Surviving and Winning® is a series of 26 half-hour television episodes and corresponding continuing medical education (CME) web activity packages. The series strives to educate and motivate the audience to take public and private action to reduce health disparities. The first of these programs will explore the national problem of health disparities. Each of the following programs will examine a specific disease or medical problem in a tasteful and compelling manner. Healthcare professionals will analyze and forecast trends for the disease. Expert solutions for closing disparity gaps will be integrated into each program. In addition, the latest medical treatments and scientific breakthroughs will be introduced.

Episode 1- PATHWAYS TO HEALTH DISPARITIES

The Surviving and Winning¨ series seeks to identify approaches to meaningful policy changes that would win public support and improve health outcomes. The purpose of this debut episode is to put faces and humanity onto the numbers. While we now have great bodies of evidence upon which to lobby for change, in the end each statistic still represents a personal tragedy or an individual triumph. Episode one will introduce viewers to health disparities among racial and ethnic groups. This program will show how health disparities are persistent and embedded in larger influences, primarily socioeconomic disadvantage, social isolation, economic marginalization, cultural and language barriers.

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There are multiple pathways through which these larger influences affect health, such as noxious working and living environments, unemployment, exposure to persistent stress, lack of resources to cope and promote healthy living, and constrained access to medical care. Analysts too easily combine people in racial and ethnic groups that are actually heterogeneous and whose members face different life and health challenges.

Episode 2 - AIDS

The AIDS epidemic in particular is recognized as a major health and socioeconomic problem that disproportionately affects low-income minorities who have poor access to care. Recent data from prevalence surveys and from HIV/AIDS case surveillance studies continue to reflect the disproportionate impact of the epidemic on racially, ethnically and linguistically diverse groups, especially women and children. African-Americans and Hispanics accounted for 47% and 20% respectively of persons diagnosed with AIDS in 2003. Seventy-five percent of HIV/AIDS cases reported among women and children occur among minorities.

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Episodes 3 & 4 - CARDIOVASCULAR DISEASE PARTS 1&2

Coronary heart disease mortality is declining in the United States as a whole, but there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. According to the American Heart Association, African-Americans are 28% more likely to die of cardiovascular disease than white Americans.

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Despite this disease disparity, by the early 1990's several studies had demonstrated quite clearly that African-Americans were referred less frequently for cardiac catheterization for coronary artery disease than their white counterparts. Communication barriers, problems in the doctor-patient relationship and bias have been suggested as more important explanations of the differences measured. Minorities have higher rates of hypertension, tend to develop hypertension at an earlier age, and are less likely to undergo treatment to control their high blood pressure.

Episodes 5-6-7-8-9 -10 - CANCER

Research shows that minorities are less likely to get regular medical checkups, receive immunizations, and be routinely tested for cancer compared to the majority U.S. population. Cancer deaths are disproportionately high among Hispanics and African-Americans. Vietnamese-American women are five times more likely to have cervical cancer and Chinese-Americans are five times more likely to have liver cancer. There will be six specific cancer specific episodes covered in the series. The episodes include:

PROSTATE

BREAST

CERVICAL

COLON

LIVER

LUNG

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Episode 11- INFANT MORTALITY

Current studies document that despite recent advances, African American and Native American babies still die at a rate that is two to three times higher than the rate for white American babies. Statistics reveal that among Native Americans and Alaskan Natives the incidence of Sudden Infant Death Syndrome (SIDS) is more than three to four times the rate for white American babies. While the national infant mortality rate has declined, the gap between African-American and white infant mortality rates has widened.

Episode 12 - DIABETES

Studies indicate that diabetes is the seventh leading cause of death in the United States. Approximately 16 million people in the U.S. have diabetes. Native-Americans and African-Americans have higher rates of diabetes and related complications such as kidney disease and amputation as compared to the total population. The Pima Tribe of Arizona has the highest known prevalence of diabetes of any population in the world. Hispanics are twice as likely as whites to die of diabetes-related causes.

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Episodes 13 -14 - ADULT & CHILDHOOD OBESITY PARTS 1&2

Approximately 300,000 U.S. deaths a year are associated with obesity and overweight (compared to approximately 400,000 deaths a year associated with cigarette smoking). While the prevalence of obesity has increased for both genders and across all races, ethnic and age group disparities exist. In women, overweight and obesity conditions are higher among African-American and Hispanic women than among white women. Among men, Hispanics have a higher prevalence of overweight and obesity. Members of lower-income families generally experience a greater prevalence of obesity than those from higher-income families. These trends are associated with alarming increases in conditions such as asthma and Type 2 diabetes in children.

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Episode 15 - ASTHMA

African-Americans represent 12.7 percent of the U.S. population but account for 26 percent of all asthma deaths. African Americans were three times more likely to die from asthma than were whites. Not only are asthma death rates higher in African-Americans, but several studies also point to racial differences in health services for patients with asthma. Preliminary data shows that asthma morbidity and mortality among Native Americans and Alaskan Natives might be equal to or greater than that of other racial groups. Individual studies and state-based surveys indicate higher asthma morbidity among American Indians/Alaskan Natives. For example, according to the 2001 California Health Interview Survey, American Indians/Alaskan Natives had the highest rates of lifetime asthma compared with all the other racial/ethnic groups.

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Episode 16 - END STAGE RENAL DISEASE

Disparities in renal disease and especially renal transplantation are arguably the most compelling examples of differential treatment. The risk of an African-American developing end-stage renal disease requiring dialysis is four times the risk for a white American. Once on dialysis, African American patients are only about 70% as likely to be referred for evaluation to a renal transplantation center. While much of the former difference may be explained by patient factors such as disease predisposition or access to care, the latter is at least partly a function of a biased health care system.

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Episode 17- IMMUNIZATION

More than 30,000 adults die each year from preventable diseases. It is estimated that two-thirds (20,000) of these deaths are caused by complications of illness from a single disease, influenza. These are especially troubling numbers, given that vaccines are effective, inexpensive, and readily available. Senior citizens are hardest hit; more than 90% of the deaths caused by influenza during the last 10 influenza epidemics were among persons aged 65 years or older. Among our senior citizens, members of African-American, Hispanic, and Asian groups are immunized at very low rates, compared to Caucasians. Disparities in the rates of pneumococcal vaccination, which prevents one of the more serious varieties of pneumonia, are even greater. These disparities exist despite the fact that Medicare Part B covers the administration of both these vaccines.

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Episode 18 - MENTAL HEALTH

American Indians and Alaska Natives appear to suffer disproportionately from depression and substance abuse. Minorities have less access to mental health services. Minorities in treatment often receive a poorer quality of mental health care. Minorities are underrepresented in mental health research.

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Episode 19 - HEPATITIS

In 2002 50 percent of those infected with Hepatitis B were Asian Americans and Pacific Islanders. African-American teenagers and young adults become infected with Hepatitis B three to four times more often than whites.

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Episode 20 - PAIN MANAGEMENT

Emerging literature is documenting racial and ethnic differences in pain management for acute, chronic, and cancer-related pain. The research indicates that racial and ethnic minorities are at risk for problematic access to pain care, poor assessment, and often receive inferior treatment for their pain across all kinds of treatment settings. As a result, the quality of pain treatment is becoming an important topic in the national debate about health and healthcare disparities.

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Episode 21 - TUBERCULOSIS (TB)

Of all the TB cases reported from 1991-2001 almost 80% were in racial and ethnic minorities. Asian Americans and Pacific Islanders accounted for 22% of those cases even though they made up less than four percent of the U.S. population.

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Episode 22 - TOBACCO/HARMFUL PRODUCTS

The marketing to and consumption of tobacco, alcohol, high-fat foods, and other unhealthy products to minority populations is a major contributor to higher morbidity and mortality. In 1998 the U.S. Surgeon General released a report documenting how tobacco companies market cigarettes more heavily toward minorities. The density of cigarette advertisements on billboards, for example, is much higher in African-American, Asian American, and Hispanic neighborhoods than in white neighborhoods. According to the National Institutes of Health members of many minority groups report higher rates of alcohol-related problems than whites.

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Episode 23

MINORITY FACULTY AT MEDICAL SCHOOLS - Minorities make up 28% of the U.S. population but only 3% of medical school faculty. However, 16% of all African-American faculty in U.S. medical schools are at just three historically black universities. Studies show that minority faculty tend to spend more time with students and patients than non-minority faculty. By improving the diversity of medical school faculty and the rate at which minority faculty are promoted, medical schools may have more role models and mentors for their minority and majority medical students, which may also improve minority application and graduation rates. Minority faculty members may also work to change curricula at medical schools, emphasizing the health care needs of minority populations.

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Episode 24 - PROVIDERS IN UNDERSERVED AREAS

According to the Institute of Medicine Report minority patients lack a consistent relationship with a health care provider because of the lack of doctors in minority communities. A 1997 study of physician practices found that the physician-to-population ratio in impoverished neighborhoods ranged from one physician for every 10-15,000 residents. Yet in wealthier areas the ratio was about one physician per 300 residents or 33 to 50 times more physicians than that of poorer areas. The American College of Physicians believes by increasing funding of initiatives, such as the Minority Faculty Fellowship Program and the National Health Service Corps helps to increase the diversity and size of the healthcare workforce in minority communities.

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Episode 25 - ENVIRONMENTAL HEALTH

Minorities are disproportionately exposed to hazardous waste. A 2003 national study found that African-Americans, Hispanics, and Asian/Pacific Islander females who were pregnant were much more likely than pregnant white females to live in areas with higher levels of air pollution, a risk factor studies have associated with low birth weight, premature birth, and infant mortality. In addition there is evidence to suggest that African-Americans are exposed to environmental tobacco smoke or secondhand smoke more than whites or Hispanics.

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Episode 26 - WRAP

The final episode will focus heavily on solutions. Risk factors change from one period to another but socioeconomic status remains strongly related to health outcomes even as risk factors change. Social status is the most fundamental influence because regardless of the risk persons with more resources, information, power, and useful networks are better able to marshal these resources to their advantage. Thus episode 26 will be devoted to identifying policies that can equalize such advantages so that one's socioeconomic status is not such a powerful determinant of health. The final episode will highlight interventions that are more universal and depend less on the resources of individuals, or at least compensate those most disadvantaged through special targeting efforts.

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