2013-07-06

Genomics|Update|Current

 

Spotlight: Why We Can't Wait: Health Disparities in Genomic Medicine



New CDC blog post: Why we can’t wait? A public health approach to disparities in genomic medicine
Why we can’t wait: 2013 Conference to eliminate health disparities in genomic medicine

CDC feature: Breast cancer disparities
CDC Health Equity Matters Newsletter

Features of the Week

Public Health Genomics Implementation- Clickable State Map

CDC clickable state public health genomic map on implementation of three Tier I genomic applications: Hereditary breast / ovarian cancer, Lynch syndrome and familial hypercholesterolemia.

New CDC blog post: A public health genomic state-by-state clickable map: Accelerating implementation of genomics applications to improve population health

CDC information: Public health action is now needed beyond newborn screening

CDC blog post: Implementing evidence-based genomics recommendations at the intersection of public health and healthcare

Why We Can’t Wait: A Public Health Approach to Health Disparities in Genomic Medicine

Categories: genomics, public health

June 27th, 2013 12:51 pm ET  -  Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention

Selected Conference Speakers and Organizers; Photo credit: Deneb Semprum

In May 2013, I attended and presented at the “Why We Can’t Wait Conference to Eliminate Health Disparities in Genomic Medicine.”  The conference was organized by the University of Miami and Stanford University, with attendees and speakers from academia, consumer organizations, government agencies, public health, clinical practice, and the private sector. A key rationale for the event is the increasing evidence that the promise of genomic medicine is not being realized equitably, highlighting the importance of dedicated resources and partnerships to address disparities in research and health care (e.g. by race/ethnicity, income and socioeconomic status).
Disparities have long existed in health and healthcare in the United States and around the world.  [PDF 509.57 KB]  These include among many factors basic nutrition, public services such as clean water, educational opportunities, and quality health care. So will genomic medicine ameliorate or worsen existing disparities? This is a central issue for the relatively young field of public health genomics, which is concerned with effective and responsible translation of genome-based science to benefit population health.

adapted from the Institute of Medicine 2003 Report

Several speakers at the conference showed that evidence-based genomic applications that can save lives today are suboptimally implemented across the US population, with remarkable disparities. For example, a recent US analysis of the utilization of epidermal growth factor receptor testing in patients with lung cancer to drive appropriate therapy showed that only 12% of hospitals ordered the test. Factors associated with increased use included affiliation with an academic center, residence in a metropolitan county, higher education and income levels. A recent publication showed that there continues to be considerable underutilization of BRCA1/2 testing in the US, especially among Black and Hispanic women, even though the recommendations for genetic services in high risk women were issued by the US Preventive Services Task Force in 2005.  It is too early to evaluate how the recent ruling of the Supreme Court on gene patents will affect disparities in implementation of BRCA testing.  For Lynch syndrome, a practice survey showed that NCI-designated comprehensive cancer centers implemented screening much more than small community-based cancer programs.

As the conference illustrated, a collaborative perspective is needed to ensure the equitable implementation of genomic medicine.  Collaborations among various players represent the existing patchwork of  the “public health system” in the United States, often discussed in reports by the Institute of Medicine (See Figure 1). Dr. James Marks, a public health leader at the Robert Wood Johnson Foundation once said:  “…no important health problem will be solved by clinical care alone, research alone, or by public health alone- but rather by all public and private sectors working together”. This is most certainly applicable to the burgeoning field of genomic medicine.

Over the past two decades, we have seen a number of collaborative initiatives primarily centered on discovery of genetic causes of disease such as the HapMap project, the H3Africa initiative, among many others.  In June, 2013, an exciting new global collaboration  [PDF 269.37 KB] was launched to accelerate genomics and clinical data sharing around the world.  I believe the time is ripe for new collaborations to address disparities in implementation of genomic medicine by developing data sources and tools that can inform population-specific health interventions and public policy.  Public health agencies at the federal and state levels have a keen interest in ameliorating health disparities in genomic medicine. Work highlighted by Michigan, Georgia and Florida at the conference and by Connecticut and Oregon illustrates public health contributions. For example state cancer registries are being used to identify cases of certain cancers for additional research (e.g. BRCA1) and for reporting information to healthcare institutions about screening for recommended tests (e.g. Lynch Syndrome). More broadly, public health programs can work with other partners to i) assess the presence and quantify magnitude of population disparities in genomic medicine implementation; ii) develop policies and guidelines to address such disparities and iii) assure appropriate implementation of validated genomic applications using a combination of policy change, provider and public education, and interactions with health care and other coalitions.  In 2009, CDC outlined the elements of a collaboration, the Genomic Applications in Practice and Prevention Network (GAPPNet), a network of interested people and organizations passionate about translation of genomics research into population health benefits (through knowledge synthesis, implementation science and stakeholder engagement).              

We live in an exciting time of great scientific discoveries and “big data”. The leading edge of next generation sequencing has reached clinical practice. Almost 10 years ago, in a IOM workshop exploring the intersection of genomics and public health, Dr William Foege, a prominent public health leader, exclaimed “the challenge to public health genomics is to overcome inequitable allocation of benefits, the tragedy that would befall us if we made the promise of genetics only for those who could afford it and not for all of society.”  We need to reap the health benefits of new scientific discoveries for all. This is simply “why we can’t wait.”

 

Health Equity Matters

In This Newsletter

Spring 2013 ~ Vol.2, #2

News You Can Use!

Commentary

Science Speaks

Blog: Conversations in Equity

Health Equity Champion

Announcements

Statistics

Quick Links

Trivia!

Archive

A quarterly e-newsletter in which the Centers for Disease Control and Prevention's (CDC) Office of Minority Health and Health Equity (OMHHE) shares news, perspectives and progress in the science and practice of health equity.

Leandris C. Liburd, PhD, MPH, MA

Associate Director for Minority Health and Health Equity, CDC/ATSDR

Welcome to Health Equity Matters, an electronic newsletter intended to promote awareness of minority health and health equity issues that affect our work at CDC and in the broader public health community, support the achievement of our goal to eliminate health disparities, and foster ongoing communication and collaboration.

This year, I was honored to be invited to the 34th Annual Minority Health Conference at the University of North Carolina (UNC) Gillings School of Public Health to deliver the Victor J. Schoenbach Health Disparities Keynote Lecture. The Minority Health Conference at UNC has the distinction of being the largest and longest-running student-led health conference in the nation. Co-chaired by two amazing young women - Chassidy Hanley and Adrienne Gill-, the theme of the 2013 conference was “Constructing the Foundation for Health Equity.” The “Millennial generation” of public health workers, researchers, and scholars is entering the workforce at a time when the urgency of addressing the root causes of health inequities is clear while the path to health equity is still being paved.

In this issue of Health Equity Matters, we highlight some of CDC’s efforts to prepare the incoming workforce, as well as national initiatives intending to enhance cultural and linguistic competence. In addition to the regular features included in Health Equity Matters, don’t miss the guest commentary provided by Dr. Lynda Anderson, Director of CDC’s Healthy Aging program, and a brief overview of the new Cochrane Public Health Group report - Community Coalition-Driven Interventions to Reduce Health Disparities – A Systematic Review.

We hope you will enjoy this issue! Special thanks to all of our colleagues across CDC who provide the content for Health Equity Matters!

We welcome your comments, and encourage you to continue to circulate the newsletter among your colleagues and friends.
Leandris C. Liburd, PhD, MPH, MA

Associate Director for Minority Health and Health Equity, CDC/ATSDR

Office of Minority Health & Health Equity (OMHHE)

News You Can Use!

Welcome to our new students!
Please join OMHHE in welcoming the 2013 CDC Undergraduate Public Health Scholars Program (CUPS) interns and the Dr. James A. Ferguson Emerging Infectious Diseases fellows. Through the leadership, recruitment and mentoring of our grantees – Columbia University, Kennedy Krieger Institute, Morehouse College, and the University of Michigan –192 undergraduate students will be participating in the 2013 CUPS program from May 29 through August 2, 2013.

The program is intended to expose students interested in minority health to the field of public health research and practice and increase the quality of public health services nationally by providing interns with hands-on, project-oriented assignments. It is expected that this exposure to public health programs will heighten interns’ awareness of and interest in public health careers. Thirty-two CUPS interns from Morehouse College will be on-site at several CDC locations.

Of the 11 graduate students participating in the eight-week Dr. James A. Ferguson Emerging Infectious Diseases Fellowship this summer, six students have been assigned to CDC in Atlanta and six to Kennedy Krieger Institute and other affiliated public health organizations in Baltimore, MD.

The Ferguson fellowship program is a professional development program that provides hands-on experience for graduate students in medical, dental, veterinary, pharmacy, and public health master’s-level graduate programs. This fellowship program is supported through collaboration with The Division of Preparedness and Emerging Infections (DPEI) in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). The 2013 Ferguson Fellowship cohort will be busy at work until July 26, 2013.

For more information, visit OMHHE's Sponsored Internship & Fellowship Opportunities

First Millennial Health Leaders Summit
More than 50 graduate and medical students selected through nominations by 14 schools of public health and medical schools across the country convened at the inaugural CDC/King Center Millennial Health Leaders Summit on April 4-5, 2013. Students were selected based on their outstanding achievements and promise as future leaders in addressing health disparities across the nation.

“Our goal with the Millennial Health Leaders Summit is for the CDC to be able to convene, in close collaboration with the Martin Luther King, Jr. Center for Non-Violent Social Change and our academic partners, Brown University and Harvard University, the next generation of leaders who will be able to take on the task of eliminating health disparities in the 21st century,” said Dr. Leandris Liburd.

Dr. Ileana Arias, Principal Deputy Director of the CDC and ATSDR, was the keynote speaker at the inauguration. The students had an opportunity to engage in discussions and interactive workshops given by health disparities researchers and policymakers within CDC. The workshops included topics, such as social media, health disparities and health literacy; community-based health equity programs; social determinants of health; “vulnerable populations”; and violence as a public health issue. The closing plenary was given by Asim Jani, MD MPH FACP AAHIVE, Chief, CDC Preventive Medicine Residency and Fellowship, who called on the Millennial Health Leaders to consider the implications of their work in health disparities at the intersection of public health and health care.

On the second day, the Millennial Health Leaders re-convened at the Martin Luther King, Jr. Center for Non-Violent Social Change, at which they were joined by about 60 high school students from the Atlanta area and a number of community leaders. Dr. Bernice King, the CEO of the King Center, gave welcoming remarks and told the participants that their very presence at the King Center with the purpose of discussing solutions to eliminate health disparities has achieved one of the critical goals that her mother, Mrs. Coretta Scott King, had for the King Center as a place for dialogue to solve the pressing problems of our society.

HHS releases enhanced CLAS Standards
HHS has launched the enhanced CLAS Standards, considered a key initiative in the department’s effort to reduce health disparities; the update marks a major milestone in the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.

Specifically, the enhanced National Culturally and Linguistically Appropriate Services (CLAS) Standards, developed by the HHS Office of Minority Health, provide a framework to health and health care organizations for the delivery of culturally respectful and linguistically responsive care and services.

By adopting the framework, health and human services professionals will be better able to meet the needs of all individuals at all points of contact, HHS said.

The enhanced standards are a comprehensive update of the 2000 National CLAS Standards and include the expertise of federal and non-federal partners nationwide, to ensure an even stronger platform for health equity.

For additional information, please visit the HHS OMH site, and specifically their Think Cultural Health webpages.

CDC works on a new Language Access Plan (LAP)
With the support of representatives from across the agency, OMHHE is coordinating efforts to outline CDC’s Language Access Plan, following the model set out in the HHS 2013 Language Access Plan (HHS LAP)  to ensure access to the Department’s programs and activities to people with limited English proficiency (LEP).

Nearly 20 percent of the U.S. population (55 million people) speaks a language other than English at home, 63 percent of hospitals treat LEP patients daily or weekly, and more than 15 languages are frequently encountered by at least 20 percent of hospitals.

In accordance with Executive Order 13166, Improving Access to Services for Persons with limited English proficiency, the HHS LAP establishes the Department’s policy and strategy for serving persons with LEP. The LAP also underscores HHS' commitment to the language access principles, which state that people with LEP should have meaningful access to federally funded programs, activities, services and benefits. The plan further serves as a blueprint for HHS agencies to develop their own agency-specific language access plans.

Community Coalition-Driven Interventions to Reduce Health Disparities – A Systematic Review
In March, 2013, CDC's Division of Community Health hosted a presentation on a Cochrane Collaborative Systematic Review titled "Community Coalition-Driven Interventions to Reduce Health Disparities among Racial and Ethnic Minority Populations – A Systematic Review."

This systematic review, which was funded by CDC's Division of Community Health, assessed the effects of community coalition-driven interventions on improving health status in racial and ethnic minority populations. The presenter, Dr. Laurie M. Anderson, Associate Professor in the Department of Epidemiology at the University of Washington, discussed the methods and findings of the review, characteristics of the community coalitions, types of health issues and intervention strategies, effects of coalition-driven interventions on health outcomes, potential risk of bias, and where knowledge gaps existed.

Literature searches were conducted in several electronic databases from January 1990 through September 2012. Searches yielded 27,649 titles and abstracts, from which 545 potentially relevant papers were assessed in full text. After screening full text papers, 59 unique community coalition studies were identified in reports from 156 publications. Most of the studies in the review were conducted in the United States, and the review included several CDC Racial & Ethnic Approaches to Community Health (REACH) sites. Other studies were from the United Kingdom, Canada, and Australia. Conditions targeted included asthma, tobacco use, healthy body weight, cancer screening, alcohol and drug use, and HIV-related risks.

Some large, broad-based, multi-level, and multi-strategy interventions aimed at improving overall health in disadvantaged communities showed no effect. However, many of the programs targeting risk and protective factors and chronic disease prevention did show modest, positive outcomes.

The review procedures are available on the Cochrane Library website (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009905/abstract).

Tribal Support Website Redesign & Tribal Consultation Policy Update
CDC's Tribal Support website has been recently redesigned. The enhanced website offers easy-to-find information about tribal activities at CDC/ATSDR, including information about the agency’s Tribal Consultation activities and Tribal Advisory Committee; resources from across the agency and from external partners; and upcoming opportunities for funding and career development. The site also allows visitors to subscribe to receive updates on CDC/ATSDR tribal activities.

The CDC/ATSDR Tribal Consultation Policy was recently revised to ensure consistency with the US Department of Health and Human Services (HHS) Tribal Consultation Policy, with input from HHS, CDC programs, the CDC Tribal Advisory Committee, and other stakeholders. In February, the draft revised policy was sent to leaders of all federally recognized tribes for a review and comment period. Comments were accepted from the public through May 20, 2013.

Emerson Elementary School class picture, ca. 1947, Courtesy of Shades of San Francisco, San Francisco Public Library

Evolution of Minority Health in Retrospective
Opening on Smithsonian magazine’s Museum Day Live, on September 28, 2013. Health is a Human Right examines some historic challenges of the past 120 years in achieving health equity for all in the US. Health is a Human Right is organized and sponsored by the David J. Sencer CDC Museum and OMHHE; and the California Endowment. The exhibit coincides with OMHHE’s 25th anniversary, which will be marked with a series of events for CDC staff to celebrate the agency's achievements in minority health. (September 28, 2013 - January 3, 2014.)

REACH Video and Vignettes
An 11-minute video showcasing the impact of community health programs funded through the Racial and Ethnic Approaches to Community Health (REACH) initiative is available online from the CDC Division of Community Health (DCH) website.
"REACH – Improving Lives, Inspiring Hope" features local communities that took action to improve the health of their residents with the goal of reducing racial and ethnic health disparities. The profiles address several chronic health conditions including diabetes, cardiovascular disease, asthma, cancer, and obesity. Separate vignette videos featuring each presenter also are available.
To view the video and the vignettes, go to the DCH website.

New Resources Link Spanish- and Asian-language-Speaking Smokers to Quitting Help

Earlier this year, CDC’s Office on Smoking and Health worked with the National Cancer Institute, the North American Quitline Consortium, and the National Latino Tobacco Control Network to establish a new Spanish-language quitline number. This number is 1-855-DÉJELO-YA (1-855-335-3569), which means “Quit now.” The goal is to provide Spanish-speaking callers with a number that is meaningful and easy to remember.

The new number became operational just before the March 4 launch of CDC’s 2013 Tips From Former Smokers national tobacco education campaign. DÉJELO-YA routes callers to their respective state quitlines so that they can receive tobacco cessation information and services.

Some Spanish-language ads in the Tips campaign are tagged with DÉJELO-YA. In addition, as of April 1, Spanish-language “Click-to-Call” banner ads began appearing on mobile phones. People who click on the ads are connected to 1-855-DÉJELO-YA.

CDC has also worked with experts at the University of California at San Diego, which operates the California Smokers’ Helpline, to make quitline counseling for Chinese, Korean, and Vietnamese speakers available nationally for the first time.

In order to promote this new service, CDC has prepared a newspaper advertisement that will appear throughout the 3 months of the current Tips campaign (April, May, and June) in Chinese-, Korean-, and Vietnamese-language newspapers.

The ad—called “Climb Out”—features an Asian man climbing out of an ashtray, representing escape from tobacco addiction. The ad copy encourages smokers to call the quitline for speakers of Asian languages, where they can access a variety of cessation information and services.

CDC’s Tips campaign will run parallel with ads from the California Smokers' Helpline that are also directed at Asian-languages-speaking audiences. Ad placements from both agencies will be coordinated so that these ads do not run during the same weeks.

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Commentary

Health Equity & Aging

Lynda A. Anderson, PhD

Lynda A. Anderson, PhD, Director, Healthy Aging Program

Applied Research & Translation Branch, Division of Population Health,

National Center for Chronic Disease Prevention & Health Promotion (NCCDPHP)

Older people are growing in number faster than any other age group, nationally and internationally. By 2030, older adults will account for roughly 20% of the U.S. population.1 Globally, by 2015, it is expected that there will be more people over age 65 than young adults aged 15 and younger.2

Analysis of aging trends in the U.S. reveals important growth within the older population, with significant increases in racial and ethnic diversity. In 2010, 80% of older adults in U.S. were non-Hispanic whites. By 2030, older non-Hispanic whites will comprise 71%, Hispanics will comprise 11%, blacks nearly 10%, and Asians about 5% of the older adult population.3 Older adults in these groups may experience the effects of health disparities even more appreciably than younger people of their racial or ethnic group.4 Age is important because it serves as a social category affecting social status and treatment as well as a measure for the length of exposure to inequities caused by race, gender and class.5

The Healthy Aging Program serves as the focal point for older adult health at CDC. Working with internal and external partners, the Healthy Aging Program is committed to leading strategic public health efforts to help older adults be healthier in healthier communities, prevent chronic conditions, and end health disparities. Two cross-cutting principles underlie our efforts to promote health equity.

- We embrace a life-course perspective to understand a person’s “placement” in society (experiences and roles) as well as life stage or age.6 This perspective can help with identifying determinants of health7 and support the development and testing of strategies at specific life stages over the life course. This is a central tenet in the work of the Healthy Aging Research Network, a subset of Prevention Research Centers, who are working with communities to understand the factors associated with healthy aging and help translate community-based programs and environmental approaches into practice through the Healthy Aging Research Network.
- We provide data to help identify key issues for older adults. The State of Aging and Health in America 2013 presents important data on 15 key health indicators for older adults related to health status, health behaviors, preventive care and screening, and injuries. The report, which was released in May 2013, focuses on several health equity issues such as health literacy and health concerns for persons who identify as lesbian, gay, bisexual, and transgender.
Other related activities and resources can be found on the CDC Healthy Aging website.

References

1. A Profile of Older Americans: 2011 

Administration on Aging (2011), U.S. Department of Health and Human Services.

2. Ageing in the Twenty-First Century: A Celebration and A Challenge

United Nations Population Fund, New York, & HelpAge International, London, (2012).

3. Population Projections

US Census Bureau.

4. The State of Aging and Health in America 2007 

CDC & The Merck Company Foundation, Whitehouse Station, NJ, 2007.

5. Wallace SP. Social determinants of health inequities and health care in old age.

In: Prohaska TR, Anderson LA, Binstock RH, editors. Public Health for an Aging Society. Baltimore MD: Johns Hopkins University Press; 2012, p. 99-118.

6. Ory MG, Smith ML, Resnick B.

Changing behavior throughout the life-course: Translating the success of aging research.

Transl Behav Med,(2012):1-4.

7. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Disparities in Health and Health Care.

U.S. Department of Health and Human Services, Washington, D.C.[April 2011].

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Science Speaks

Selected publications from OMHHE authors:

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Dr. Ana Penman-Aguilar, (OMHHE Associate Director for Science) authored a newly published manuscript.
Penman-Aguilar A, Carter M, Snead MC, Kourtis AP.
Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S. Public Health Rep. 2013 Mar;128 Suppl 1:5-22. PubMed PMID: 23450881

This paper was published in a special supplement of Public Health Reports focused on Sexual Health. The authors reviewed scientific literature on socioeconomic influences on teen childbearing. All studies included in the review identified at least one statistically significant association relating socioeconomic factors (e.g., neighborhood disadvantage or neighborhood-level income inequality) to teen birth.

The paper suggests directions for future research and practice related to teen childbearing.

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Ramal Moonesinghe, PhD, (OMHHE Senior Mathematical Statistician) was an author on a poster presentation at the Behavioral Risk Factor Surveillance System (BRFSS) Conference, March 19, 2013

Man-huei Chang, MPH, Michael T. Molla, PhD, Benedict I. Truman, MD, Heba Athar1, MD, MPH, Ramal Moonesinghe, PhD, Paula W.Yoon, ScD
Life Expectancy for the U.S. Population by Sex, Race/Ethnicity, and Geographic Region: 2007-2009
This Poster presentation showed that healthy life expectancy can be used to monitor trends in the health of populations and identify health inequalities. Healthy life expectancy in the U.S. varied significantly by sex, race, and ethnicity. Healthy life expectancy can be readily understood and used by public health officials, healthcare providers, and policy makers.

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CAPT Sonja Hutchins, MD, MPH, DrPH, FACPM, (OMHHE Senior Medical Advisor) authored an abstract for an oral presentation at the Preventive Medicine 2013 Conference in the session "Scientific Abstract Presentations in Population Health" entitled, Relationships Between Community Preventive Health Indicators, Social Determinants of Health and Life Expectancy, 2009 Community Health Status Indicators (CHSI), United States.

Community preventive health indicators (leading modifiable risk behaviors and conditions) for heart disease and stroke vary across counties in the United States and are linearly linked to county-level socioeconomic status (SES) and life expectancy. Lower SES counties have worse community preventive health indicators and shorter life expectancy than higher SES counties.

This presentation suggests that targeting socioeconomically disadvantaged counties with intensive preventive interventions may reduce county-level risks for cardiovascular disease.

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Conversations in Equity

Our blog Conversations in Equity shares and exchanges perspectives and progress in the science and practice of health equity.

See the latest post and add your comments today!

Health Equity Champion

Timothy P. Shriver, PhD

Chairman of the Board and CEO, Special Olympics

Exclusion, marginalization, and discrimination against population groups perceived as “different” from the majority of Americans minimize their personhood and human rights, and undermine our ability to achieve health equity for all. The discourse of equity requires that we renegotiate how opportunities for health and wellbeing are structured educationally, politically, and socially. We are pleased to honor Dr. Timothy Shriver as Health Equity Champion for his efforts to promote a policy and culture that understands, supports, and integrates people with disabilities in the workings of all aspects of our society.

We salute Dr. Shriver and congratulate him on being a champion for the cause of health equity!

--Leandris C. Liburd

Tim Shriver is a social leader, educator, activist, film producer, and business entrepreneur. He is the Chairman & CEO of Special Olympics , serving more than 4 million Special Olympics athletes and their families in 180 countries. He has helped transform Special Olympics into a movement that focuses on acceptance, inclusion, and respect for all individuals with intellectual disabilities.

“The Special Olympics movement is proud to be a catalyst for change, not just for people with disabilities but for all of us,” Dr. Shriver said. “We continually see great transformations in our athletes – increased confidence, enhanced social skills, better job skills, and improved health and wellbeing. But, ultimately, it isn’t our athletes who need to change. It’s us. We need to alter society’s attitudes and actions and allow people with intellectual disabilities to be their best. And a change in health care is the change we need.”

Health is one area where Special Olympics has worked to bring about this change. Over the last 15 years, the organization’s Healthy Athletes™ program has grown from a handful of healthcare professionals providing screenings at one event, to the world’s largest public health initiative specifically for people with intellectual disabilities. The program has a presence in 122 countries, and has provided more than 1.3 million health screenings. Launched by pioneers Dr. Steven Perlman and Dr. Paul Berman, it has since engaged more than 120,000 health professionals worldwide, and supplied health services, products, and referrals free to its athletes.

The impact of this work is felt well beyond the athletic fields. Data collected has made scientific research possible and convinced policy-makers across the globe to make changes to improve access to health care. Partnerships with the US Centers for Disease Control and Prevention, corporations, and nonprofit organizations have allowed the program to offer life-altering interventions like prescription eyewear, dental care, and hearing aids – interventions that would otherwise be unobtainable. Thousands of health professionals have been among the most deeply affected participants --53% report life changing attitude shifts and significant changes in their practices.

The problems, however, remain staggering. In 1995 when Special Olympics first offered health screenings, the results showed dramatic health problems among the athletes – 35% had untreated dental decay, 23% failed a basic visual acuity test, and 15% needed to be immediately referred to the Emergency Room for care. Sadly, these conditions remain for most people with intellectual disabilities around the world. “I was shocked and disgusted then and I remain shocked and disgusted now,” Dr. Shriver said. “One of our volunteers explained it to me, ‘Doctors often don’t want to see these patients, and when they do, it isn’t real care, it’s a ‘quick and dirty’ - a rushed look and a nudge out the door.’ I know we can do better than that; we must do better than that.”

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