Healthcare Between Blacks and Whites: Racial Disparities in Medical Treatment - Essay Example

Black-White Disparities in Health Care There are persistent and considerable differences in the quality of health among black and white Americans today. On average, the mental and physical health of Blacks is much poorer than that of Whites today. Since the 1960s, the life expectancy of black Americans is six years shorter than white Americans, with Black men less than 45 years old having a 45% higher rate of lung cancer and ten times the likelihood of dying from hypertension than White men under 45. The reasons of this disparity may lie both in need and access; Blacks are more likely to require health care but are less likely to receive it. The difference between this access to health care and treatment of these two ethnicities reflects their continuing differences in income, education and other factors that contribute to the gaining of complex and extensive services, health care being one. Statistics show that people who self-identify as White are physically and mentally happier than people who self-identify as Black. In addition, the annual mortality rate of Black infants almost three times as great as that of White infants (National Center for Health Statistics, 2006). Also, the rate of tuberculosis among Blacks is s approximately eight-to-nine times the incidence among Whites; the incidence of asthma is four-to-six times as high, and the incidences of diabetes and hypertension are about twice as high. Several studies have also documented racial disparities among patients who undergo kidney transplantation. In one study, the researchers reviewed all patients on chronic dialysis in the United States in 1983 and all patients on chronic dialysis in the upper Midwest between 1979 and 1985. Non-white dialysis patients were two-thirds as likely as white patients to receive a kidney transplant. Large Black–White health disparities are also seen in complications associated with pregnancy and childbirth. As noted, the Black infant mortality rate is substantially higher than the White infant mortality rate. The maternal mortality rate among Black women is also substantially greater than among White women, and is essentially invariant across the age of the mother. Although the absolute number of Black and White women who die during childbirth has declined dramatically overall, this disparity has not appreciably diminished in the last 50 years. Irrespective of mother’s educational level, about twice as many (2.1) Black neonates are born with low-birth weight as White neonates (National Center for Health Statistics, 2006). There are different causes that may contribute to this disparity in health care treatment between these two groups. These are: genetic/biologic factors, prejudice and related processes, and socioeconomic factors. The first, genetic or biological factors refer to the different genetic admixtures-the percentage of genes that come from certain populations. For example, Huntington’s disease is only found among Whites, and sickle cell anemia most commonly affects descendants of Africa and the Mediterranean ancestry (Fincher et al, 2004). However, placing too much emphasis on simple genetic explanations of Black-White differences in health status, rather than partitioning the variance among potential causes and looking for interactions among these causes may have negative consequences. One result of this is that it may lead to some people grossly misusing the colloquial concept of race. A racial phenotype or social construction of a person’s race is, at best, an imperfect proxy for a person’s genetic admixture. Another negative consequence is the failure to recognize that the prognosis, even for illnesses that have strong genetic components, can be greatly affected by environmental factors and disparate treatments. This is not to say, however, that doctors should not consider a patient’s genetic population when considering the etiology of a certain disease or deciding treatment, rather there should be an intelligent, informed understanding of what a person’s “race” really represents. When considering this factor, the question then becomes how much variance in the differences is explained exclusively by genetic factors. The second cause for this disparity is prejudice and related processes. This is inclusive of racial attitudes, stereotypes and discrimination, and how this affects the physical and psychological well-being of Blacks. Research shows that there is a connection between the belief and perception that one has been the target of racism and mental and physical health problems. The mental health problems included depression and anxiety disorders, with the physical health problems consisting overall poorer health status, breast cancer, high blood pressure, and increased tobacco use, which may all increase the chance of mortality. Among Black women, perceived racism was associated with and increased chance of preterm labor and delivery as well as low birth weight babies. This prejudice and related processes may also result in Blacks living in difficult social and physical environments such as socially isolated environments or segregated housing, which may contribute to serious negative health consequences for the residents of these areas. In response to this occurrence, Mays et al. (2007) proposes that people respond to prejudice and discrimination as they do to any threatening stimuli because over time, these chronic demands may wear down the body’s regulatory mechanisms, thereby susceptibility to disease. Another cause is socioeconomic status (SES). Regardless of how one may measure SES, it is clear that the lower the status of an individual on this index, the poorer their mental and physical health. In America, SES strongly differs with ethnicity. As a group, Blacks are poorer, have less education, are less likely to be employed, and if employed, more likely to hold lower-status jobs than Whites (Institute Of Medicine, 2003). Thus, it is argued that the socioeconomic disparities between Blacks and Whites are responsible for a significant portion of the disparities between the two groups’ health status. Blacks are without exception the disadvantaged group. For example, with coronary heart disease, disparities are found in almost every aspect. Relative to Whites, Blacks are less likely to be seen by a coronary specialist, less likely to be prescribed appropriate preventive and emergency medications for their heart disease, and less likely to receive surgical procedures intended to remedy various types of coronary heart disease (Fincher et al., 2004). The most obvious way in which socioeconomic variables affect healthcare system variables is through the fairly strong linear relation between a family’s financial resources and the quality of healthcare they receive. One thing that can contribute to disparity as well is that Blacks tend to be less trusting of a White doctor. It’s been reported that Black patients were more likely to schedule appointments with their physicians and were less likely to postpone or delay these appointments when they had a Black physician rather than a White physician, even after controlling for health status (Mays et al., 2007). Whether the racial disparities in treatment decisions are caused by differences in income and education, sociocultural factors or failures by the medical profession, they are unjustifiable and must be eliminated. Not only do the disparities violate fundamental principles of fairness, justice, and medical ethics, they may be part of the reason for the poorer quality of health of blacks in the United States. In order to pave the way for the elimination of this disparity of healthcare between Blacks and Whites, there first needs to be greater access to medical care. There is a need to ensure that black Americans without adequate health care insurance are given the means necessary for access to health care. It’s important that Congress addresses the need for Medicaid reform. Secondly, there should be greater awareness. Because racial disparities may be occurring despite the lack of any intent or purposeful efforts to treat patients differently on the basis of race, physicians should examine their own practices to ensure that inappropriate considerations do not affect their clinical judgment. In addition, the profession should help increase the awareness of its members of racial disparities in medical treatment decisions by engaging in open and broad discussions about the issue. Such discussions should take place as part of the medical school curriculum, in medical journals, at professional conferences, and as part of professional peer review activities. Lastly, there should be practice parameters. The efforts of the specialty societies, with the coordination and assistance of the American Medical Association, to develop practice parameters should include criteria that would preclude or diminish racial disparities. More African Americans and members of other minorities should be trained and incorporated into health care professions as primary health care providers, specialists, and leaders. This would go a long way toward facilitating the elimination of disparities in care because minority physicians, nurses, and social workers have historically been the health providers treating minority patients in minority communities. WORKS CITED Fincher, C., Williams J. E., MacLean, V., Allison, J. J., Kiefe, C. I., & Canto, J. (2004). Racial disparities in coronary heart disease: A sociological view of the medical literature on physician bias. Ethnicity and Disease, 14, 360–371. Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. (B. D. Smedley, A. Y. Stith, & A. R. Nelson, Eds.). Washington, DC: National Academies Press. Mays, V. M., Cochran, S. D., & Barnes, N. (2007). Race, racism and the health outcomes among African Americans. Annual Review of Psychology, 58, 201–225. National Center for Health Statistics. (2006). Health United States 2006 with chartbook on trends in the health of Americans. Hyattsville, MD: U.S. Government Printing Office. Read More