MINORITY HEALTH: Major Disparities Remain

      Despite progress in civil rights, "[b]lacks get sick easier, stay sick longer and die sooner than whites," the AP/Richmond Times Dispatch reports in a look at racial inequalities in health care. "[A] black baby's life expectancy is 6 1/2 years shorter than a white baby's. Blacks are more likely to be born too little and are less likely to survive their first year," and suffer disproportionately from cancer, hypertension and asthma. And many of the disparities persist "even among middle-class blacks with health insurance and college degrees." Health and Human Services Secretary Donna Shalala commented, "We have been, and remain, two nations: one majority, one minority -- separated by the quality of our health. The time has come to stop accepting disparities with resignation." But the reasons for the disparities are "multifaceted" -- ranging from poverty to poor dietary habits to a lack of minority providers to a distrust of the health care system -- and as a result, the solutions are elusive (11/27).

On The Island
      In an analysis of "high-tech, advanced medical care," Newsday reports that African Americans on Long Island and in Queens, NY, "get bypass operations at a rate less than one-quarter that of whites," and angioplasties at one-third the rate of whites. "African Americans wait longer in local hospitals for kidney transplants. They get hip and knee replacements at a rate that's lower than whites. Black women get more of the scarring kind of hysterectomy operation than white women, and fewer of the less-invasive type. ... Blacks with diabetes and circulatory problems get more leg amputations, but fewer leg-saving operations than whites," Newsday reports. The disparity persists "even when the type of insurance was the same," and "at high income levels." Nassau County Health Commissioner Kathleen Gaffney said, "You get treated by what you look like. If you're black ... the physician is less likely to take your symptoms as seriously, so you may not get the same response. There continues to be health care stereotypes in terms of minority patients being less compliant ... and there is also a perception that they are less motivated and less educated. It becomes a self-fulfilling prophecy because they're treated differently by health professionals." Newsday reports that disparities in treatment across races are the "dirty little secret of medicine," and have been documented in studies since the 1980s. Dr. Arnold Epstein, chair of the department of health policy at Harvard University School of Public Health, said, "What is striking is that the findings are not subtle and that we as a country have done nothing about it." Providers note that "black patients often come in with disease more advanced, health more compromised," and black patients and doctors note a deep distrust of the health care system that may result in care delays. In fact, at least two studies have found that blacks may decline life-saving treatments like invasive heart procedures. One of the study's authors, Dr. Jeff Whittle, noted that "people refusing were those who thought they were going to die from the procedure or thought they couldn't trust their doctors." He said, "There's a profound mistrust coming through." Another upcoming survey finds that "doctor's don't recommend cardiac surgery as often for black patients as whites," which may be due to physician perceptions about that patient's support environment, ability to adhere to treatment regimens and life expectancy (Fessenden, 11/29). Newsday also takes a look at St. Francis Hospital, a "hugely successful, nationally known center of high-tech medicine" that specializes in cardiac procedures. While St. Francis is one of the area's busiest and most successful cardiac hospitals, "[o]nly 2% of the bypass and angioplasty patients the hospital admitted" in the past five years were black. While hospital officials and doctors note that the area around St. Francis is largely white and affluent, the hospital draws white patients from other regions in the area, but few minority patients. Newsday reports that "St. Francis provides a case study of the increasing stratification of health care," and "provides a window into the role institutions, and complex referral patterns between doctors, play in the health gap between the races" (Fessenden, 11/29).

Provider Choice
      This month's issue of the Journal of the National Medical Association explores the role of race and gender in medical education, noting that minority physicians tend to treat patients with similar backgrounds, and that provider diversity improves health outcomes because minority patients will be more likely to seek care early. The study of 564 fourth-year medical students found that women and minorities most often cited difficulty in establishing support networks with peers and the need for superior academic achievement in order to be judged equal to white students (National Medical Association release, 11/25).