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Why is SCD Not Recognized as a CDC Health Disparity Topic?

In its 2011 “Health Disparities and Inequalities Report,” the Centers for Disease Control states, “In recent decades, the nation has made substantial progress in improving U.S. residents’ health and reducing health disparities, yet health disparities by race and ethnicity, income and education, disability status, and other social characteristics still exist.” In its own words, this landmark report “addresses disparities in health care access, exposure to environmental hazards, mortality, morbidity, behavioral risk factors, disability status and social determinants of selected health problems at the national level.”

The CDC’s report included twenty-two (22) health disparity topics that were chosen because they met one or more criteria. These criteria included, “Leading cause of premature death among certain segments of the U.S. population; social, demographic, and other disparities in health outcomes exist; effective and feasible interventions exist to address health outcomes; and high quality data were readily available from national health monitoring systems.” Due credit should be provided to the CDC for the effort to call out these disparities yet its list does not include SCD, a condition that arguably represents the ultimate of all health disparities.

The CDC’s report includes analytic essays grouped by six (6) different categories. Those categories are; 1) Social Determinants of Health; 2) Environmental Hazards; 3) Health-Care Access and Preventive Health Services; 4) Health Outcomes – Morbidity; 5) Health Outcomes – Mortality; and, 6) Health Outcomes – Behavioral and Risk Factor. Some of the topics included in the “Health Outcome – Morbidity” category are Obesity, Pre-term Births, Potentially Preventable Hospitalizations, Current Asthma Prevalence, Diabetes, Asthma, HIV/AIDS and Hypertension.

The absence of SCD from the CDC’s list of disparities is worthy of discussion, especially since it is listed as “Priority 4” in the CDC’s National Center on Birth Defects and Developmental Disabilities strategic plan. The CDC identifies Priority 4 as “Preventing and controlling complications from hemoglobinopathies, like Sickle Cell Disease (SCD) and Thalassemia.” This demonstrates that the CDC has established some level of commitment to SCD. However, it has elected not to elevate it to its overall list of health disparity topics.

SCD and its complications drastically reduce life expectancies when compared to the general population. There is a tremendous lack of medical knowledge about SCD and inadequate levels of experience and preparedness for treating it within the health care industry. In addition, the lack of medical provider readiness has a direct and profound effect on health outcomes. Therefore, it appears that SCD should qualify as a health disparity based on the criteria utilized by the CDC. But it isn’t. What do you think?

From the paper entitled “Sickle Cell Disease: The Ultimate Health Disparity”

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