Margaret Heckler served as Secretary of the U. S. Department of Health and Human Services from 1983 to 1985. She introduced the Heckler Report in 1985. Although her contributions were many, it was her work in the advancement of minority health that gave hope to those on a road paved with setbacks and unfulfilled promises. And while science and technology have progressed and advanced new treatments, healthcare continues to reckon with the effects of unequal access and delivery of inequitable care.
On August 2, 1790 a total of 3.9 million people were counted in the first census. In this census, to my surprise, there were only three racial categories: free whites, all other free persons, and slaves. The data did not include ethnic groups. Hispanics were the first ethnic group to appear on the census report in 1970, due to the Equal Employment Opportunity Classification (EEOC) changing Spanish-American/Hispanic from a racial to an ethnicity designation. It was also the first time that the option to identify by their own race was available. This was the beginning of the United States minding minority health data.
In what I call the most historical meeting of Black health, Margaret Heckler met with Dr. Louis Sullivan, then President of Morehouse School of Medicine, who would later become HHS Secretary; Dr. David Satcher, President of Meharry Medical College, who would later serve as U.S. Surgeon General; Dr. Walter Bowie, Dean of Tuskegee University; and Dr. M. Alfred Haynes, Dean of Charles R. Drew University of Medicine and Science. They presented the findings of the Association of Minority Health Professions Schools’ study, entitled Blacks and the Health Professions in the 1980s: A National Crisis and a Time for Action.
This study highlighted the shortage of minorities in health professions and significant health disparities among African Americans. It would underscore the need for increased educational opportunities for African American nurses and doctors as a leading strategy for improving progress in minority health.
I have used the Heckler Report as an integral part of my professional growth, cultural competence and health literacy, specifically because it was a landmark of the first convention of a group of health experts by the U.S. government to conduct a comprehensive study of minority health. It elevated the conversation of health inequity and placed structural racism onto a national stage.
It was most significant in that it documented the persistent health disparities in the African American community, for the first time. The report examined six major causes of death accounting for more than 80% of mortality among African Americans and other minority groups compared with Whites. These include cancer; cardiovascular disease, stroke; diabetes; homicide; and infant mortality.
It help spearhead the Office of Minority of Health in 1986, continuing the momentum of improving the health of ethnic minority populations through federal policies and programs. Today, it is still one of the most influential and recognizable tools used by scholars in addressing social determinants of health to reduce health disparities.
Our nation is built on the idea that everyone has the right and opportunity to access effective and efficient healthcare. However the reality of this idea is, it does not exist. The United States healthcare system is deemed one of the wealthiest and most technologically advanced; but also one with the worst outcomes. Health disparities are a direct reflection of our nations inability to invest in the services and systems that are needed to employ and provide equitable care.
Despite the ground breaking release of the Heckler Report, the nation’s progress toward ending health disparities continues to stagnate. Unfortunately, the COVID-19 pandemic has worsened health inequities for the disadvantaged, with no hope in sight.
The Centers for Disease Control and Prevention estimates that across the COVID-19 continuum, hospitalization rates are at least 2.5 and 4.5 times higher, respectively, among Black, Hispanic, and Native Americans than among White populations, and that African Americans have died from COVID-19 at twice the rate of Whites.
We have come far, but we still have a long ways to go.
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