Is Health Care Race Blind?
Gamble, Vanessa
Recently, I attended a conference on race and medicine. As part of his presentation, one of the participants showed a slide of an invitation for a social event that had been sent out by an...
...The theme of the event was "Jungle Fever...
...Preterm delivery (delivery at less than thirty-seven weeks gestation) is a major factor in infant mortality...
...The health status of African Americans and the services that they receive are inextricably linked to social, political, and economic factors...
...In other words, men living in one of the world's wealthiest countries had a lower survival rate than those living in one of the poorest...
...That of black men is seven years shorter than white men...
...She found that hospital personnel dealt with her differently because she was white...
...The "Jungle Fever" episode makes this painfully clear...
...This episode graphically illustrates why it is crucical that the debate over health care reform confront issues of race and racism...
...A much-publicized article in The New England Journal of Medicine (January 1990) further underscores the appalling health status of African Americans...
...A few dismal statistics will show the inadequacies of a health reform program that limits itself to questions of reimbursement and avoids tackling American racism...
...I was married and owned my own house...
...An elderly African-American woman came to him after another surgeon had declined to operate on her...
...They based their conclusions on data that had been compiled before the epidemics of crack and AIDS had begun to wreak havoc on the lives of Harlem residents...
...The anger and frustration that many African Americans feel when they encounter the health care system can be heard in the words of Alicia Georges, a professor of nursing at Lehman College...
...Discussions of health promotion must also mention racial targeting by cigarette and alcohol companies, the paucity of supermarkets with fresh produce in poor neighborhoods, and, as the above example makes clear, the importance of decent housing...
...In 1985, Margaret Heckler, secretary of the Department of Health and Human Services, released a report of a task force on black and minority health...
...The black man was looking at the couple with glee, obviously in anticipation of his supper...
...African Americans are being denied therapies that can often relieve symptoms and perhaps prolong life...
...In Georges's case, the physicians saw her Charlene A. Calarneau skin color and immediately assumed that she had pelvic inflammatory disease...
...Reginald Peniston, who was then a cardio-thoracic surgeon at Howard University Hospital, a black hospital located in Washington, D.C...
...She had outlived the normal life expectancy of a black woman...
...These women were three times as likely to die as white women...
...Middle class women are also affected...
...Peniston recalled an appalling incident...
...Peniston performed the surgery and the woman did fine...
...African Americans themselves correctly recognize that they are treated differently in the health care system...
...Calls for responsible behavior should not be allowed to deflect consideration of broader factors...
...Of all those under sixty-five, 15 percent are white, 25 percent are African American, and 35 percent are Latino...
...One of its conclusions was that unhealthy life-styles greatly contributed to the health status of African Americans...
...It found that older black patients on Medicare got heart bypass operations only about one-fourth as often as comparable white patients...
...The dance was to be held on January 12, 1994...
...Insurance alone, however, won't end the disparities I have described...
...After narrowing during the 1960s and 1970s, the gap in life expectancy between black and white men widened during the 1980s...
...Genetic factors linked SPRING • 1994 • 201 Health Care Reform to race do not fully explain the rates...
...Pelvic inflammatory disease is usually a consequence of sexually transmitted diseases, including gonorrhea and chlamydia...
...Recently, I attended a conference on race and medicine...
...A few years ago, National Public Radio did a report on racial inequities in health care...
...If the physicians conducted their research today, there is a strong possibility that the figures would present an even grimmer picture...
...Efforts to improve the health care of African Americans cannot be blind to these realities...
...Three years later another study in JAMA reinforced these findings...
...Researchers associated with the Centers for Disease Control have recently argued that racism and sexism adversely affect the lives of all African-American women, no matter what their social class...
...The infant mortality rate for AfricanAmerican babies is twice that of white babies and three times as high in some urban areas...
...Their inclusion in the Clinton program should be applauded...
...However, the role of race cannot be discounted...
...Questions about the appropriateness of high tech medicine aside, these procedures are the treatment of choice at the present time...
...She finally told the physician that if she got rid of the cat there would be nothing to protect her children from rats...
...Important, certainly, but if we ignore racial issues, we risk further entrench 200 • DISSENT ment of the already appalling disparities in health that exist between black and white Americans...
...They were surrounded by a monkey eating bananas and a black man with a bone in his nose...
...Medical factors did not fully explain the differences...
...In fact, it reflects and even reinforces the beliefs, tensions, and power dynamics of the wider society...
...Racial disparities in health status and access to care persist even for those African Americans who have financial resources...
...Several factors have contributed to the poor health of African Americans...
...The everyday stresses of racism and sexism, the argument goes, negatively affect the pregnancies of black women...
...Abraham recounts the story of a young black mother with severe asthma that was exacerbated by the presence of a cat in the home...
...Issues of race and racism are as pervasive and disturbing as they have ever been, and they must be challenged in all aspects of American life, including medicine...
...Many black women report similar incidents...
...A national telephone survey conducted in 1986 found that African Americans were more likely than whites to report that their physicians did not inquire sufficiently about their pain, did not tell them how long it would take for prescribed medicine to work, did not explain the seriousness of their illness or injury, and did not discuss test and examination findings...
...The physician's reason...
...An incident described by Laurie Kaye Abraham in her new book, Mama Might Be Better Off Dead: The Failure of Health Care in Urban America, highlights this complexity...
...Back a few years ago, I was having excruciating abdominal pain, and I wound up at a hospital in my area," she recalled...
...Often she accompanied them to the hospital...
...As part of his presentation, one of the participants showed a slide of an invitation for a social event that had been sent out by an Indiana medical society...
...Of course, financial barriers to health care have been significant...
...Black men younger than forty-five have a 45 percent higher rate of lung cancer and are ten times more likely to die of hypertension than their white peers...
...The women's physician repeatedly urged her to get rid of the animal...
...But immediately, in looking at me, they said...
...Yet "race-blind" reform will at best only narrow but certainly not erase racial disparities in health care...
...Why the racial disparities...
...It does result in abdominal pain, but so do many other conditions, some of which can be fatal...
...They found that white patients hospitalized at a Veterans Administration hospital were more than twice as likely to have angioplasty and three times more likely to undergo bypass surgery...
...She had come face-to-face with the stereotype of black women as sexually promiscuous...
...In this study, white and black patients had similar rates of hospitalization for chest pain, but the white patients were one-third more likely to undergo coronary angiography and more than twice as likely to be treated with bypass surgery or angioplasty...
...For example, when they entered a room together, they addressed her first rather than a family member...
...This reluctance stems in part from the illusion that medicine is a value-neutral profession...
...The racial disparities in infant mortality are, in part, the result of a higher occurrence of preterm deliveries in African-American than in white women...
...In 1989 The Journal of the American Medical Association (JAMA) published a report that demonstrated racial inequities in the treatment of heart disease...
...In a 1991 Time magazine article, she 202 • DISSENT Health Care Reform recalled an experience that she had had in an emergency room...
...High infant mortality rates are not restricted to poor black mothers...
...Thus far, public discussion has focused on the elimination of financial barriers...
...There is a growing body of medical literature suggesting that even when African Americans have health insurance, racial disparities persist...
...SPRING • 1994 • 203...
...The life expectancy of black women is six years shorter than that of white women...
...As part of the research for her book on urban health care, Laurie Abraham, a white woman, followed a poor black family for three years...
...An estimated thirty-seven million Americans of all races do not have health insurance...
...She refused...
...The program included an interview with Dr...
...There are several possible explanations including health problems that precluded the use of the procedures, differences in the willingness to accept medical advice or undergo surgery, and differences in the severity of illness...
...African-American women aged forty-five to sixty-four are twice as likely to die of diabetes as white women of the same age group...
...The implication here is clear: if only black folks would learn to take better care of themselves their health would significantly improve...
...The authors, two physicians from Harlem Hospital, found that black men in Harlem had shorter life expectancies than men living in Bangladesh...
...But the solution to the health care problems of African Americans is more complex than a "Say no to drugs, say yes to skim milk" approach suggests...
...This study suggests that the national health insurance program that already exists does not solve the access problems of the African Americans it covers...
...Disparities were greatest in the rural South—white patients had the surgery seven times as often as black patients...
...Such stories are not isolated...
...The racial disparities persisted even after adjustments were made for differences in income...
...African Americans are less likely to have access to particular technologies...
...Health education and health promotion are certainly important—and can and should play a role in efforts to improve health and decrease medical costs...
...People are not always in control of every aspect of their so-called life-style...
...Oh, she just has pelvic inflammatory disease.' " Perhaps because of her nursing background, Georges recognized the implications of the questioning...
...Researchers in a study that The New England Journal of Medicine published last year also found race related differences in access to cardiac technologies...
...Unfortunately, the medical profession is hesitant to grapple with issues of race and racism...
...A report issued in February 1994 found that physicians were less likely to give pregnant black women information about the hazards of smoking and drinking during pregnancy...
...Social factors must be taken into account...
...The stated goal of the Clinton plan, increased financial access to health care for all Americans, is important and admirable...
...Progress," Heckler stated, "depends more on education and a change in personal behavior than it does on more doctors, more hospitals, or more technology...
...The first thing that they began to ask me was how many sexual partners I'd had...
...The men from Bangladesh had a 55 percent chance of reaching the age of 65, while the men from Harlem had a 40 percent chance...
...Of the estimated 52,000 new cases of cervical cancer diagnosed in 1988, over half of the cases were among African-American Health Care Reform women...
...The announcement showed a white couple, dressed in safari garb, in a boiling cauldron of water...
...Medical decisions are even now being made based on skin color, and white lives appear to have higher value...
...Racism has resulted in disproportionate poverty, segregated housing, inferior schools, and unemployment...
Vol. 41 • April 1994 • No. 2
