The Racial Gap in Health Is Spread Across All Domains of Health - Essay Example

Racial Gap in Health 2009 Health differences and hence healthcare requirements are determined by the cultural, social and economic parameters as much as racial differences in health risk behavior. However, racial differences in health are also related to the socioeconomic parameters. Analysis of determinants of health differences between racial and ethnic communities is then essentially one of studying the materialist conditions resulted by the social inequalities in terms of environmental factors. It is found that indigenous people in America and Australia have lower life expectancy than non-indigenous people. The question is whether this is because there are differences in racial and ethnic parameters regarding health risk behaviors or socioeconomic parameters that affect the racial and ethnic communities result in different health outcomes. In this paper, I will discuss the implications of race and ethnicity on health, and the way socioeconomic parameters differ across race and ethnicity. While race refers to the biological and genetic differences between groups of people, ethnicity refers to the cultural and socioeconomic differences as well as the genetic differences of groups of people (Lyons and Chamberlain, 2006). Typically, research on health behavior differences focus on racial and ethnic differences that include differences in biological and cultural behavior. For example, the African American people in the United States are found to have lower health outcomes because they are considered to be less worried about being obese and having sedentary lifestyles, both leading to heart attacks, strokes, high blood pressure and Type II diabetes (Bailey, 2006). According to Bailey (2006), blacks have a “flexible cultural definition of healthiness, with black women more satisfied with their health even if they are fat, which, according to them, is “large-boned” and not overweight. On the other hand, physical fitness and weight control is generally a great concern for the whites, more so with white women. Besides the cultural differences in the approach to obesity, dietary differences also contribute to the racial differences in the incidence of illness among the Afro-Americans and the Euro-Americans. While the intake of spices, oil and sugar is much higher among the African Americans, the Euro-Americans, rooted to their tradition of healthier diet from the plantation days, consume less fat and sugar (Bailey, 2006). The black experience even after the abolition of slavery has centered around discrimination and segregation, further pushing them to poverty, lack of education and health awareness. As Zinn (1999) said, "the biological uniqueness of women, like skin color and facial characteristics for Negroes, became a basis for treating them as inferiors". The dehumanization of the Africans have perpetuated through the centuries. This has made race as an issue in healthcare. Among the healthcare profession, too, there is a discrimination against African Americans among white physicians. In a study conducted on 618 patient encounters, it was found that physicians reported less favorably on the African Americans (vanRyan and Burke, 2001, cited in Fann, 2003). Doctor in generally consider socioeconomic class as synonymous with intelligence. Hence, African Americans, who are lower in the socio economic class is often considered to be less intelligent. During physician-patient interaction, as well, race and ethnicity often has an effect on decision making. For example, surveys have found that white patients are more likely to go breast cancer screening, eye examination for diabetes, beta blocker medication for treatment of myocardial infraction and follow up for mental illness after hospitalization (Fann, 2003). Recognizing that there are dietary differences among the African Americans and Euro-Americans, it must also be accepted that blacks are subject to financial and emotional stress resulting from inter-generational disparities that they have bee subjected too. It is quite likely that higher stress levels are the cause of increased incidence of hypertension and diabetes among African Americans. Besides, a large number of blacks live in unhygienic living conditions that cause diseases. For example, it has been found that 53 percent of toxic waste in the US is generated from factories that are located at sites where 75 percent of the population are minority communities and toxic wastes are known to result in various types of diseases (Villarosa, 2002). While the typical illnesses that plague the African Americans are generally the same as those suffered by the Euro Americans, the severity and the frequency of incidence is often higher among the former, primarily because of differences in diet, living conditions and stress levels, as opposed to genetic differences. For example, African Americans have 40 percent more heart diseases and 33 percent more diabetes. To top it all, African Americans are more vulnerable to HIV/AIDS and death rates among them are far higher. Carriers of sickle cell trait, that leads to hemolysis and thrombosis, is believed to have originated from America to survive malaria (Fields, 2001). Infant mortality is higher among African Americans, mainly because of poverty leading to lower birth weight, age of mother, lack of income and education. African Americans are also diagnosed more for schizophrenia and are less likely to have access treatment for depression, manic depression or anxiety. When patients in requirement of renal transplantation are surveyed, it is found that black patients are more likely to be put in waiting lists or to receive transplants at all. It is felt that organ transplants in the United States are often weighed according to human lymphocyte antigen and favor whites. Blacks also have a higher incidence of prostrate and cervical cancer, implying that they are less subject to screening (Modlin). In the United Kingdom, the Pakistani community is more prone to heart diseases, diabetes, lung cancer and other endemic diseases that are carried by new immigrants or those who travel home frequently. In the United States, it has been seen that African Americans, Hispanics and Asians are less likely to receive coronary angioplasty, bypass surgery, advance cancer treatment, renal transplant or surgery for lung cancer than white patients with similar level of income, insurance cover, age, morbidity, type of hospital or any other parameter (Geigger). Pakistanis are at high risk of coronary heart diseases and diabetes mellitus. In addition, Pakistani women are at risk of dyslipidemia and cardiovascular diseases than American women. Other health problems of Pakistanis include tuberculosis, hypertension, oral submucous fibrosis as a result of tobacco chewing habits, cancer, particularly resulting from smoking or submucous fibrosis. Pakistani immigrant women are also at higher risk of breast cancer than those at home (Periyakoil, n.d). Many of these diseases, however, are related to poor nutrition, lifestyle patterns including smoking and tobacco chewing, early marriage or marriage between first cousins putting them at risk of thalassemia or infection carried at the time of immigration or during travels to home country. All these are socioeconomic factors that affect health outcomes than biological or cultural differences. While the paradigm of cultural study in health and nutrition is based on the racial difference in the attitude towards health, illness and restoration of health, there is another school of thinking that disregards the biological differences among races. In the United States, for example, the government has adopted a series of policies to eliminate differences of racial health by 2010 on the assumption that there is a positive correlation of race and ethnicity with health disparities. Opponents to cultural study of health, however, argue that race is a social and political construct and has no biological basis hence does not have any health implications. According to Graves (2002), human genetic diversity implies that there are shared genes among the African Americans and the Euro-Americans. Hence, ideas like the Bell Curve that distinguishes I.Q between the blacks and whites are defunct, according to Graves, as are differences in health parameters between the races. Besides, inter-racial sexual relationships over the generations have meant that there are no unique genetic characteristics of any race, according this theory. In the social approach to health, differences in health are not attributed to biology and genetic differences alone. Hence, barriers to access to food, education and medical care to disadvantaged women among immigrant communities affect women’s health more acutely than men’s while powerless and lack of control over sexual decisions result in the high incidence of HIV/AIDS among African women than among white women in the United States (Philips, 2005). According to Root (2000), it is difficult to define race itself as there may be various definitions of race, depending on one or more parent belonging to a particular race, or on the basis of self-identification. There may also be large genetic variations within what is now termed as race, which in itself is variant from the biological definition, depending on marital status and so on. Also, genetic variations in biology, after considering the socioeconomic parameters, may not be reliable as all socioeconomic parameters may not have been accounted for. Also, many genetic diseases like sickle-cell disease are prevalent in different races, thus disproving that genetic diseases can be explained by racial differences alone. Racial biological differentials have long been discarded and alternative explanations like discriminatory healthcare practices, patients’ mistrust based on past experiences, lack of cultural competence on the part of physicians and other healthcare personnel are now offered. Explicit or implicit stereotyping often affects clinical decision-making. The role of race, gender and language is really a matter of clinical decision as much as it is a sociological interest. Research on areas like breast screening is also limited for ethnic communities, resulting in lack of sufficient information on health problems suffered by them. However, it is recognized that “’Ethnicity’ is useful for public health if it can help to differentiate between cultural groups with different health care needs, lifestyles and attitudes. This ‘ethnicity’ is multi-dimensional and included information that can be collected such as birthplace, cultural heritage, and skin colour, but also more tacit and intractable dimensions such as social networks and other wider dimensions of identity” (Petersen 2007, cited in Wilson). Yet, all the information that is available on ethnic patient population is that it is identical to the resident population, which is not the case. The lack of sufficient patient care for immigrant and ethnic communities is seen from the lower proportion of breast screening, which can prevent breast cancer, done for such women. Although ethnicity is not generally associated directly with breast screening, there is a low awareness of the need for screening among the immigrants. Besides Asians and East Europeans, Irish are a white ethnic community, the largest white immigrant community in the United Kingdom. The Irish community suffers from mental health problems because of racial stigma, negative stereotypes, poverty, homelessness, unemployment, poor living and social support, lack of faith on the criminal justice system, all of which gives rise to a high incidence of depression, suicide and alcoholism. Because of lack of knowledge on services available and stereotyping, Irish immigrants delay asking for help (actiondre). Developing culturally competent care services imply acquiring the knowledge, skills, attitudes and personal traits of the particular group of people differentiated by religion, race, ethnicity or community. In an increasingly diverse society, cultural competence in healthcare is essential to provide effective services. For best patient outcomes, healthcare professionals need to be sensitive to the cultural mores, religious beliefs, lifestyle and family patterns. Typically, the African Americans distrust the formal healthcare system. This is partly the result of adherence to tradition but more because of discriminatory treatment like the Tuskee Study conducted during 1932 to 1972 on syphilis in which the blacks were considered as samples. Even earlier, blacks were used to test treatment for heat strokes and techniques for treating vaginal fistula in black women without anesthesia. There is a fear and mistrust of the white healthcare professionals among the blacks. This has been compounded by the fact that African Americans comprise only a small part of the healthcare profession in the United States (Fields, 2001). Thus, race and ethnicity is important in studying differences in health outcome as much as these determine the socioeconomic position of different races. Although race and ethnicity are usually considered in terms of the biological and cultural attributes, socioeconomic parameters of the disadvantaged races and ethnic communities are crucial in studying the health outcomes and provision of healthcare to the disadvantaged groups. Poverty, backwardness, adverse dietary and living conditions and stress on account of lack of income are the socioeconomic factors that afflict particular races and communities more than others, which lead to various diseases that are often identified misleadingly as cultural attributes of race and ethnicity. Works Cited Graves, The Dr. J.L. Jr., The Emperor’s New Clothes: Biological Theories of Race at the Millennium, Rutgers University Press, 2002 Periyakoil, Vyjeyenthi S et al (n.d). Health and Health Care for Pakistani American Elders. Stanford University. Retrieved from http://www.stanford.edu/group/ethnoger/pakistani.html Bailey, E. J., Food Choice and Obesity in Black America: Creating a New Cultural Diet, Praeger Publishers, 2006 Geiger, H. Jack (n.d). Racial Stereotyping and Medicine: The Need for Cultural Competence. http://www.cmaj.ca/cgi/content/full/164/12/1699 Action DRE, Mental Health and the Irish Community, http://www.actiondre.org.uk/positivesteps/irish_community.html Darzi, A., A Framework for Action: Summary. Healthcare for London. London, NHS London, 2007 Petersen, J., Breast Cancer Screening Uptake: Analysis of Ethnicity, Birthplace and Name Origin Southwark PCT 2003-2006 DRAFT. Southwark Knowledge Transfer Partnership. London, 2007 Wilson, Kristin, Uptake and Ethnicity: The London Perspective, The Cancer Screening Programmes, NHS Villarosa, Linda, A Conversation with Joseph Graves; Beyond Black and White, January 1, 2002, New York Times, http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F06E6DC1430F932A35752C0A9649C8B63 Fields, Sheldon D, health belief system of African-Americans: Essential information for today's practicing nurses, Journal of Multicultural Nursing & Health, Winter 2001 Fann, RJW, Race Consciousness and African American Health, Online Journal of Nursing, January 31, 2003, Vol. #8 No. #1, Manuscript 3. Available: http://nursingworld.org/ojin/topic20/tpc20_3.htm Modlin, Charles, Culture, race and disparities in healthcare, http://www.ccjm.org/pdffiles/Modlin403.pdf Root, M, The Problem of Race in Medicine, Philosophy of the Social Sciences, 31, p 21-29 Read More