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Friday, Jul 10, 2009
A prestigious, congressionally mandated report has found that minority Americans receive glaringly inferior medical care. The Bush response: Take a Loved One to the Doctor Day!
May 2, 2002 | African-American infants are more than twice as likely as whites to die before turning 1. The average life expectancy for black men is 66, eight years shorter than for white men. Blacks of all ages suffer higher rates of illness and death from just about every major disease, including diabetes, heart disease, AIDS and a variety of cancers.
And the numbers for treatment are just as bad. Inferior care occurs at every step in the system: prenatal checkups, routine care, therapy for life-threatening illnesses, mental health treatment, pain control before death. African-Americans are less likely to undergo heart bypass, angioplasty, kidney dialysis, transplants and other expensive procedures. They get less aggressive treatment for cancer, and they're slower to get the latest drugs for HIV. And in the rare instances when blacks get more aggressive care, it is not necessarily a good thing: They are, for example, more likely to have leg amputations for diabetes instead of sophisticated, conservative limb-saving treatment.
There are no surprises in these data, documented most recently in a congressionally mandated report, by the prestigious National Academies' Institute of Medicine, titled "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." The most exhaustive analysis ever published on the subject, the institute's 586-page review of just about every study that has appeared in a medical journal reaches some stark conclusions: Disparities in care and treatment for all racial and ethnic minorities are pervasive, harmful to patients, and overwhelmingly not their fault.
The Bush administration finally addressed the issues in the institute's call to action -- part of a chorus that has droned on for years -- with a gesture that has some health experts reeling. The plan, announced by Tommy Thompson, secretary of Health and Human Services, is "Take a Loved One to the Doctor Day," scheduled for Sept. 24 , 2002. Thompson, with cosponsor ABC Radio Networks, is encouraging communities to offer health fairs, screenings and other "wellness" events where participants can be weighed, poked, tested, examined, questioned and counseled. One day to make up for a whole lifetime without ongoing, comprehensive care.
"It's comedy," says Dr. Thomas LaVeist, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. "Or it would be comedy if this weren't such a serious problem. It's very depressing, actually.''
"Take a Loved One to the Doctor Day" is a crusade that essentially pins the problem of healthcare disparities on the patients, as if they were somehow responsible for a healthcare system that often gives them second-rate care or shuts them out altogether. By preaching the virtues of checkups and offering redemption to minorities identified as medical slackers, Thompson ignores the roots of healthcare inequities -- poverty, institutional racism, lack of funding, and the shortage of services in minority communities -- and shifts the blame to the victims. He also sidesteps the very sticky matters of bias in the largely white medical profession, and the failure of HHS to enforce civil rights in healthcare.
"It is disconcerting that the leadership of the Department of Health and Human Services would come up with a solution that is so far off the mark," LaVeist adds. "It really displays a staggering misunderstanding and lack of understanding of the problem."
It is particularly hard to explain such a lack of understanding in the wake of the Institute of Medicine report, published in March, just weeks before the announcement of "Take a Loved One to the Doctor Day." In addition to spelling out, in impressive detail, the nature, extent and impact of disparities of medical treatment, the study also pinpoints the causes, placing heavy responsibility on doctors, hospitals, insurance companies, lawmakers and government regulators.
In their analysis of the health gap, institute researchers first identify barriers to care, the most significant being (no surprise here) money. Blacks are twice as likely as whites (and Hispanics are three times as likely) to have no health insurance, a situation that more or less guarantees that a patient will get no treatment until he or she turns up seriously ill in the emergency room.
But access is not the only cause, or even the major cause, of inequities. The institute report found that even when minorities do get care, it tends to be inferior. In a statement typical of the report's dry and unblinking language, the researchers write: "Racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled."
In other words, simply getting minorities into the examination room is not the answer. Because once they are there, the odds are good that the treatment they get will be compromised by the bias of the doctor. There isn't a nook or cranny of the medical system, according to the report, in which minority patients are not treated differently, by which, according to the data, the researchers mean -- emphatically -- worse.
