of my actions, last
Notiona ll
year the fiscal year 1977 appropriations act added language to convey its continuing concern for equal opportunity in the industry. I have recently introduced an amendment to the appropriation recommended for fiscal year 1980 for the Corporation for Public Broadcasting's EEO compliance activity. I have proposed that the Office of Education be directed to immediately increase its efforts to award public broadcasting facilities grants to eligible minority individuals and groups. In conclusion, ladies and gentlemen, I, as well as my colleagues of the Congressional Black Caucus, am actively involved in improving the quality of health for our people in the black community. As I look over this audience, my faith is renewed in the encouragement and endorsement you give those of us who have been elected to represent you. I pledge my continued efforts to the struggle and will tirelessly work on your behalf. Again, I thank you for inviting me.
1979 NMA Convention The 84th annual convention and scientific assembly of the National Medical Association will be held in Detroit, Michigan from July 29-August 2, 1979.
The scientific program will include Aerospace and Military Medicine, Anesthesiology, Basic Science, Community Medicine, Dermatology, Family Practice, Internal Medicine, Neurology and Psychiatry, Obstetrics and Gynecology,
Ophthalmology, Orthopedics, Otolaryngology, Pediatrics, Physical Medicine and Rehabilitation, Radiology, Surgery, and Urology.
SINCE
752
1895
JORA
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
