Summit a checkup for diversity

African Americans, American Indians and Native Alaskans in Washington are significantly more likely to die from chronic diseases than white residents. In King County, their infants are more than twice as likely to die as white babies.

And in general, minorities die from disease more often than white people.

The reasons are wide-ranging, health-care providers say: from institutional racism and a lack of affordable health care to a poor understanding of different cultures and fear by some minorities that they will not be treated with respect.

Those facts and others have driven the state's policy makers, health-care providers and community activists to hold the state's first Diversity Health Summit today in SeaTac to discuss ideas for reducing racial health disparities. It will feature workshops on everything from promoting diversity in the health-care work force to cancer screening in communities of color. Gov. Christine Gregoire is expected to attend.

The summit will be an inspiring show of unity, say activists and health-care providers.

"This is an absolute watershed for our state," said Don Sloma, policy director of the Washington Health Foundation.

The federal government has set a 2010 deadline for eliminating all health disparities. So King County is using federal money to address the high rate of diabetes, asthma and other chronic diseases among minorities in South King County in particular. A legislative committee has also been working on a proposal due this fall to address health disparities. Access to health care is part of the problem. A recent King County study found that 36 percent of Latino residents were uninsured. For African Americans and American Indians, the rate was 22 percent and 21 percent, respectively. Even with public-health clinics, getting care for chronic conditions such as diabetes can be difficult, said Rayburn Lewis, a vice president at Swedish Medical Center in Seattle.

Specialists are not often available to patients on Medicare or the state's Basic Health insurance.

"We need to widen access to specialty care," Lewis said. "It's the one great hole."

Even when minorities have access, experts say, a fear of doctors can stand in the way of good health.

Racial bias remains an issue in the health-care system, just as it does in the business world, and society in general, local health-care professionals say. In a King County survey, for example, one in six African Americans and one in nine of all people of color reported discrimination from health-care providers.

A National Institute of Medicine study showed minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery and are less likely to receive kidney dialysis or transplants. By contrast, they are more likely to receive certain less-desirable procedures, such as lower-limb amputations for diabetes and other conditions.

Dr. Ben Danielson, director of the Odessa Brown Children's Clinic in the Central Area, said most health providers are well-intentioned and unaware that bias is affecting their work.

"It's an ongoing bit of work that we as a society have to do," Danielson said.

Staying away from the doctor proves deadly to many minorities. Even with breast cancer, for example, a disease in which early detection is crucial to survival, many African-American women remain reluctant to have mammograms, because they have had poor experiences with doctors in the past, a state study showed.

That could partly explain why the breast-cancer mortality rate for African-American women has held steady at about 35 percent, while the rate for white women with the disease has dropped, health providers said.

In some cases, a disconnect over cultural customs exists between doctor and patient. Ira SenGupta, director of the Cross Cultural Health Program in Seattle, is helping to train state employees in "cultural competency," a kind of fluency in customs and rules of different cultures.

Without it, SenGupta said, doctors often end up alienating patients and keeping them away from needed checkups. An example is an elderly Asian widow who was asked on a questionnaire how many sexual partners she has had, SenGupta said.

"To ask her that question directly would really offend her, and shut down the trust," SenGupta said.

State health officer Maxine Hayes of the Department of Health said it is also crucial that the government look beyond the health-care system to other factors, such as income and where people live, that influence health disparities.

"It's very clear to us," Hayes said. "Those things have as much, or more, to do with health status."

Cara Solomon: 206-464-2024