Unfair Treatment: Racial Inequality Produces Health Disparities
- Created on January 31st, 2008
Among the many wrongs afflicting the U.S. health care system is the seemingly intractable problem of racial inequality and unfairness. A half–century after schools were ordered desegregated and more than 40 years after the passage of the 1964 Civil Rights Act, racial disparities continue to pervade our system for treating the sick, injured and dying. Equally troubling is the lack of attention and resources given to promoting health and wellness in communities of color.
No less an authority than the U.S. government has confirmed that racial, ethnic and socioeconomic disparities continue to be seen across almost all dimensions of health care, including quality, access, types of care and clinical conditions.
The National Health Care Disparities Report, published annually by the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services, reported that blacks received poorer quality care than whites for 16 of 22 core measures, while quality was lower for Hispanics in 17 of those measures. On the subject of access to health care, blacks fared worse in two out of six of the areas studied, while access for Hispanics was worse in five out of six.
Perhaps the most disturbing element of the AHRQ’s most recent report is the trend line, which shows that health care quality is actually worsening for people of color across a third of the indicators, while improvements were seen in only a quarter of them. As one example, when looking at how quickly blacks and whites received treatment for an illness or injury, the disparity increased by nearly 10 percent from 2000 to 2003.
It is discouraging that, even as government agencies, non–profit groups and community organizations work to make communities healthier, there is so little real progress. While the existence of health care gaps between rich and poor would certainly come as no surprise to most Americans, the notion of a racial divide in this area of most basic human need should be a wake up call to our nation.
What can be done about it?
While the government looks at health status through certain prime indicators–life expectancy, the death rate, and infant mortality–as well as through morbidity indicators such rates for acute and chronic disease like cancer and cardiovascular disease, the obvious racial disparities tell us that we should focus much more seriously on addressing the "social determinants of health." A large body of research now confirms that social and environmental factors like jobs, schools, housing, insurance coverage, geographic location, gender, race and ethnicity have a major impact on health outcomes.
It may not shock you to know that people who live in substandard housing, attend failing schools and don’t have good jobs are more likely to have serious problems. But our society has yet to come to terms with this. We must begin connecting the dots and strategically address the wider social and environmental issues that contribute disproportionately to poor health outcomes among minorities.
Prompted by the AHRQ report’s findings, the Tri–Caucus of the U.S. Congress and a bipartisan group of U.S. senators have sponsored separate legislation to address health disparities. Both pieces of legislation, if passed, would increase recruitment of racial and ethnic populations in the health professions, continue current health promotion and disease prevention activities targeting racial and ethnic groups, establish new programs to increase community health workers and relieve environmental health concerns to reduce barriers to accessing care.
These legislative efforts are a good start, but not nearly enough to address the root causes of poor health outcomes for African Americans and other people of color.
To cure what really ails our health care system–and to cast out the specter of racial inequality–will require not only fresh and innovative policies and a robust national effort, but also a determination at the local and community level to uncover and address the particular social causes of pervasive health disparities. This will require increasing collaboration between health professionals and civic leaders–along with support from the private sector–to expand the scope of the health care discussion to include issues such as the quality and affordability of housing, the level of employment and job security, the quality of education, and a variety of other social issues.
The Health Policy Institute of the Joint Center for Political and Economic Studies, with support from the W.K. Kellogg Foundation, has launched a national initiative to reduce/eliminate health disparities by identifying their complex underlying causes and defining strategies to address them. The Place Matters initiative is now active in 22 counties and two major cities where racial disparities in health care have been identified.
While legislation and court directives have in the past been effective in advancing racial equality, it is clear that more is required when it comes to health disparities. Reversing the widening racial disparities in our health care system will require determined action at every level of our society. Now is the time to renew our commitment and hold our leadership accountable.
Gina E. Wood is the Deputy Director of the Health Policy Institute. The Health Policy Institute (HPI) is a principle program of the Joint Center for Political and Economic Studies. The HPI was operationally launched in 2002 with a grant from the W. K. Kellogg Foundation. The Foundations’ purpose was to enable the Joint Center to build a health policy institute that would facilitate the participation of "neglected" or "unheard" voices in health policy debates and that would improve the health of underserved and diverse people by supporting national partners in efforts to help communities inform policy and sharing promising practices. For more information visit www.jointcenter.org.