San Francisco Examiner - May 25, 2004
Justin Nyberg, Staff Writer

On the other hand, blacks are two to three times more likely to die from diabetes than other races, and have much higher rates of lung cancer, cardiovascular disease, and homicide.

In a medical system that must provide equal access to health care by law, the statistics beg a simple question: Why?

The answer, however, is complex.

"There are many societal, cultural, behavioral, environmental issues that cause these lines to diverge," said Dr. Scott Morrow, the county's lead health officer. "You have to understand those if you are going to make interventions to change the slope of that line."

For example, in the Ravenswood City School District in East Palo Alto, 43 percent of fifth graders, and 49 percent of eighth graders, are overweight, according to Luisa Buada, CEO of the Ravenswood Family Health Center.

Buada said poor eating habits among many East Palo Alto families are caused by a lack of education about nutrition, cultural eating preferences and the lack of cheap, healthy food in the city, which is 59 percent Hispanic and 22 percent black. There is not a single large supermarket in the city, she said, and there is limited availability of fresh fruits and vegetables at the ubiquitous liquor stores and corner groceries.

"Dollar for dollar, it costs less to buy frozen food, processed food, fast food," Buada said. "You are going to get things higher in fat, higher in carbohydrates."

Some disparities have little or nothing to do with the local health care system. For example, Asians in San Mateo County are 20 times more likely to be diagnosed with tuberculosis than whites. The reasons have to do with the high rates of infection in Asian countries, how those countries deal with the disease, and with U.S. immigration policy, according to Morrow.

"The fix of that is completely different than, for example, why African Americans have high rates of heart disease and diabetes," Morrow said.

Health disparities are not only evident along ethnic lines, but along gender lines as well. Women and girls in San Mateo County are twice as likely to end up hospitalized with self-inflicted wounds as men and boys, but males are twice as likely to inflict serious injuries on others. Other disparities are seen among groups with differing levels of income and insurance coverage.

But in San Mateo County, where race and socioeconomic disparities are closely linked, ethnicity is often used to identify problems affecting large sectors of the county's population.

Overall, the greatest number of health problems is found in the black community. Blacks have the highest rates of HIV infections, strokes, prostate cancer and overall mortality. The homicide rate is 10 times higher among the county's African-American population than its white population, and the rate of hospitalizations from substance abuse is about nine times higher that of Asians, and almost double that of whites.

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