Date: 2016-06-13
Speaker: JACKSON LEE (democrat)
Chamber: H

Madam Speaker. there is no doubt how much I appreciate the Congressional Black Caucus and Congresswoman BEATTY and Congressman JEFFRIES for always being timely in allowing us to give a message to our colleagues. We hope maybe the American people will hear us. but we accept that this body is the body to which and to whom we speak. So I am thankful for that. I want to pay tribute. overall. to the Congressional Black Caucus because we are actually here speaking of health disparities. because it was the caucus that triggered this debate through the years that we have been trying to get universal access to health care and was the moving force in the 2009. 2008. and 2010 passage. ultimately. of the Affordable Care Act. where the work that we did. joining Congresswoman Donna ChristianChristiansen. at that time. and FRANK PALLONE on the Congressional Health Caucus. but on the CBC we had the health disparities task to ensure that the language in the Affordable Care Act addressed the issue of health disparities. There was a large section on that that built on some of the work that some of us had already done creating the Office of Minority Health that I had worked on in years past. So it was the lightning bolt of the caucus. and then working with the Congressional Asian Pacific American Caucus and then the Congressional Hispanic Caucus that we raised the issue that no one was talking about. I remember debating on the floor of the House on the issues of dealing with senior citizen African American men and how they access health care. how do women access health care. and how do women impacted by diabetes access health care. These are some of the diseases that have a proclivity to the African American population. We were finding out that we even had an issue where medical professionals didnt know how to ask the questions. How do you address someone who needs to be diagnosed for prostate cancer or may be diagnosed for prostate cancer and is an African American male. a senior citizen? My father ultimately died from cancer that metastasized from the prostate to the lungs and the brain. so we knew we had a serious issue. So today. I want to mention four points. but I am going to focus on the last one. obesitya question of access to health care and physical fitness. Many times we live in areas where there is no access to a pool or a tennis court. Mental healthif you lived your life in a segregated America. if you were called "Boy" and "Girl." it is a different mental health situation than maybe others may have faced. If you live in a situation of poverty. of a single household. maybethis is not across the boardthese issues will be impacted. If you lived around gun violence. if you saw your 15yearold friend being shot dead in the street. there is a question of mental health that we need access to that care for us to be able to reach out or maybe counselors to be able to provide for children. HIV/AIDS is something that we have lived through. I remember going to funerals of friends in the 1980s and into the 1990s. particularly with HIV/AIDS. So we have worked in the Congressional Black Caucus to massively talk about testing. Let me get to this point that I want to dwell just for a moment on. and that is gun violence. I was here on the floor earlier with my head held down and my heart heavy as my district. today. had a memorial. They had one yesterday. We will have one tomorrow and have one on Wednesday. I mourn with Congresswoman CORINNE BROWN of Florida. We are offering legislation dealing with the assault weapons and to complement legislation already passed or already in place. But it is important to note that this is a health issue. because the Centers for Disease Control can assess and study every health issue that faces America today. but they are legislatively. by law. prohibited by my friends on other side of the aisle. by Republicans. disallowed every year to give them permission to study gun violence. Gun violence is killing our children and killing our families. In Orlando. it killed Latinos who happened to be the attendees at the Pulse Club. The LGBTQ community was the dominant community. and a hateful terroristic act using AR15s and Glock guns killed them. The incident was the deadliest mass shooting. The next deadliest incidents in recent history were April 16. 2007. Virginia Tech. 32 killed. 17 injured. December 14. 2012. Sandy Hook. 26 killed. 1 injured. October 16. 1991. Killeen. Texas. 23 killed. 27 injured. According to Everytown index of mass shootings where four or more people are shot and killed. the incident was the ninth mass shooting in the United States in 2016. and the 150th mass shooting in United States since January 1. 2009. The mass shooting with guns impacts both the mental health. the sanctity. and the minority community. It is shameful that we are not allowed to engage in the kind of research that a Harvard professor talked about. and that is the assessing of violence and the assessing of violence with guns. The materials I have before me make it very clear that most of these violent acts are done with gunsdone with guns. San Bernardino. Chattanooga. Charleston. Garland. Oak Creek. and Fort Hood were all done with guns. So I stand here today to challenge this issue of health disparities to say that the heavy brunt of killings. singular killings. are impacted by poverty. lack of access to health care. the proliferation of guns in our inner city communities. and the failure of the United States Congress to put real gun safety legislation. closing the loophole. the Jim Clyburn rule that says that. if you dont get the review and approval by ATF. you do not get the gun. You have to wait until you get the approval from ATF. which may be trying to determine whether this person with multiple problems. mental health or background issues. doesnt need to get a gun and then ultimately go kill their spouse. their children. their neighbors. their family members or strangers. So it is my belief today that this health disparities debate is crucial. and we should come away from here recognizing that obesity. the issues of mental health and HIV/AIDS can be. with great investment. researched for cures. or cancer that proliferates in our community. triple negative breast cancer. legislation that I have put forward and have gotten passed about that impact. But it is the gun violence that we are doing absolutely nothing about. The disparities and the impact on minority communities is atrocious. I want to close simply by saying the word or the acronym LGBTQ community. I want to say it over and over again. because I think it is shameful that. in our debate. in our recognition of the tragedy of Orlando. that we dont acknowledge the horrific hate crime and the hatefulness against that community. As I stand here. that community is diverse. and there are African Americans who are LGBTQ. So I would ask that. as we move forward this week. we will be reminded of this hatefulness and we will have a cure. We will be reminded of this violence. and we will have a cure. That cure. first of all. will be to restrain the use of assault weapons and these weapons of wartype bullets that men and women in the United States military say have no business on the streets of America. I believe. Congresswoman. that health disparities are an important wall and division to overcome. I thank the gentlewoman for having this Special Order to ensure that we will confront these issues and try to save lives. Racial disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. I want to focus on four areas of racial disparities in health that impact African Americans that we can do something about: 1. Obesity. 2. Mental Health. 3. HIV/AIDS. and 4. Gun Violence. African Americans. based on 2015 Census data. comprise 13.2 percent of the U.S. population. or about 42 million people. Socioeconomic status. in turn. is linked to mental health: People who are impoverished. homeless. incarcerated or have substance abuse problems are at higher risk for poor mental health. As the founder and chair of the Congressional Childrens Caucus. I am especially concerned about the childhood obesity epidemic among AfricanAmerican youth. More than 40 percent of African American teenagers are overweight. and nearly 25 percent are obese. The percentage of children aged 611 years in the United States who were obese increased from 7 percent in 1980 to nearly 18 percent in 2012. African American youth are consuming less nutritious foods such as fruits and vegetables and are not getting enough physical exercise. This combination has led to an epidemic of obesity. which directly contributes to numerous deadly or lifethreatening diseases or conditions. including the following: Hypertension. Dyslipidemia (High Cholesterol or High Triglyceride Levels). Type 2 Diabetes. Coronary Heart Disease. Stroke. Gallbladder Disease. Osteoarthritis. Asthma. bronchitis. sleep apnea. and other respiratory problems. Cancer (Breast. Colon. and Endometrial). When ethnicity and income are considered. the picture is even more troubling. African American youngsters from lowincome families have a higher risk for obesity than those from higherincome families. Efforts such as the Lets Move! Campaign by the First Lady are pivotal to ensuring that communities are able to provide healthy snacks and food and encourage healthier decisions. Since the mid1970s. the prevalence of overweight and obesity has increased sharply for both adults and children. NonHispanic blacks have the highest ageadjusted rates of obesity at 47.8 percent. According to the CDC. 37.6 percent of men and 56.9 percent of women twenty years and over are obese. Every year. more than 40 million Americans struggle with mental illness. African American men are as likely as anyone else to have mental illness. but they are less likely to get help. Racism continues to have an impact on the mental health of African Americans. Negative stereotypes and attitudes of rejection have decreased. but continue to occur with measurable. adverse consequences. Historical and contemporary instances of negative treatment have led to a mistrust of authorities. many of whom are not seen as having the best interests of African Americans in mind. According to the Department of Health and Human Services Office of Minority Health: Adult blacks are 20 percent more likely to report serious psychological distress than adult whites. Adult blacks living below poverty are two to three times more likely to report serious psychological distress than those living above poverty. Adult blacks are more likely to have feelings of sadness. hopelessness. and worthlessness than are adult whites. How African Americans view mental health over generations is a major barrier to accessing mental health services and treatment. In 1996. MHA commissioned a national survey on clinical depression. The survey explored the barriers preventing Americans seeking treatment and gauged overall knowledge of and attitudes toward depression. This survey revealed that: 63 percent of African Americans believe that depression is a personal weakness. This is significantly higher than the overall survey average of 54 percent. Only 31 percent of African Americans believed that depression was a "health problem." African Americans were more likely to believe that depression was "normal" than the overall survey average. 56 percent believed that depression was a normal part of aging. 45 percent believed it was normal for a mother to feel depressed for at least two weeks after giving birth. 40 percent believed it was normal for a husband or wife to feel depressed for more than a year after the death of a spouse. Many of these problems persist to this day. As Doctor William Lawson of Howard University (and MHAs District of Columbia affiliate) pointed out in an NPR interview in 2012. "Many AfricanAmericans have a lot of negative feelings about. or not even aware of mental health services. The "Mental Health: Culture. Race and Ethnicity Supplement" to the 1999 U.S. Surgeon Generals Report on Mental Health. states the following: AfricanAmerican physicians are five times more likely than white physicians to treat AfricanAmerican patients. AfricanAmerican patients who see AfricanAmerican physicians rate their physicians styles of interaction as more participatory. African Americans seeking help for a mental health problem would have trouble finding African American mental health professionals: In 1998. only 2 percent of psychiatrists. 2 percent of psychologists and 4 percent of social workers said they were African Americans. The public mental health safety net of hospitals. community health centers. and local health departments are vital to many African Americans. especially to those in highneed populations. African Americans of all ages are underrepresented in outpatient treatment but overrepresented in inpatient treatment. Few AfricanAmerican children receive treatment in privately funded psychiatric hospitals. but many receive treatment in publicly funded residential treatment centers for emotionally disturbed youth. In 2012. there were an estimated 356.268 inmates with severe mental illnesses in U.S. prisons and jails. There were only 35.000 mentally ill individuals in state psychiatric hospitals. The report. "The Treatment of Persons With Mental Illness in Prisons and Jails." jails "in 44 of the 50 states and the District of Columbia. a prison or jail in that state holds more individuals with serious mental illness than the largest remaining state psychiatric hospital." the report said. African Americans today are overrepresented in our jails and prisons. People of color account for 60 percent of the prison population. The Stanford Law School Three Strikes Projects report stated that. "over the past 15 years. the number of mentally ill people in prison in California has almost doubled." In California. 45 percent of state prison inmates have been treated for severe mental illness within the past year. African Americans also account for 14 percent of regular drug users. but for 37 percent of drug arrests. Illicit drug use is frequently associated with selfmedication among people with mental illnesses. In January 2014. the Texas Observer reported that. of the 9.000 inmates in Harris County Jail more than 25 percent take medication for mental illness. which means that the jail treats more psychiatric patients than all 10 of Texas staterun public mental hospitals combined. The passage of the Affordable Care Act created access to health care for those who purchase health insurance and for the poor living in states that are participating in the Medicaid component of the ACA. Disparities can occur. if physicians do not refer patients with signs of mental illness for proper treatment or if referred patients do not seek out treatment. Disparities in access to care and treatment for mental illnesses have also persisted over time. As noted by the Office of Minority Health: Only 8.7 percent of adult blacks. versus 16 percent of adult whites. received treatment for mental health concerns in 20072008. Only 6.2 percent of adult blacks. versus 13.9 percent of adult whites. received medications for mental health concerns during 2008. While 68.7 percent of adult whites with a major depressive episode in 2009 received treatment. only 53.2 percent of adult blacks did. The Affordable Care Act will have an impact on this gap by 2016. Depression and other mental illness can be deadly if left untreated. Suicide is the third leading cause of death among African Americans 15 to 24 years old. Untreated mental illness can also make African American men more vulnerable to substance abuse. homelessness. incarceration. and homicide. African Americas are the racial/ethnic group most affected by HIV in the United States. According to the CDC. 44 percent (19.540) of estimated new HIV Diagnoses in the United States were among African Americans. who comprise 12 percent of the US population. HIV/AIDs are now the leading cause of death among African Americans ages 25 to 44ahead of heart disease. accidents. cancer. and homicide. At the end of 2012. an estimated 496.500 African Americans were living with HIV. representing 41 percent of all Americans living with the Virus. Of African Americans living with HIV. around 14 percent do not know they are infected. African Americans accounted for an estimated 44 percent of all new HIV infections among adults and adolescents (aged 13 years or older) in 2010. despite representing only 12 percent of the U.S. population. HIV is a sexually transmitted disease or STD. it is also spread through intravenous drug use. HIV infections spread through sharing of needles has declined with needle programs. while the STD rates of infection among African Americans has increased at rate higher than any other ethnic group. Have their HIV status checkednot once but annually. Know the HIV status of sexual partner. If HIV positive: Know how to get on antiviral medication. 2 small pills taken each day. and stay on them. Where to go for information if you or your partner is HIV positive. In 2010. men accounted for 70 percent (14.700) of the estimated 20.900 new HIV infections among all adult and adolescent African Americans. The estimated rate of new HIV infections for African American men (103.6/100.000 population) was 7 times that of white men. twice that of Latino men. and nearly 3 times that of African American women. In 2010. African American gay. bisexual. and other men who have sex with men represented an estimated 72 percent (10.600) of new infections among all African American men and 36 percent of an estimated 29.800 new HIV infections among all gay and bisexual men. Of those gay and bisexual men. 39 percent (4.321) were young men aged 13 to 24. According to the CDC. the numbers of new HIV diagnoses among African American women fell 42 percent between 2005 to 2014. but it is still high compared to women of other races/ethnicities. Most new HIV infections among African American women (87 percent. 5.300) are attributed to heterosexual contact. In 2012. there were 72.010 Texans living with HIV/AIDS. Texas has the 10th highest number of HIV diagnoses in 2013 and ranks 18th for deaths from HIV. Currently 14 percent of the people living with HIV are undiagnosed and only 30 percent of the people with HIV are virally suppressed. which means that 70 percent of the people who are ill are not on medication that can help limit their ability to infect others. HIV is an unnecessarily disproportionate burden on the African American and Latino community. There is a wall of misinformation about the illness and an uncomfortable silence regarding the need to speak about the illness not only to the young. but also the older persons. When treatments were first developed in the 1990s they had lots of side effects that made patients very ill. Few talk about the advances in HIV treatment that now involve taking 2 small pills a day with the result leaving patients feeling healthy and able to engage in lifes normal activities. The virus count for those who take their medication is so low that it often does not register in tests. This does not mean that people are cured. but it does mean that there is no reason not to get tested so that you know if you are in need of treatment. Anyone can become infectedso it is up to all of us to educate our families. neighbors. coworkers and friends about getting tested. There are some insurance company practices that have a detrimental impact on the ability of people with HIV to enroll in qualified health insurance plans. In states like Texas that are not fully participating in the Affordable Care Acts Medicaid expansion this is especially problematic for HIV patients who are poor. Some states allow insurance carriers to post misleading or intentionally vague formularies on market place websites or excluding essential HIV medications from drug formularies and impressing high cost sharing. Out of pocket medication cost each month should be capped.