The Color of Health Care

Root contributor and American Prospect writing fellow Adam Serwer wants to know: Why aren't people talking about the racial inequities in the current health care system?

This article was original posted on The American Prospect:

Last week, over 8,000 people lined up to be treated by medical volunteers at the Forum stadium in Inglewood, California. It was a rare moment of visibility for the hidden faces of the health-care debate — the 46 million Americans without health insurance, who have largely been obscured by the rage and fear expressed at town hall meetings and rallies. The majority are nonwhite and live in segregated neighborhoods without access to quality health care. It was the first time the organization, Remote Area Medical, had arranged this kind of an event in an urban area, the teeming crowds a reminder of the ongoing health-care crisis plaguing people of color. “This need has existed in this country for decades and decades,” RAM founder Ed Brock told the Associated Press. “The people coming here are here because they are in pain.”

They are in pain because of an inadequate health-care system exacerbated by the ongoing legacy of racial segregation, which limits access to quality care. “Segregation is still a profound problem in the United States,” says Brian Smedley, a health-care expert with the Center for Joint Political and Economic Studies. “We’ve made a lot of progress in the past 50 years, [but] in many U.S. cities, we have segregation levels that are not far below apartheid South Africa.”

That ongoing de-facto segregation has a profound effect on the quality of care to which people of color — insured or otherwise — have access. While the health-care bills being debated in Congress would expand access to and quality of care for people of color, ultimately racial health disparities can’t be eliminated without better distribution of health resources. That doesn’t just mean more and better primary-care providers in minority neighborhoods; it also means environmentally safe living conditions, access to fresh and healthy foods, and safer and more exercise-friendly neighborhoods.

Racial disparities related to health care can be broken down into two categories: access and outcomes. Nonwhites are 52 percent of the uninsured population, the largest proportion of which is Hispanic, at 30 percent — but those numbers don’t tell the whole story about access. Even when people of color are covered, their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods. The facilities that exist are often of lower quality and lack the resources institutions located in primarily white areas have.

What this means is that even when minorities are covered by health insurance, they’re less likely to have quality care and less able to afford the associated out-of-pocket expenses — and the results are staggering. Children born to black women are more than twice as likely to die within their first year of life as are children born to white women. This disparity is unaffected by income or education level. According to the Kaiser Family Foundation, the mortality rate for infants of college-educated black women is 11.5 deaths for 1,000 live births, more than twice that for infants of similarly educated white women, 4.2 for 1,000 live births.

It’s not just infant mortality. According to a 2004 analysis published in the American Journal of Public Health, if the mortality rate of blacks had been the same as that of whites between 1991 and 2000, 880,000 deaths could have been avoided. People of color are more likely to suffer and die from chronic diseases such as diabetes, cancer, and cardiovascular disease, they’re less likely to get the kinds of life-saving treatments that whites get, and they’re more likely to receive the kinds of treatments you would avoid if you could — such as limb amputation for diabetes.

African Americans made up almost half of the new cases of HIV infection recorded in the 2000 Census. People of color are less likely to have seen a dentist. Only 27 percent of African Americans and Hispanics, 36 percent of Asian and Pacific Islander Americans, and 41 percent of Native Americans and Alaska Natives reported seeing a dentist in the past year, compared to nearly half of whites who had. A fifth of black adults report being in poor or fair health, slightly more than Hispanic adults and nearly twice as many as white adults. Some of these conditions are due to disparities in employment, education, and wealth. Language and cultural barriers also hinder effective care, preventing patients and doctors from communicating effectively about medical problems and treatments. But disparities persist even when controlling for income and education levels, the most reliable indicators of quality coverage.

“The reasons why many racial and ethnic minority groups have poorer health literally from the cradle to the grave are many and varied; they’re primarily related to socioeconomic differences,” Smedley says, “but they’re also profoundly related to living conditions.”