Chartbook on Health Care for Blacks
Part 2: Trends in Priorities of the Heckler Report
Table of Contents
Report of the Secretary's Task Force on Black and Minority Health (Heckler Report)
The year 2015 marked the 30th anniversary of the Report of the Secretary's Task Force on Black and Minority Health (also known as the Heckler Report), released in 1985 under the leadership of then U.S. Department of Health and Human Services (HHS) Secretary Margaret M. Heckler. The landmark report marked the first convening of a group of health experts by the U.S. government to conduct a comprehensive study of racial and ethnic minority health and elevated minority health onto a national stage.
The Heckler Report documented persistent health disparities that accounted for 60,000 excess deaths each year and synthesized ways to advance health equity. This marked the beginning of a new era in addressing minority health issues, beginning with the creation of the HHS Office of Minority Health in 1986 and leading up to the Affordable Care Act in 2010.
Black Population Before and After Heckler Report (Census Years 1980 and 2010)
- Census data on race:
- Collected for more than two centuries.
- Did not include ethnic groups until the 1970s.
- Was not precisely defined for non-Whites.
- Was self-reported in 1980 and 2010.
- Office of Management and Budget racial groups:
- Defined five categories in 1997:
- Black or African American.
- American Indian or Alaska Native.
- Native Hawaiian.
- Added sixth category (Some Other Race) in 2010 and allowed people to identify more than one race
- Defined five categories in 1997:
- Question 6 of the 2010 Census regarding race had 15 different choices and respondents could identify one or more choice.
- Historically, there has been undercounting of the population in key geographic areas, particularly those with increased minority representation.
- Data from the 1980 and 2010 Census were used whenever possible for this section; data from the Current Population Survey were used to depict a more updated view of the population within these time periods (1985 and 2015) and are so noted.
U.S. Black Population, 1980 vs. 2010
|Total population (millions)||26.5||38.9 (42.0)|
|Percentage of total population||11.7||12.6 (13.6)|
|Urban vs. rural (% of total)||13.5 vs 6.6||28.1 vs. 8.2|
|Regional Distribution (%)|
2010 Source: The Black population: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau; September 2011; for urban/rural data: Race & ethnicity in rural America. Rural Research Brief. Washington, DC: Housing Assistance Council; April 2012. http://www.ruralhome.org/storage/research_notes/rrn-race-and-ethnicity-web.pdf (1.4 MB).
1980 Source: Demographic trends in the 20th century. Suitland, MD: U.S. Census Bureau; November 2002; for urban/rural data: 1980 Census of Populations. Table 37. Summary of General Characteristics: 1980. U.S. Census Bureau. http://www2.census.gov/prod2/decennial/documents/1980/1980censusofpopu8011u_bw.pdf (21.24 MB).
- African Americans or Blacks in the United States have undergone different definitions as a racial/ethnic minority. Census data represent the most reliable and consistent data available; however, methods and definitions of race, poverty, environment, and other categories have changed over time. These different definitions make comparison of data challenging. Information on all populations is provided in certain areas to best show how the African American population is being affected.
- Total population data used were "Black only" reported in the 1980 census. For the 2010 data, the first number represents "Black only" and the number in parentheses represents Black alone or in combination with another race.
- According to the 1980 census definition, the urban population comprises all persons living in places of 2,500 or more inhabitants incorporated as cities, villages, boroughs (except in Alaska and New York), and towns (except in the New England States, New York, and Wisconsin).
Geographic Distribution of the U.S. Black Population
|Top 10 States With Largest Number of Blacks||Top 10 States With Largest Percentage of Blacks|
|New York||New York||District of Columbia||District of Columbia|
|Florida||North Carolina||Maryland||South Carolina|
|North Carolina||Maryland||North Carolina||North Carolina|
Source: Bureau of the Census. 1980 Census of population. Volume 1. Characteristics of the population. Chapter B. General population characteristics. Part 1. United States summary. Washington, DC: Government Printing Office; May 1983. Publication No. PC80-1-B1. http://www2.census.gov/prod2/decennial/documents/1980/1980censusofpopu8011u_bw.pdf (21.24 MB); Rastogi S, Johnson Td, Hoeffel EM, et al. The Black population: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau; September 2011. Publication No. C2010BR-06. https://www.census.gov/prod/cen2010/briefs/c2010br-06.pdf (9.975 MB).
- According to the U.S. Census Bureau, Blacks live throughout the country, with the highest concentration in the South (about 55%). In 2010, the District of Columbia had the largest percentage of Blacks (51%), and Mississippi was second with 37%. New York had the largest number of Black residents (3.1 million) although States in the South had a higher percentage of Blacks.
- According to a report by the University of South Carolina (Probst, et al., 2002):
- Seventy percent of poor Blacks in nonmetropolitan areas live in Mississippi, Georgia, North Carolina, Louisiana, Alabama, and South Carolina.
- "Rural poverty affects both individuals and communities. The proportion of poor persons is higher among minority populations, and total community economic resources are more constrained in communities where minority groups represent over half of the population."
- Thirty-four percent of the nonmetropolitan Black population is poor compared with 13% of the nonmetropolitan White population.
- In nonmetropolitan counties where the majority of the population is Black, the average total county income is 67% of the national value, and bank deposits average 56% of the value for majority White counties.
U.S. Black Population by Selected Characteristics, 1980 and 2010
|Age (U.S. Census Bureau, 1983 and 2011)|
|Median Age||24.9 years||31.4 years|
|Life Expectancy (Arias, 2015)|
|Family Composition (U.S. Census Bureau, 1981; Lofquist, et al., 2012)|
|Female Head of Household||40%||30.1%|
|Income (U.S. Census Bureau, 1982; DeNavas-Walt & Proctor, 2015)|
|Median Household Income||$10,674 (29,455)||$34,882|
|Mean Household Income||$13,970 (38,228)||$48,817|
|% Below Federal Poverty Level||32.5 (all races, 13)||27.4 (all races, 15)|
|Business Ownership (Peters, 1987; U.S. Census Bureau, 2007)|
|Education (U.S. Census Bureau, 1999 and 2012)|
|High School Graduate||51.2% (age 25+)||82%|
|College Graduate||8.4% (age 25+)||18.0%|
- The percentage of female head of household with children under 18 years at home has increased for all races since the 1950s. Blacks had the largest increase from the 1950s to the present.
- Between 1970 and 1980 the percentage of Black women maintaining a household more than doubled. In 1980, women first became eligible to be identified as "householder of a married couple household"; since then, they have "...represented an increasing proportion of all married couple householders for every race and Hispanic origin since 1980" (Hobbs & Stoops, 2002).
- In 1950, 78% of Black families were married couples, compared with 56% in 1980 and 28.5% in 2010. In 2010, the percentage of Black families maintained by a single female was 30%. In 2010, nonfamily households represented 35% of Black households. Unmarried couple households (opposite and same sex) could be family or nonfamily, depending on the relationship of others in the household; these represented 7% of Black households.
- Blacks' median income is under the level of all other racial and ethnic groups, including Whites, Asian, and Hispanics.
- From 1960 to the present, Black-owned businesses have transitioned from predominantly small personal service types (e.g., beauty salons, barber shops) to industrial types. The business ownership rate for Blacks has been lower than for other racial and ethnic groups. For example, in 1982, Blacks owned 12.1 firms per thousand, compared to 62.9 for Whites, 28.6 for Asians and 19.5 for Hispanics (Peters, 1987). In 2007, 7% of U.S. firms were owned by Blacks, and 1.9% of U.S. firms with employees were owned by Blacks (U.S. Census Bureau, 2007).
- "[B]usinesses owned by disadvantaged minorities tend to be smaller and less successful than non-minority-owned businesses." (Fairlie & Robb, 2008).
Health of the Black Population in the United States
|Relative Risks and/or Prevalence|
|Diabetes||Overweight and obesity|
|Tuberculosis||Complications during perinatal period|
|Low birth weight||Periodontitis|
|Top 10 Causes of Mortality in Blacks|
|Diseases of the heart||Diseases of the heart|
|Malignant neoplasm||Malignant neoplasm|
|Cerebrovascular diseases||Cerebrovascular diseases|
|Unintentional injuries||Diabetes mellitus|
|Diseases originating in perinatal period||Nephritis, nephrotic syndrome, and nephrosis|
|Pneumonia and influenza||Chronic lower respiratory diseases|
|Chronic liver disease and cirrhosis||Septicemia|
|Nephritis, nephrotic syndrome, and nephrosis||Alzheimer's disease|
- A 2002 South Carolina University report indicated that "84% of counties where African Americans are the majority of the population are HPSA's [Health Professions Shortage Areas]" (Probst, 2002). The 1985 Heckler report indicated, "Relative risks for specific causes of death... are disturbingly high among Blacks compared to the White populations...Relative risk does not indicate the largest numbers of deaths; rather, it reflects the comparative likelihood of dying from a particular cause." For Blacks, tuberculosis, hypertension, homicide, and anemia were among the top life-limiting conditions. Diabetes was also identified as a reason for increased morbidity among Blacks in the 1980s.
- In the early 1980s, HIV/AIDS was not well identified or diagnosed. In the 21st century, it had high prevalence and is the 11th or 12th (depending on gender and age) leading cause of death among Blacks. In 2010, 49% of all HIV-related death were among Blacks. In the United States in 2011, the diagnosis rate of HIV/AIDS was 15.8 per 100,000, but among Blacks this rate was 60.4. Of total HIV diagnoses made between 2008 and 2011, Blacks made up 47% of the total, 64% of women, 66% of infections documented as heterosexual contact, and 67% of children under age 13 years. Blacks diagnosed with HIV are less likely to be linked to care, remain in care, or receive adequate treatment (CDC, 2014).
Historic Events Before and After the Heckler Report
|Major Accomplishments, Challenges, Significant Moments in History Prior to Heckler Report
Major Accomplishments, Challenges, Significant Moments in History After Heckler Report
- Blacks in the United States, including slaves, descendants of slaves, and other immigrants have been an integral part of America's history. They have been scientists, educators, laborers, and leaders; they have been part of every major event or era in America's history.
- After the Emancipation Proclamation by President Lincoln, they have also been essential to the U.S. government. Since the 41st Congress in 1869, there has been Black representation in Congress, mostly in the House of Representatives.
- Three Senators were elected in the period before the Heckler report, and six Senators have been elected since. The first Black female Senator was elected for the 103rd Congress in 1993.
- Several Black Supreme Court Justices have been appointed, the first by President Johnson in 1967, the Court's 96th Justice. Another Black Justice was appointed in 1991.
- The first Black President was elected in 2008.
Priorities of the Heckler Report
- The Heckler Report found that six causes of death accounted for more than 80% of mortality among Blacks and other minority groups compared with Whites. These include cancer; cardiovascular disease and stroke; chemical dependency (measured by deaths due to cirrhosis); diabetes; homicide and accidents (unintentional injuries); and infant mortality. Based on the findings, the report outlined recommendations in areas of urgent need, including health information and education; health services delivery and financing; health professions development; data development; and research agenda.
- Data on “other minorities,” including Hispanics:
- Was very limited in the 1980s.
- Is much more available today.
- With the rapidly increasing diversity of the Nation and persistence of health disparities, the Heckler Report 30th anniversary serves as a call for all Americans to take action and accelerate efforts toward ending health disparities and achieving health equity in their community.
Progress on Priorities of the Heckler Report for Blacks
|Priority||Trends||Most Recent Disparity||Disparity Change|
|Care for Cancer||71% Improving||50% Worse||67% Narrowing|
|Care for Cardiovascular Diseases||78% Improving||33% Worse||No Change|
|Care for Substance Use Disorders||No Improvement||No Disparity||No Change|
|Care for Diabetes||25% Improving||78% Worse||67% Narrowing|
|Suicide Prevention and Mental Health Care||33% Worsening||75% Worse||No Change|
|Infant Mortality and Maternity Care||100% Improving||33% Better||No Change|
- All measures for infant mortality and maternity care and most measures of care for cancer and care for cardiovascular diseases were improving for Blacks.
- No measures of care for substance use disorders were improving and suicide prevention seemed to be getting worse for Blacks.
- Groups With Disparities:
- For many measures of care for mental health disorders, diabetes, and infant mortality, Blacks received worse quality of care than Whites. Blacks tended to receive better quality of maternity care.
- Of measures for which Blacks received worse quality of care than Whites, narrowing of the gap was observed for several measures of cancer and diabetes care. No narrowing of disparities was observed among measures of cardiovascular and mental health care.
- Summary: Of priorities in the Heckler Report:
- Suicide prevention and mental health care for Blacks is worsening, with many disparities and no reductions in disparities over time.
- Blacks also experience many disparities in care for diabetes.
- Care for substance use disorders is poor for all ethnic groups.
Page originally created March 2016