Minority Development—An Overview

Minority Development-An Overview By Robert D. Gibson and Fernando D. Garcia

There is no area of huma!l l~fe more important to an individual than his health, and there can be no area of policy of greater importance to a nation than the health of all of its people. (Stat ement of The Honorable William R. Roy, U . S. H ouse of Representatives, H earing bef ore the Comm ittee on Way s and A1eans , House of Representatives, 9 2nd Cong ress on N ational H ealth Insurance Proj1osals , No vember 79, 7977.)

M

any communities in our nation are comprised of persons who, because of low economic and social status, have been denied the enjoyment of the normal privileges, rights and opportunities of an affi uent society. Regardless of status and position, these persons possess certain inalienable rights which are constitutionally guaranteed. We now look upon access to health care as one of these rights, which means that n1embers of the health professions are expected to render health services of acceptable quality to underprivileged patients as well as to advantaged persons. Obviously, that this is not fact has been demonstrated by the health statistics of the minorities and the poor. In the 38 years that have elapsed since Lee and Jones first concluded that there was a shortage of physicians in the United States, 1 an increasing number of authors from widely different backgrounds have concurred in this finding. Those conclusions have been further extrapolated to indicate that there may also be a shortage of pharmacists. Now, on the basis of more refined data, and prognostications somewhat less refined, it is rapidly becoming fashionable to blame the insufficiencies of the health care delivery system on maldistribution. These academic exercises are necessary, and deeply immerse us in the evolution of change, but they provide little comfort or relief for the poor, hungry, malnourished, crippled and diseased. For these are the victims 74

of either professional manpower shortages andjor maldistribution. Who are the poor, the victims of inadequate utilization of health care resources? A few years ago most Americans were shocked to learn that approximately one-fourth of the nation's population was poor. They had become an invisible group (if they were white) whose poverty was hidden beneath their apparent similarity to other Americans. They appeared to be healthy, they betrayed few of the signs of despair and desperation that characterize the poor in other parts of the world, and they wear much the same clothes as do we of the non-poor classification. And, unless they were easily identified as minorities they were alluded to as "The other America." Black, brown, red and yellow America was something else. It was there; everyone knew it, but it had become a phantom population in public housing, segregated middle class neighborhoods, migrant farm workers housing, federally supported reservation domiciles or remote marginal farms in the deep south. Today the poor are no longer invisible. They constitute a revolutionary force in American society for their condition is inextricably woven with other than economic issues such as civil rights, civil dissent and the morality of war. It is no longer possible to deal with the poor solely in terms of their Jiving standards. The poverty of the black and brown American cannot be cured without reference to his civil rights and his aspirations for greater political power. The poverty of the American Indian, although not so familiar to most Americans, is isolated both culturally and socially from mainstream America. Yet his civil rights, too, must be considered in any approach to the amelioration of his poverty.

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

The white American who fal1s into the poverty group seemingly suffers little challenge to his civil rights. Yet he is allied with all the other racial or ethnic groups to the extent that he is bewildered by the intricate and overlapping health and welfare measures that were designed in another age to meet another problem. Now, we believe, there is a growing consensus today that the poor themselves, whether culturally, racially or economically defined, assisted by public funds must provide a large part of the leadership and energy to improve their condition. Yet, it is difficult to visualize an improvement when access to education is thwarted by financial barriers, not to mention the changes which must take place within the social fabric of the ethnically and culturally different socioeconomically disadvantaged. The issue of minority access to college is one of the dominant issues of the 1970's. Around that issue revolves a host of questions and problems related to the gravity of the racial and ethnic conflict in America, and the answers to delivery of health care to those not receiving it must be partially tied, if not significantly interwoven into access to higher education. Access for the poor, then, is mostly economically controlled. Lack of ability, for example, is not a barrier to entry into the first grade of elementary school, but it is at the point of entry to college. If society were to decide that everyone must go to college, just as it decided years ago that all must attend elementary school, the ability barrier would disappear because it would be irrelevant. The same observation could be made about barriers caused by lack of money. If it were to be decided that all the direct and indirect costs of higher education were to be charged against society at large and that the individual consumer of education would be charged

nothing, the cost barrier would disappear. The point is that barriers came into being and now continue to operate because society either permitted them to evolve or consciously created them. Availability of Care Our government and the people have two major concerns with respect to health care- the first is the availability of care, the second is the cost of care. What we are concerned with here is the availability of care. It is said that the best indicator of the availability of health care services for any population is the physician/population ratio. The national figure of 141 physicians per 100,000 population is the ratio cited by the surgeon general as necessary to protect the health of the people. As for the pharmacists it is estimated that in 1969 there were 2,000 black pharmacists out of a total population of about 120,000 pharmacists. 2 • 3 Quick calculations show that of the total number of pharmacists in the U.S., P/2 percent are black. To relate this even further the total figure s describe that there are about 69 pharmacists per 100,000 population; 4 or seven per 10,000 of the white population as compared to less than one per 10,000 of the nonwhite population.* This, then, could suggest that there is an inequity in the provision of pharmaceutical services to the minority community. The American Pharmaceutical Association Policy Committee on Organizational Affairs addressed itself to this problem in its report to the House of Delegates at the 1971 annual meeting and since it is related to the geographical area where our school of pharmacy is located it becomes pertinent in illuminating some of the need for our thrust toward minority recruitment. From paragraph 4.10 of Recruitment of Pharmacy StudentsThe inequity in pharmaceutical services to minority communities can be typified by looking at the Bayview-Hunters Point district of San Francisco. This community has a population of 22,000 persons, 9I percent of whom are nonwhite, yet is served by only two pharmacies in the area. This ratio of one pharmacy to II ,000 people is in contrast to a nationwide ratio of one pharmacy to 3,200 people and an overall ratio for San Francisco of one pharmacy to 3,000. The residents of the Bayview-Hunters Point district cannot possibly receive the same degree of care in pharmaceutical services as residents of other areas of the city. Part of the reasons for this discrepancy lies in the low numbers of minority students graduating from the Schools and Colleges of Pharmacy in the United States.

Robert D. Gibson, assistant dean for student affairs and director of pharmaceutical technology at the University of California school of pharmacy, has been a member of the faculty since 1962. He earned a BA at the University of Oregon and BS and PharmD degrees at the University of California. He spent one year at Cairo University, UA.R, as a visiting Fulbright Professor in pharmaceutical technology and hospital pharmacy, and seven months as a consultant to the office of rese(lrclz and statistics, Social Security Administration, HEW. Gibson has been active in local, state and national pharmaceutical associations serving as an officer or member of several associations and committees, including the APhA, ASHP, CPhA, ACA , FIP and the Royal Society of Health. He has authored several articles covering his interests ranging through drug utilization review, dosage form design , and the development of health care to the poor through minority recruitment.

Fernando D. Garcia is a fourth-year pharmacy studellt at the University of California at San Francisco. He is actively involved in improving the delivery of health care to the Chicano community and is presently working in a community clinic in San Francisco. He helped design and develop the dispensatory at La Clinica de Ia Raza in Oakland, California , where he is presently employed. He has also been active in minority recruitment and is a member of SAPhA and SCPhA.

The 1960 census showed that 2.6 percent of all practicing pharmacists in the U.S. were nonwhite while 12 percent of the total population were nonwhite. Since 1960 there has been no significant effort on a nationwide basis to increase this percentage. In order to improve the quality and the quantity of pharmaceutical services in minority communities it is first necessary to increase the number of pharmacists from these communities.

Equal access to health care, primarily for the poor, the near poor and the catastrophically ill, and those who live in remote rural areas, has not been achieved. Elliot L. Richardson, then secretary, Department of Health, Education, and Welfare, in a presentation on The National Health Insurance Partnership Act before the House Committee on Ways and Means (October 19, 1971) stated that lower income groups and racial minorities have far poorer health,

FIGURE l

Persons With Higher Incomes are Healthier Than the Poor Proportion of population with activity-limiting chronic conditions

30.0

25.0

20.0

0

All incomes

Under $3,000

$3,000$4,999

$5,000$6,999

$7,000$9,999

$10,000

and over

Fiscal Year 1966 *See also articles by H ill and McClain (80-82) and by Scott and Rogers (83-86) f or related statistics.

Sour ce: " Limitation of Ac tivity a nd M c bility Due to C hronic Conditions, U. S. , July 1965-J u n c 1966," Vital aT! d H ealth Statistics, Series 10, N o. 45, N a tion a l Cen ter fo r H ealth S ta tistics, U. S. D e p a rtmen t o f H ea lth, Educa ti o n , a nd W elfar e.

Vol. NS13, No. 2, February 1973

75

FIGURE 2

Non-Whites See Physicians Less Often Than Whites

l\ \ \ \ \ \ \ \~1

Physician visits per person· per year White

~Non-white

4. 7

All'ihcomes

Under $3,000 $3,000-6,999 Fiscal Year 1967

Source: "Differentials in Hea lth Characteristics by Color, U.S., July 1965-June 1967," Vital and Health Statistics, Series 10, No. 56. N ation al Center for H ealth Statistics, U.S. J?epa rtment of Health, Education, and Welfare.

but at the same time receive far less health service than other groups (Figures 1, 2, 3, 4 and 5, pages 75, 76, 77). Similarly, low income groups have far less health insurance protection and children In low income families are the least protected of any population group (Figures 6 and 7, page 78). Gross measures of health status indicate that health has been improving, not worsening, and the cause of the crisis in

health care is not to be found in the general status of health. These gross measures mask very large disparities in health status among subpopulations in the U.S. On nearly every index, the poor and the racial minorities fare worse than their opposites. Their lives are shorter; they have more chronic and debilitating illnesses; their infant and maternal death rates are higher; (Figure 8,

page 79) their protection, through immunization, against infectious diseases, is far lower. And they also have far less access to health services-and this is particularly true of poor and non-white children, millions of whom, for example, receive little or no dental or pediatric care. Part of the health care crisis, then, is our awareness of these differences among our people-the denial to some of a life span as long and as relatively free of disabilities and illnesses as that which others enjoy-accompanied by a sense of injustices that denial entails, and by experiences that denial and its effects can and should be obviated. If this is an adequate description of part of the health care problem, in which race and income and related socioeconomic variables are playing dominant roles, then we must begin to consider the alternatives to alleviate this problem. We submit then, that reforms in education, which mean access to education, and an education in pharmacy in particular, must be embraced. Further, changes in basic commitments and attitudes are necessary. Finally, financial resources to assist the poor to obtain an education in pharmacy must be made available.

Access to Health Care Through Education The barriers to higher education for the minorities are numerous and may include the test barrier, the barriers of

FIGURE 3

Physician Use for Preventive and Routine Services Increases With Income §§§§ Under ~ $2,000

53.9 .$2,000$3,999

•

D

$7.000$9,999

1~$4,000~$6,999

33.0

Percent of physician for preventive services

visits

Percent of persons under 17 having routine physical

Percent of persons under 17 with visit to a pediatrician

Percent of women with visit to obstetrician-gynecologist

Fiscal Year 1964 Sources: White, E. L., "A Graphic Presenta tion on Age a nd Income Differentials in Selected Aspects of Morbidity, Disability, and Utilization of Health Services," Blue Cross Association, Vol. 5, No. 1, M a rch 1968 .

Inquiry

"Characteristics of P atients of Sel ected T yp es of Medical Specia lists a nd Practitioners, U.S., Jul y 1963-June 1964," Vital and H ealth Statistics, Series 10, No. 28, National Center for Health Statistics, U.S. Department of Health, Education, and Welfare.

76

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

poor preparation, the money barrier, the distance barrier, the motivation barrier, and, of course, the racial barrier. That these barriers are operating is evident in the "Report on Enrollment in Schools and Colleges of Pharmacy First Semester, Term, or Quarter, 1971-72." 5 This report showed that a total of 618 black students were enrolled in colleges of pharmacy; about 3.5 percent of an pharmacy students (blacks comprise about 11 percent nationally), and 33.7 percent of the black students are women. Of these 618 black students, 263 are enrolled in the four predominantly black colleges. The number in the remaining colleges then represents only 1.63 percent of the total enrollment. The number of Chicano students was 203 (1.23 percent) with the great majority being reported in Texas and New Mexico schools. 20.7 percent of the seven-tenths Chicano students are women. American Indian students are the most under-represented with only eight students (seven men, one woman) enrolfed. On the other hand, the "other" category, which consists mostly of st.udents of Asian ancestry, comprises the largest minority group with 816 students (4.95 percent) enrolled. Of these, 40.3 percent are women. West Coast colleges enrolled the majority of these students. Racial minorities accounted for 1,645 students, approximately 10 percent of the total (16,476 full-time students). Interestingly, the percentage of women in this group (35.5 percent) is much higher than for white students (22. 7 percent). Also of interest is the fact that 19 percent of the students attending the four predominantly black schools are from foreign countries. The graduate enrollment of racial minorities shows grand totals of 47 blacks (28 masters and 19 doctoral candidates), nine Chicanos (two masters and seven doctoral candidates), and one American Indian (masters candidate). Thus, of the 2,020 students enrolled in graduate schools of pharmacy, 68 (3.3 percent) are of black, Chicano or American Indian extraction. Obviously, the barriers to which we refer are partially responsible for the low percentages of minorities in institutions of higher education. And, of course, these low percentages contribute to the shortages and rna/distribution of pharmaceutical services to the poor, who, incidentally, are predominantly of minority identification. Efforts to lower the barriers to higher education are being made and include reaching out to a new population (minority recruitment), broadening admission standards, paying the bill and changing the institutions. Despite impressive gains, even greater efforts will be required in the

FIGURE4

50 % Higher Disability Days for the Poor AGE-SEX ADJUSTED RATES

22.8

Family income Under $3,000

~ $3,000~ $4,999

D

Restricted activity days

Bed disability days

$5,000$6' 999

Work-loss days

Fiscal Year 1966 Source : " Disa bility Days, U.S ., July 1965-June 1966," Vital and Health Statistics, Series 10, No. 47, National Center for H ea lth Sta tistics, U .S . Department of Health, Education, and Welfare.

FIGURE 5

Non-Whites Have More Disability Days Than Whites Restricted Activity Days Per Year White Non white

White Nonwhite

White Nonwhite FISCAL YEARS 1966 AND 1967 Source: " Differ entia ls in H ealth Characteristics by Color, U.S., July 1965-June 1967," Vital and Health Statistics, Series 10, No. 56, N a tiona l Center for Hea lth Sta tistics, U.S . Department of Health, Educa tion, a nd Welfare.

future to remove the barriers that restrict the entry of the minorities into higher education. There is temptation to be melodramatic about the problems of minority education. Extension of higher education opportunities for under-represented minorities could lead to profound social adjustments, and hence it is threatening to some people. 6 The lowering of barriers that now restrict certain groups might very wen result in universal higher education, which in turn might upset the "social ecology" and lead to far-reaching changes in social expectation, organization and behavior. The stakes appear to be large. 7 To avoid "future shock," as described by Alvin Toffier, whose symptoms are with us now, and may overwhelm us, we must plan and adapt for the future.

And yet, the present situation is neither strange nor new. From its earliest days, America has been engaged in a continuing struggle between those seeking to extend or to restrict opportunity for the latest claimants to equality. Until recently the black colleges have carried almost alone the responsibility for completing the education of onetenth of this country's population. The rest of our national system of higher education has hardly begun to perform their share of that responsibility. It is more than a matter of educating a racial minority, or educating the poor. It is a fundamental question whether institutions designed to serve a favored group can so renew themselves that they learn to serve all the people of the nation. Vol. NS13, No. 2, February 1973

77

FIGURE6

The Poorer a Person the Less Likely He Is To Have Health Insurance Percent of under age 65 population with insurance coverage 100 Hospital Insurance ~ Surgical

92.3

Insurance

80

60

40

20

0

l.-----'"'

Year 1968 Source:

Under $3,000

$3.000-$4,999

$5' 000-$6 ' 999

FJGURE 7

Less Than One-Fourth of Children Who Are Poor Have Hospital Insurance Percent with hospital insurance

D

Percent without hospital insurance

Percent of under age 17 population 100

80

60

40

20

$3 '000-$4, 999

$5 '000-$6' 999

$7,000-$9,999

$10,000 and over

Source: Health Interview Survey, 1968, N ational Center for Health Statistics, U.S. Department of H ealth, Education, a nd Welfare .

To condemn only the institutions of higher education is intellectual dishonesty. The number of "qualified" minority applicants is probably much smaller than had been expected and hoped for by minority spokesmen. Direct responsibility for increasing that number falls more heavily on elementary and secondary schools than on higher institutions. However, colleges and universities are responsible for the staffing of lower schools and for helping to determine their educational priorities. 78

$7.000-$9.999

$10,000 or more

FAMILY INCOME Monthly Vital Statistics Report, February 2, 1970, N ation al Center for Health Statistics, U.S. Depa rtment of Health, Education, and Welfare.

Further, state planning is lagging, state legislatures pinch budgets and major federal support has not materialized. Most institutions, private and public, black and white, have tended merely to react to minority pressures rather than take the initiative in planning. Most institutions simply have no long-term policy regarding minority enrollment. Some highly selective, competitive and prestigious colleges and universities have changed admission standards and they have survived. They have recog-

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

nized that "high-risk" students are indeed academic risks and do require special handling and assistance. If they do not recognize this fact, they (and their easily disenchanted new clientele) must be prepared to accept a higher academic attrition-and further estrangement from the minority communities. Also, that they are contributing to the shortages and maldistribution of health care manpower. The health industry is the third largest industry in America, and it is projected that by 1975 it will be the largest single employer outside of the federal government. Therefore, the institutions of higher education must address themselves to the nation's problems in an informed and positive manner. Educational institutions must produce health professionals in the numbers and varieties necessary to meet the health needs of all of our residents. This will require imaginative changes in the educational process and a close relationship between educational" and health service institutions. The Chicano Community Why are so few Chicanos applying to schools of pharmacy? Like all other minorities, the Chicano community is an oppressed and deprived community. The barrios are lacking in health and legal care. Unemployment runs high, children do without necessary essentials. Because finances were very limited, the Chicano, who had a good academic record and the ambition, would get sidetracked into career fields that "wouldn't cost so much" to go to college.

FIGURE 8

The speed with which a commitment will be realized depends upon the priority assigned. We consider it a serious mistake to assign less than the highest priority to improving health care of the population as a whole through minority recruitment.

Infant Mortality Rate of Non-Whites is Double That of Whites INFANT DEATHS PER 1,000 LIVE BIRTHS

73.8

Making Available Financial Assistance

White ~ Non·white

Source: Vital Statistics of the U. S. , 7967, N a tiona l Center for H ealth Statistics, U .S. Depa rtment of Health , Education, and Welfare.

Editor's Note:

The bars for 1960 are erroneously reversed.

The Economic Opportunity Program gave many minorities, including Chicanos, an opportunity to obtain a firm grip on their future. Financially, the doors to higher education were opening. The popular undergraduate majors were business and sociology for the Chicano who went on to college. Inevitably, as was expected, the graduate began to apply to professional schools. Law attracted most, and is followed by an increased number of applicants to the schools of medicine and dentistry. Why not pharmacy? The pharmacist is a health professional. True, but the traditional pharmacist as viewed by the Chicano community is a drugkeeper, a businessman whose drugs are overpriced. Further, this pharmacist usually has not been an active participant in the health care of the community. Because of the above image of the pharmacist, many Chicano students do not relate pharmacy with health care. Another much-encountered reason is that the Chicano student has not been adequately informed that opportunities for minorities exist in the field of pharmacy. Commitment · ·

Another barrier to an education in pharmacy must be discussed. The attitudes of the professional practitioners, and the lack of leadership from our local, state and national pharmaceutical associations, cannot escape indictment. The past has dem-

onstrated that they have neglected or refused to initiate, without prodding, any activity to increase minority enrollment in pharmacy schools. The American Pharmaceutical Association, during its 1971 annual meeting in San Francisco, was sharply criticized by members of its House of Delegates for not delivering on its policy, adopted a year earlier, to make special efforts to recruit disadvantaged ethnic and racial minorities. The result of that challenge is that APhA is now making an effort to deal with minority recruitment and development problems in pharmacy. The point, however, is that the challenge to assist in increasing the number of health professionals from minority groups was accepted only after a confrontation over priorities. And, unfortunately, the priorities are related to minority recruitment specifically rather than to improvement in the delivery of pharmaceutical services generally through minority recruitment. It is our experience that local and state associations are making the same kinds of noises but not really making any commitments. And this commitment is the most important aspect to be considered. The determination of whether or not to commit ourselves to a minority recruitment program makes the difference between a paper plan to be filed and a commitment to a viable entity. Commitment is tantamount to achievement. The decisions to split the atom and to place a man on the moon are eloquent sagas illustrating this point.

The need for higher education is just as great among racial and ethnic minorities and the poor as it is in the rest of the population, but the colleges and universities have been slow to serve even the most able students in this segment of society. Those of us who have been trying through increased minority recruitment efforts find our efforts blunted by the fact that funds to support students while in school, whether they be scholarships, grants or loan funds, are inadequate. The first and most obvious step in any successful recruitment program is the securing of sufficient funds for financial aid. If our recruitment programs are to reach into the low income areas, then we will be reaching students whose families are unable to contribute toward their education. Because many are barely able to sustain themselves with food and clothing, it is unrealistic to suggest that they can pay tuition and other fees. In respon e some say that there is a growing list of government programs and private philanthropic organizations which provide substantial financial support to economically disadvantaged students. We reply by quoting President Hitch of the University of California, "The university's highly successful Educational Opportunity Program has so far been supported entirely from nonstate funds, but the financial limit has been reached, and if the program is to continue to provide educational opportunity to increasing numbers of disadvantaged students, state support in 1971 is essential". The financial picture is indeed bleak. Therefore, our professional associations, whether they be local state or national must assist in locating and establishing financial assistance for the underprivileged. One approach would be to make low interest loans available. For example, the association could approach the local bank and negotiate to make loans available to the minorities through guarantee. (We have been informed by one bank that a $5,000 guarantee would make $20 000 available in loans to the midorities.) The fact to be recognized here is that the minority student usually has little collateral and, therefore, is a poor risk for the banking communit~. Simply, by assisting the sch?ols . In securing · loan funds for h1gh-nsk students 1n pharmacy associations (continued on page 94) Vol. NS13, No. 2, February 1973

79

An Overview (continued from page 79)

would be aiding recruitmep.t of the underprivileged. Minority Manpower Concerning manpower needs, the growing complexity of health care is creating increasing demands for pharmacists. Christopher A. Rodowskas has predicted that 400 million to one billion prescription orders per year will go undispensed by 1975.8 Similarly, T. Donald Rucker, a former Social Security Administration health economist, predicts a sportage of 71,000 pharmacists· by 1975 based on current dispensing practices. 9 To recite forecasts indicating that the future pharmacy manpower demands will exceed the supply, and to use these forecasts as a basis for commiting ourselves to minority recruitment is specious reasoning. It enshrouds the real issue. To design recruitment strategy on the

premise that pharmacy manpower requirements dictate tapping of the potential minority manpower is not facing, or refusing to recognize, the real issue of socio-economic discrimination, whether de facto or otherwise. It'is a cop-out. However, if the manpower shortage predictions allow the necessary justification to direct minority students into the health professions then that approach must be embraced, for the improvement of health care delivery is dependent , in part, upon the availability of professionals to attend to the needs of all segments of our society. Increased minority participation in the delivery of pharmaceutical services requires an effort we must all accept. It is time to realize the concept which is most relevant to the problems of minorities in this country-that being the double standard of health care. The quality and quantity of health care -in general, and pharmaceutical services in particular, is far more lacking in minority communities than it is to the

Recruitment and Retention (continf!ed from page 86)

professions program. The latter program will offer appropriate tutoring in quantitative procedutes, mathematics, chemistry, general physiology, genetics and erpbryology. The Satqrday Institute has proven successfuP 2 and a similar prograP'l was instituted at the Howard University college of pharmacy in the fall of 1972, in conjunction with the college of nursing, the department of speech and th.e school of education in two area high schools. It is felt that only through this method can the emerging black health professional be upgraded. · 1he 'problem of minority recruitment and retention is difficult , but not insoluble. Students will have to understand the problem and the faculty and administration must be willing to break tradition, in certain instances for the benefit of the students. However, there will be a readjustment necessary on both parts. This will involve ·pain; for as Francis Thompson.has writtenNothing begins and nf? thing ends, That is not paid in moan For we are born in others' pain And perish in our own. 94

Acknowledgments The authors gratefully acknowledge the cooperation of Dr. Richard A. Williams for pre-publication data on the book, "Black-Related D iseases;" Ms . Barbara I. B loom, director, division of careers and recruitment of the American H ospital Association; Mrs. Sylvia W. Jones, directo r of recruitment of the American Speech and Hearing Association fo r pre-publication data on rec ruitment seminars held; Ms. Nyla H annum, a concerned student of the University of the Pacific whose term paper on "Black Opportunities in Pha rmacy" which paralleled ou r findings; Donald Ford and Kenneth J ohnson and Dr . D . B. McNair Scott of the University of Pennsylvania school of veterinary medicine for invaluable inJpiration.

References 1. Fisher, A. F., "Solution s to the Distribution Prob-

2. 3.

4. 5. 6.

7.

8.

9.

! 0.

11.

lem," p r esented at the Worksh op on Min ori ty G r oup R ecruitmen t and R eten tio n , American H ospi tal Associatio n (Aug. 2-3, 1971) "Health Car e a n d the Negro Pop u lation," Nationa l Urban League, 4 (1967) "Higher Education and the Nation's Health," A specia l r ep ort and recommen dations by the Carnegie Commission on Higher Education, 13 (McGr aw-Hill ) (1970) Eisen ber g, L., " R acism, the Family and Society: A Crisis in Values," Ment. H yg., 5 2, 512 (1968) K iefer, D . M., "On the R oad to ZPG," Chern. Eng . News, 20 (Dec. 2, 1971) Bayless, T. M., a n d R osensweig, N. S., "A R acia l Differen ce in Incidence of Lactase Deficiency," J AMA, 197 , (12), l38 (1966) Huan g, S . S., and Bayless, T. M., "Lactose I ntolerance in Healthy Children," NEJM, 276, 1283 (1967) Cuatrecasas, P., Lockwood, D. H., and Caldwell, J . R. , "Lactase Deficiency in the Adult-A Co~mon O ccurr ence," Lancet, 1, 14 (1965) Cook, G . C ., and Kajubi, S. K., "Tribal I n cidence of Lactase Deficien cy in Uganda," I bid., 1, 725 (1966) Thomp son, R. H.," Con siderations Invclving the Shortage of Black Dentists," J. Dent. Ed., 82 , 396 (1970) . J APhA, NS10, No. 6, 335 (1970), see page 75 fo r t he p er tinen t excerp t from this r eport.

Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION

genera] public as a whole. The responsibility for decisive action which would improve the delivery of health care for aH rests on the shoulders of ail ofus. • References 1. L ee, R . I. , a n d J ones, L . W., The F undamentals of Good Medical Care, U niversity of Chicago P r ess, Chicago (1933) 2. D ata comp iled by D ean C h au n cey Coop er, H oward U n iversity College of Pha rmacy, Washington , D .C. (O ct. 1969) 3. " H ealth Man power P er sp ective: 1969, U. S . D ep a r tm en t of H ealth, Education, a nd Welfa re, P ublic H ealth Service, 15 4. "Vital a nd H ealth S tatistics D ata on N a tion a l H ealth R esources," U.S. D ep ar tm en t of Health, E d ucation , a nd Welfar e, Public H ealth Service, Pharmacy Manpowe r, U.S., 2 (1966) · 5. O r r, Jack E., Am . J. Pha rm . Educ., 36, 120 (1972) 6. Bowles, F ra nk H ., Access to Higher Education : T he I nternation al Stud y of University Admissions, N ew York: UNESCO (1963) 7. F ord Foundatio n Rep or t, Minority Access to College, Sch ocken Books, New York, (1971) 8. R od owskas, C h ristopher A ., " T he P ending Criais in Profession al Productivity," J A Ph A, NSlO, 196 (Ap ril 1970) 9. R ucker, T . D on ald, a nd Sob aski, William J ., " P harm acy Manpower T om orrow," Addreaa before Pha rmacy P ublic H ealth Meeting, Houston, T exas (O ct. 25, 1970)

12. Cooper , C . I., person a l communication . 13. Cooper , C. I., "Negr o Enr ollmen t in Colleges of P har macy," ann ual R ep ort of Howard U niver sity college ofphar macy, 3, (1968-1969 ed.) 14. I bid., 3, (1969-1970 ed .) 15. I bid., 3, (1970- 1971 ed .) 16 . Orr, J . E., " R eport on Enr ollment in Schools and Colleges of P harmacy First Semester , Term or Q uarter, 1971-1972," Am. J. Pharm. Ed., 36, 126, (1972) 17. Dove, D. B., "Minority Enrollment in U.S . Medical Schools, 1969-70 compar ed to 196869," J. Med. Ed., 45, 179 (1970) 18 . S troud, R. V., "About Black People," H ear. Speech News, 8 (Mar ch-Apnl1970) 19. Scott, K . R. , editor, "Pr oceedings of the Semin a r on R ecr uitment a n d R etention of Minor ity Disar;l vantaged Students to the Health Professions," Subcommittee Newport, R esolution 3, 79 (1971) 20. I bid., 58 21. I bid., Subcommittee II R eport, Point 8, 82 22. I bid., Subcommittee III R epor t, R esolution 2, 84 23. I bid., R esolution 3, 84 24. I bid., Subcommittee I R eport, R esolution 5, 79 25. I bid., Resolution 2, 79 26. I bid., Subcommittee II R eport, Point 9, 82 27 . I bid., P oin t 10, 82 28. I bid., Subcommittee I R eport, R esolution 4, 79 29 . I bid., Subcommittee II R epor t, Point 11, 82 30. "A R eport to the Board of the North Carolina Consortium for the Health and Manpower Development Program of the National Urban Coalition," Summer Program in Health Sciences, University of North Carolina Chapel Hill (Aug . 6, 1971) 31. Haller, R . M ., "Preparatory Input for Makin g Sp eech Pathology and Audiology Relevan t fo r Minority Group Students" presented at the American Speech and Hearing Association convention (Nov. 12, 1969) 32. Ford, D., J ohnson, K. and Scott, D. B. MeN., personal communication. 33. Cooper, C. I., "Negro Enrcllment in Colleges of Pharmacy," Annual R eport of Howard University college of pharmacy, 4 (1971-1972) (Data presented after original article was submitted fo r publication.)