The headlines from medical journals tell a recurring story, with slight variations for increasingly pernicious-sounding diseases and ailments. To scan just a few recent studies:
• Racial disparities persist in the treatment of lung cancer
• Racial disparities in diabetes outcomes widespread
• African Americans with colorectal cancer have poorer outcomes, lower survival rates
• African-American women still have poorer breast cancer outcomes
• African Americans at increased risk for earlier pre-term births
African Americans — and minorities throughout the United States — show consistently poorer health outcomes than whites, the complicated result of factors ranging from high rates of uninsurance to poorer education, housing and employment. The trend is so embedded in the U.S. health care system as to pose one big question today:
While we’re at it overhauling health care, could the government try to close some of these gaps, too?
The Congressional Black Caucus has pushed a handful of provisions into both the House and Senate health care bills to try to do just that. Health experts caution, though, that legislative prodding can be only a first step toward broaching a problem that has deep societal roots.
Then there is also this complication: Scientists aren’t even certain why some racial health disparities exist, and to some extent, policymakers can go only as far as the research will lead them.
“While there are some factors in racial and ethnic disparities that we don’t understand — and we should do more research to make sure we do understand them — that current lack of knowledge should not in any way impede the urgency of going forward on all the other things where we know we can make a substantial difference,” said Lesley Russell, who authored a report out last week from the Center for American Progress on opportunities to address racial disparities in health reform.
Several of reform’s main aims — whether or not you agree with the cost and methods for attaining them — would benefit minorities alongside the general population. Minorities compose a third of the U.S. population, but they make up more than half of the uninsured, and so any bill that decreases those ranks – and increases the number of people who actually have a primary-care doctor — could help close the gap in access to care.
Disparities arise, though, beyond basic access to insurance. The House bill includes a provision to create (and study) a Medicare demonstration program that would reimburse translators for patients who don’t speak English. Both House and Senate bills also include scholarship programs to push more people from disadvantaged backgrounds into health care work so that the field better represents population diversity at large, providing what advocates term “culturally competent” care. Hispanics, for example, make up 12 percent of the population, but only 2 percent of nurses.
Additionally, the House bill would reauthorize the Indian Health Care Improvement Act for the first time since 1992. And it would require the creation of an “Office of Minority Health” within the office of the secretary of Health and Human Services, as well as within several other agencies like the Centers for Disease Control and Prevention, and the Food and Drug Administration. Such offices could coordinate the kind of data and research that’s still needed to understand racial disparities.
As today’s minority population eventually becomes the American majority — as is predicted to happen by 2042 — the cost and inefficiencies in their health disparities will increasingly be borne by the population at large. This discussion, though, has barely figured into the public debate of the bills.
“There have been a lot of hot issues that have consumed the players in this game,” Russell said. “And the groups that support addressing these disparities have chosen to work more quietly in the background.”
It’s possible, too, that we haven’t heard much about racial disparities — such as that the African-American infant mortality rate in America is twice the national average — because they tug at the moral imperative argument for passing health reform. And the Obama administration clearly calculated early on that it’s easier to sell the American public on economic arguments than moral ones.
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