The highly influential New England Journal of Medicine published a series of perspectives on racial bias in health care. Dr. Mary Bassett, New York City’s health commissioner, suggested that the medical community should not only do more to improve the health of black patients but also play an active role in combating racism.
There is no question that the health of blacks is significantly worse than the health of whites. The average life expectancy of blacks is much lower than that of whites, which is 77.9 years. The life expectancy of black males is 69 years, which is lower than life expectancy in Cuba, Iran and Syria.
True, black men are six times likelier to be injured or die from violence than any other ethnic group. But heart disease, strokes and cancer are also more common and more serious in blacks.
Lung cancer is the leading cause of cancer deaths for black people, followed by prostate cancer in men and breast cancer in women. Black men have the highest rate of prostate cancer and death in the world — more than twice the rate for whites. Black women are less likely than white women to develop breast cancer but are likelier to die from the disease.
There is no question that increased awareness of this problem is having an effect. In the past 15 years, the risk of cancer has decreased by about 2 percent per year in blacks, but the risk of death remains 30 percent higher.
In 2002, the Institute of Medicine published a report titled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” which concluded that racial discrimination within health care settings contributes to poor medical care for many blacks and other minorities. Blacks are less likely than whites to be screened for disease, to have preventive measures to reduce disease risk, to receive counseling on the importance of weight control and exercise, and to receive therapy for existing diseases. The prevalence of overworked health care providers in economically distressed neighborhoods and minorities having inadequate or no insurance were also cited as factors leading to disparities in evaluation and treatment of disease. But sadly, poor care is also more prevalent when black people’s income, age, diagnoses and insurance are the same as those of whites.
On Dec. 14, 2014, at 2 p.m., thousands of medical students from 70 medical schools held “die-ins.” The campaign, called “White Coats for Black Lives,” was the largest protest at medical schools since the Vietnam War. Students have produced a call to action that addresses discrimination and racism in their training before and after graduation from medical school.
The closer we look the more obvious it becomes that racism — though perhaps it’s subtler and less talked about than before — is alive and well in America. The causes are multifactorial and include generations of discrimination, low socio-economic status, inadequate access to a decent education, little opportunity to truly experience the American dream, lack of access to health care and a pervading suspicion of the predominantly white medical community.
No matter your political persuasion, the poor health among the disadvantaged in general and among the black community in particular is a national and international scandal. And we are all to blame. Our elected officials are paralyzed when it comes to progress, and if anything, they are making it harder rather than easier for black enfranchisement and advancement. And the plight of rural communities that are composed of minorities receives little attention, and their future seems mostly hopeless.
Though their motives are pure and their hearts are in the right place, most of those in the health care community have little interest in the serious health improvement of all our citizens. Most medical graduates elect to pursue high-tech and high-paying specialty careers. Fewer and fewer are reaching out to poor communities. And the majority of primary care physicians refuse to accept Medicare or Medicaid.
In every corner of our lives, the poor, the disadvantaged and the discriminated are marginalized. As the rich get richer and the poor poorer, change will only come when a crisis occurs. It will take drastic reform, better education and equal opportunity for this country to be able to continue bragging that we truly are the greatest nation on earth.
Dr. David Lipschitz is the director of the Dr. David Health and Wellness Center in Little Rock. To find out more about Dr. David Lipschitz, visit www.drdavidhealth.com