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Mr. Chairman and members of the subcommittee, thank you for the opportunity to present the views of the Association Minority Health Professions Schools. I am Dr. David Satcher, the President of Meharry Medical College in Nashville, Tennessee and the President of the Association of Minority Health Professions



Our Association is comprised of 8 historically black health professions schools; the Meharry Medical and Dental Colleges, in Nashville, TN; the Charles R. Drew University of Medicine and Science in Los Angeles, CA; the Morehouse School of Medicine in Atlanta, GA; the Florida A&M University College of Pharmacy in the Texas Southern University College of

Tallahassee, FL; Pharmacy and Health Sciences in Houston, TX; the Xavier University of Louisiana College of Pharmacy in New Orleans, LA; and the Tuskegee University School of Veterinary Medicine in Tuskegee, AL. These institutions have trained 40% of the nation's Black physicians, 40% of the nation's Black dentists, 50% of the nation's Black pharmacists, and 75% of the nation's Black veterinarians. Most of these graduates are working in the nation's underserved rural and inner city communities.


Mr. Chairman, we are very proud of the accomplishments of institutions, especially given the significant challenges that we have overcome throughout our existence. Our schools are considered by many to be a national resources. Only recently has the federal commitment to supporting these institutions and the students who attend our schools become a significant issue.



For a long time our schools have struggled against terrific odds to survive. The support of your subcommittee in terms of for programs impacting our students and our


institutions has had and will continue to have a significant impact in enabling us to achieve our mission to improve the poor health status of Blacks and other minorities and to address the underrepresentation of blacks and other minorities in the health


Mr. Chairman, despite the recent federal support that has been provided to our institutions, there is a historic shortage of minorities in the health professions While Blacks represent approximately 128 of the U.S. population, only 2-3% of the nation's physicians, dentists, pharmacists, and veterinarians are Black. Studies have demonstrated that when blacks are trained in the health professions, they are much more likely to serve in medically underserved areas, more likely to take care of other minorities and more likely to accept patients who are Medicaid recipients or otherwise poor. For this reason, it is imperative that the federal commitment to training blacks in the health professions be strong. It is also important to note that our institutions endure a financial struggle which is inherent in our

mission to train


individuals to serve in

underserved areas. plight of our students, our institutions are not able to use tuition to respond to the discontinuation of capitation or other forms of federal support for health professional education. In addition, because the patient populations served by these institutions have been historically poor, they have not earned money from the process of patient care at a time when the average medical school gets 40 to 50% of its revenue from patient care.

Because of the financial

There is a direct correlation between the health disparity among Blacks and Whites and the underrepresentation of minorities in the health professions. The 1985 HHS Secretary's Task Force Report on Black and Minority Health documented that the infant mortality rate for blacks is almost double that of whites, and

that life expectancy for blacks is significantly shorter than that for whites. Blacks suffer disproportionately high rates of cancer, diabetes, pulmonary complications, and other disorders that contribute to 60,000 annual excess deaths per year among blacks when compared to whites. If not for the efforts of historically black health professions schools, the health status disparity between minorities and the general population would be

even greater.

Unfortunately since this historic report the health status disparity between the two groups has actually worsened. Black

life expectancy has

decreased and AIDS, which was not even

mentioned in the 1985 report is now a leading cause of death and


affects blacks and other minorities

minorities who constitute 24% of the population but 45% of the

AIDS victims.

HHS Budget Proposal

Mr. Chairman, the proposed budget for FY'92 for the Department of Health and Human Services is progressive with respect to minority health initiatives but there is room for improvement. HHS Secretary Dr. Sullivan is to be commended for his leadership in specifically addressing and


minority and disadvantaged health in the budget.


Louis Stokes and Senator Edward Kennedy are also to be commended for their outstanding leadership in passing last year's Disadvantaged Minority Assistance Act, which authorized 117 million dollars to be appropriated. That initiative included many programs to aid minority health including an expansion of the Centers for Excellence program and increased funding for the National Health Service Corps.

However, we are concerned that there may be a growing sentiment to trade the support for current health professions programs for the minority health initiatives. This would be inappropriate. The minority health initiative is a distinct and critical thrust which is not intended to replace support for traditional health professions training programs.

Many HHS programs of concern to AMHPS have either been zeroed in the President's budget proposal or have not been increased enough. For example, the AHEC program which provides training and health care resources to medically underserved areas is eliminated in the President's budget when in fact the program needs to grow. Similarly, funding to two year medical schools has been zeroed when these schools, which are improving their medical curriculum and making preparations to become 4 year schools must receive increases in federal support.

Other programs, such as the National Health Service Corps, need significant increases in order to improve upon its essential function of providing health care to the medically underserved. The President's FY '92 budget proposes only a 10% increase in NHSC funding an insignificant amount given the 1,500 designated health manpower shortage areas in our country.

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Education Department Budget

The FY'92 budget proposal for the Department of Education is disappointing with respect to historically black health colleges and universities. We also believe that Student Loan and Grant payments need continued adequate support.

The recommended level of support for HBCUs is inadequate. The deteriorating pool of minority applicants to medical schools,

the growing debt burden of minority students pursuing health careers and the persistent shortage of minority faculty in medical schools were all cited by the Council on Graduate Medical Education as major factors contributing to the deteriorating state of minority representation in medicine. Department should develop a comprehensive plan that addresses the national problems which suppress educational opportunities for minorities in the health professions. The President's budget proposal did not recommend an increase for HBCUs or HBCU graduate institutions. AMHPS supports expanding the eligible institutions for participation in these programs with increased funding to accommodate their needs while not displacing support for currently participating schools.

Specific Programs

The Education

Minority/Disadvantaged Institutional Improvement, Disadvantaged Assistance, and Exceptional Need Scholarships

of Excellence.

Last year Congress passed the Disadvantaged Minority Health Improvement Act. One component of this measure was an expansion of the institutions eligible for Centers of Excellence (COE) grants. However, while funding was provided for new Hispanic Centers of Excellence and new Native-American Centers Excellence, no new funding was authorized for "other" new Centers COE funding is need to support these



predominantly minority institutions which train a disproportionate number of minority health professionals and provide a great deal of care to minority populations. President's budget does not include an adequate funding increase for centers of excellence. Last year the Disadvantaged Minority Health Improvement Act was severely underfunded in the areas of health services for residents of public housing, capital

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