Socioeconomic Status, Race and Health: Is Health Care Colorblind?

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Socioeconomic Status, Race and Health: Is Health Care Colorblind?

Reference Resource: Office of Minority Health and Health Disparities (OMHD)

Prepared by: MARC IMHOTEP CRAY, M.D.

“It’s not just a health-care issue or a socio-economic status issue or a race issue. It is in part all of these things.”

Slide 2 : Socio-economic and health issues do not fully explain health status disparities in black folk It was only about 50 years ago that African-Americans were “able to participate in our society” “RESEARCH IS BEST INFORMED IN THE CONTEXT OF A NATION-CLASS-GENDER ANALYSIS”

Fueling Disparities : Fueling Disparities Patient-Level Variables Patient preferences, mistrust, comfort level Seeking treatment (or not) Adherence to treatment (or not) Effectiveness of treatment Healthcare Systems-Level Factors Language barriers Availability and access to health care Ability to navigate clinical bureaucracies Lack of insurance, differences in insurance Managed care limitations Care Process-Level Variables Bias, prejudice, stereotyping, clinical uncertainty Decisions made with limited time and information Effect of patient response on physician Institute of Medicine Report (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Income and Health Percentage of persons with fair or poor health status by household income, United States, 1995. : Income and Health Percentage of persons with fair or poor health status by household income, United States, 1995.

Slide 5 : Wealth is important because we know that across all causes of morbidity (DISEASE) , economic status is the leading indicator of poor health

Slide 6 : Source: DHHS. Health, United States, 1998 Disparities: Infant Mortality Rates (Mothers > 20 Years of Age)

Slide 7 : What are some of the historical reasons for racial disparities in health? African-Americans are less compliant with treatment suggestions since they are less trusting of institutions like health-care systems Access to care is largely a function of health-insurance status, which is largely a function of employment status, which is largely a function of educational attainment So if that population has less education, it will have less access to health care

Slide 8 : The accumulated consequence of the Blackman’s history OF OPPRESSION plays itself out in a lot of statistics we see today: educational and wealth attainment, involvement in the criminal-justice system and health Poor Health status is a piece of THE FALLOUT OF OUR HISTORICAL OPPRESSION, an outward manifestation

Slide 9 : One problem is that the remedies are operating within separate silos THE problem is not amenable to having a solution in just one area It’s not going to be solved just by physicians, for example It’s not possible to detangle health from the social and economic factors

Slide 10 : Think of the care process, access to care comes first and then, among those with access, there’s utilization If those with access utilize it, do they get the same quality of care? And are they compliant once they are given a regiment? We find race disparities at each level But don’t physicians play a big role?

Slide 11 : employment, Geographies (rural) / mobility and socio-economics Even if they get access, African-Americans may be less inclined to use the services because of a historical or a contemporary mistreatment—or perceived mistreatment In Blacks there are access disparities because of:

Slide 12 : The Institute of Medicine of the National Academies report in 2002 [“Racial and Ethnic Unequal Treatment: Confronting Disparities in Health Care”] The Report Discovered race differences in the quality of care, for those who utilize it
Patient Perceptions: For the Average African American and Latino, How Big a Problem is…? : Patient Perceptions: For the Average African American and Latino, How Big a Problem is…? *Having Enough Doctors and Providers Near Home ^Difficulty Getting Care Because of Race/Ethnicity Source: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, 10/99

Slide 14 : How big a problem are HEALTH disparities? It depends on how you quantify it( remember, poverty and ignorance = death and disease) It is a very big problem from an equal rights perspective, There is a seven-to-eight-year life span difference between African-Americans and whites From a moral perspective, that’s significant (“right to life”) the economic costs haven’t yet been quantified
Biases in Medicine: Differences in Heart Surgery Rates by Race, Disease Severity, and Survival Benefit : Biases in Medicine: Differences in Heart Surgery Rates by Race, Disease Severity, and Survival Benefit Source: Kaiser Family Foundation: Key Facts on Race, Ethnicity and Medical Care, 1999

Slide 16 : Are you saying there’s racism within the health-care system? Yes Physician bias plays some role, but as the Institute of Medicine concluded, and we agree, this is not the only problem We know that the way the person is treated within the health system will influence whether they are compliant If you feel you were mistreated or got poor quality then you’re less inclined to be compliant

Patient Perceptions: Experience With Being Treated Unfairly When Seeking Medical Care Because of Race/Ethnicity : Patient Perceptions: Experience With Being Treated Unfairly When Seeking Medical Care Because of Race/Ethnicity Source: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, 10/99

Slide 18 : How much does MISTREATMENT AND POOR QUALITY OF CARE contribute to disparities in health between races? Compliance and treatment are an important part of determining health status disparities, but not the only part. Most Black people don’t have any health-care interaction during the year. The system is set up for curative not preventive medicine This is why physicians alone won’t solve health disparities They are not in a position to do it

Slide 19 : The quality of housing, whether you’re exposed to a lot of allergens / toxins Alcohol, tobacco and other drugs (atod) The amount of stress you encounter diet, exercise and proper rest What is happening in the physical environment is going to have much more of an effect on your health

Slide 20 : So how do we move toward health equality? We need cultural competency training for people in the health-care profession, Accreditation of hospitals and health systems should include awareness of health disparities as one criteria to determine accreditation We need to engender more trust of the health-care system among minorities, health education programs to try and get people to realize that you need to use the health-care system when it is available

Slide 21 : Fixing educational and wealth disparities of historical oppression will also address health disparities NO OTHER GROUP’S EXPERIENCES APPROACHES THE NEGATIVITY OF: AFRICAN AMERICAN’S 246 YEARS OF CHATTEL SLAVERY, 100 YEARS OF LEGAL SEGREGRATION AND APARTHIED AND ONLY ONE GENERATION OF ”FREEDOM”

Slide 22 : It’s not just getting more African-American and Hispanic doctors It’s not that simple The solutions are societal.; correcting the fallout of slavery, segregation and present day race and class inequalities It’s improving opportunities for everyone and changing black people’s attitudes in terms of health behavior

Slide 23 : changing black people’s attitudes in terms of health behavior smoking, alcohol consumption, diet and exercise. Take tobacco and alcohol White adolescents are more likely than black adolescents to consume alcohol and tobacco But by the age of 30, it’s reversed There are higher rates of smoking and alcohol consumption for African-Americans—and Hispanics, for that matter—than for whites

Slide 24 : African-Americans go into adulthood, as they leave their families and go into society, they encounter socio-structural and institutional racism as major stressors They turn to drugging, drinking and smoking as a coping mechanism Whereas, smoking and drinking in white teens is youthful experimentation, and it begins to decline in adulthood What does that say? Best theory I’ve heard

Slide 25 : This is not the first time health disparities have bubbled to the top of the health-care agenda Still, this time it seems to have much more staying power and there are real resources being put into it A lot of people are much more aware of the health disparities, and there’s less denial about it We have made a lot of improvements in terms of awareness. That’s the first step I am cautiously optimistic because I take the long view and believe in self-reliance Do you think that we’ll see health disparities erased anytime soon? The end, Thank you for your attention

Further Study:

OUR STORY IN BRIEF! The Relationship Between America, Blacks, Health and Medicine

"YOUR CHILD CAN ATTEND MEDICAL SCHOOL FREE"

HIV and AIDS Education: Basic and Advanced/ Special Focus on sub-Saharan Africa

Medical Apartheid: From the Tuskegee Experiments to the Present: Text, Audio and Video

RBGz "Imhotep Virtual Medical School"-For Advance High School and College Pre Med Student