Vulnerable Populations: African American Community - Research Paper Example

Vulnerable Populations: African American Community Justin T. Tidwell Fort Hays State University Introduction This paper sets to analyze African American community of the USA as a part of vulnerable populations. According to the US census Bureau, African American population includes around 35.7 million people, or 12.69% of the total US population, which makes it the largest minority on the US territory (US Census Bureau, 2002). Despite this fact, a considerable share of the African American community is included into the vulnerable populations group when it comes to discussing healthcare in context of quality, access and cost of care. Vulnerable populations can be defined as social groups, who are experiencing health disparities, which are a result of lack of resources and increased exposure to risk (Anderson et al., 1999; Flaskerud & Winslow, 1998). Such vulnerable groups often consist of people of color, those who live below the poverty line as well as people who are marginalized by sexual preference, immigrant status, religion, or creed (Flaskerud, et. al., 2002). Health Care Needs of African Americans Although there is certain difference in perceived health status of African Americans as compared to the Whites, no dramatic difference is perceived in health status is seen in comparison to the white population. For example, 31.3 % of Blacks rated their health as excellent (as opposed to 37.1% in the white population); 27.6% as very good (30.2% respectively); 25.6% as good (21.4% respectively); 10.9% as fair (7.7% respectively) and 4.6 as poor (as compared to 3.6% in white population) (Bhandari, 2006). Nevertheless, according to Statistical data collected by American Centers for Disease Control (CDC), morbidity and mortality rates among African Americans are higher in regards to almost every major disease. Possible health issues include: prevalence of HIV/AIDS, hypertension, stroke , asthma, lung and bronchus cancer death, cerebrovascular disease, coronary heart disease, diabetic amputation, diabetic case rates, infant and neonatal mortality, and the number of strokes per 100000 population (Centers for Disease Control and Prevention, 2007; CDC, 2008). Statistical data make it quite obvious, therefore, that this population has special health care needs, which might not be addressed properly in terms on health care quality, cost and accessibility. Quality of health care is the achievement of optimal physical and mental health through accessible, cost-effective care that is based on best evidence, is responsive to the needs and preferences of the populations and respectful of patients’ families, personal values and beliefs (Jimbo, 2004). Quality health care should be provided on a fair basis, irrespectively of color, age, income, sex or language. This is an important aspect of medical practice because evidence shows that practitioners tend to have biased attitude when it comes to diagnosing and observing black patients. For example, a study, which focused on interrelation of sex, race and physicians’ recommendation for cardiac catheterization, has established that patient’s sex and race are highly likely to affect the physician’s recommendation for a surgery (Schulman et al., 1999). Another study by Van Ryn and Burke (2000) found that physicians tend to rate blacks more negatively than whites. It should be noted however, that such bias is not a result of deliberate efforts, but is rather a “result of subconscious perceptions… Subconscious bias occurs when a patient’s membership in a target group automatically activates a cultural stereotype in the physician’s memory regardless of the level of prejudice the physician has” (Shulman et al., pp. 624-625). Access to health care and its cost for the African Americans community is another aspect which requires attention. Access to health care is defined as the ability of a person to receive health care services. Such ability is two-fold: on the one had it means availability of personnel and supplies and on the other hand it also implies ability to pay for those services (Segen, 2006). The notion of cost of health care can be subdivided into two separate notions: actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and health expenditures and fees, which is the amount charged, regardless of cost (Mondofacto, 1998). Relying on the above mentioned definitions we can identify barriers to health care both on the structural and system-wide levels. The biggest structural obstacle to health care is poverty. Rust et al. (2004) has found poverty to be a significant factor in the overall low rate of health care utilization among Blacks. Needless to say that people who live below the poverty line often lack means of communication and transportation to be able to meet their appointments. On the system level the biggest barrier to health care provision is lack of healthcare providers, especially in rural and poor urban areas. Hospital bureaucracy is also a contributor to overall patient dissatisfaction and is one of the factors discouraging health care seeking behaviors. Another example of a system-wide barrier to health care is lack of cultural competence of medical and health care personnel. Many African Americans do not have the same access to health care system as white people due to high cost of health care. Poverty rates among Blacks are higher than among white persons (DeNavas-Walt, Proctor & Lee, 2005). Poverty is a considerable factor because of patient inability to cover the cost of the health services received, or inability to purchase an insurance policy or make a co-payment. Statistical data show that health insurance coverage is significantly lower for the Black community as compared to the white one. Health insurance coverage reaches 89.7% for Whites as opposed to 80.7% for Blacks. Conversely, 10.3% of the white population is not insured as opposed to 19.3% of the Black population. Attempting to rectify this disparity, government has extended its insurance programs to the African American community, which reflects statistically as 23.8% of government insured Whites versus 33.4% of government insured Blacks (Bhandari, 2006). Among other factors which hinder access to health care for the African American community are income, geography, culture and previous personal experiences. For example, many blacks resent going to health care providers due to failure to comply with previously prescribed regimes, or having to wait for an appointment with the doctor or a general feeling of segregation or alienation (Spector, 2000). Statistical evidence confirms this trend, presenting a dramatic drop in the rates of utilization of medical services, doctor visits during the past 12 months and, resulting from this, frequency of prescribing medication (Bhandari, 2006). Finally, research focusing on interrelation of race and the likelihood of seeking medical assistance has established that despite the fact that African Americans are more likely to live near high-technology hospitals than Whites, they are not as likely to travel to that hospital for an appointment (Blustein & Weitzman, 1995). Besides accessibility and cost issues, part of the explanation why African Americans choose not to seek health care services, comes from the history of the Black population. For years, and this is especially true for elderly African Americans, the Black community grew in a segregated and an isolated health care and social services system. Consequently, a lengthy period of improper treatment and mostly careless attitude has contributed to the overall feeling of distrust towards the country’s health and medical care system. The infamous Tuskegee Syphilis Experiment has had a tremendous destructive impact on the system credibility. It was the longest non-clinical study in medical history (Jones, 1981). Lasting for 40 years, it involved 399 poor sharecroppers with syphilis. Participants of the study were promised that their disease would be treated, yet no one ever received treatment. Despite the fact that penicillin had become a standard treatment of syphilis by 1947, the information about it was being concealed from the public till the closure of the experiment in 1972. (CDC, n.d.). The experiment has left a trail of distrust towards the health care system. Resulting from it were myths that HIV/AIDS infection was a form of genocide of Blacks. These myths are especially supported among the uneducated representatives of the Black Community. Alpha Thomas, a health educator with the Dallas Urban League, stated: “So many African Americans people that I work with do not trust hospitals or any of the other community health care service providers because of the Tuskegee Experiment. It is like… if they did it, they will do it again” (p.43) (as cited in Thomas, 1991). Research has shown that lower level of health care among African Americans revolves around subjective as well as objective factors. Subjective factors include bias of health care and medical personnel, patient reluctance to attend hospitals because of not trusting the system, not being diagnosed or treated properly, long waiting times and hospital bureaucracy. Among subjective factors one could name poverty and lack of health care providers. Recommendations In view of the reasons leading to poorer health status of the Black community overall, various recommendations can be given in regards to improvements of the health care system. Recommendations part of this paper include the following courses of action: 1. Utilizing services of the health provider of the same race or, if the health care provider is of different race, minimizing biased thinking or patient treatment via education. 2. Educating patients on the importance of regular visits to health care providers. Good examples of education strategies include dissemination of printed matter (leaflets, newspapers, stands, flyers), audio as well as video materials (by means of radio, TV, banners etc), utilization the power of community. A good example of an education strategy is informing a patient about health care opportunities during health care sessions. 3. Re-establishing credibility of health care providers. This can be realized in a number of ways, the first and the most important is respectful treatment of patients. Using respectful titles “Mr” or “Mrs” is a good example of polite behavior. Part of establishing credibility is knowledge of the Tuskegee experiment and ability to answer patient questions in a competent and at the same understandable manner. The most comment response to questions concerning the experiment is ignoring questions about it. Needless to say this doesn’t facilitate understanding between patients and health care providers. 4. Facilitating conversations between a health care provider and a patient. This helps to establish rapport with the patient and will not only enhance patient experience, but will also facilitate a more effective health care process. 5. On a general system level the recommendations can be narrowed down to resolving problems of poverty and health insurance coverage. It is understandable, however, that both problems are long standing and are unlikely to be eliminated in the short run. For example, the problem of poverty appears to be an issue without a clear solution since. It has existed for decades and attempts to eliminate it have been relatively ineffective. The same holds for extending insurance policies to other strata of society. If the state assumes the role of “equalizer” and starts granting health insurance policies to those who don’t have then, then the remaining population will be at a disadvantage, not mentioning the increased tax pressure. Conclusion Poorer health status of African American population is result of various factors. While there is still a number of issues which need to be addressed at the global level (e.g. resolving the problem of poverty, health insurance coverage, education etc), there is a considerable number of factors which can be changed at a personal or institutional level. This paper has put emphasis on recommendations which can be implemented on a personal and institutional level and would thus lay foundation for structural changes in the health care system. Surprisingly, results of this study show that reasons for not seeking health care are a result of subjective, rather than objective factors. It is also worth noting that there are other minorities within the US, including Hispanics and Asians, who are in poorer conditions when it comes to health care provision as compared to the African American community. However in case with other minorities the bias factor is less prominent as other factors come into play (for example, not understanding the language). Conversely, the Black part of the US community seems to be at a poorer state of health largely due to a significant impact of bias and prejudice. Therefore most effort should be undertaken to minimize and eliminate the influence of such subjective factors, which is likely to improve the overall health status of the African Americans. References Anderson, L., Fullilove, M., Scrimshaw, S., Fielding, J., Normand, J., Zaza, S., Wright-DeAguero, L., & Higgins, D. (1999). A Framework for Evidenced-Based Reviews of Interventions for Supportive Social Environments. Annals of the New York Academy of Sciences, 896(1), 487-489. Bhandari (2006). Health Status, Health Insurance, and Health Services Utilization: 2001. US Census Berau. Retrieved from www.census.gov Blustein, J. & Weitzman, B. C. (1995). Access to Hospitals with High-Technology Cardiac Services: How is Race Important. American Journal of Public Health, 85(3), 345-351. CDC (2008). Summary Health Statistics for U.S. Adults: National Health Interview Survey. Vital and Health Statistics, 242(10), 24-57. CDC (2007). Cases of HIV Infection and AIDS in the United States and Dependent Areas, HIV/AIDS Surveillance Report, Volume 19. CDC (n.d.) U.S. Public Health Service Syphilis Study at Tuskegee. Retrieved from www.cdc.gov DeNavas-Walt, C., Proctor, B.D. & Lee, C. H. (2005). Income, Poverty, and Health Insurance Coverage in the US, 2004. Current population reports P60-229. Washington, DC: US Government Printing Office, 2005. Flaskerud, J. H. & Winslow, B. J. (1998). Conceptualizing Vulnerable Populations Health-Related research. Nursing Research, 47(2), 69-78. Flaskerud, J. H., Lesser, J., Dixon, E., Anderson, N., Conde, F., Kim, S., Koniak-Griffin, D., Strehlow, A., Tullman, D., & Verzemnieks, I. (2002). Health Disparities among Vulnerable Populations: Evolution of Knowledge over Five Decades in Nursing Research Publications. Nursing Research, 51(2), 74-85. Health Care Cost (n.d.) In Online Medical Dictionary. Retrieved from http://www.mondofacto.com Jimbo, M. (2004). Family Medicine: its Core Principles and Impact on Patient Care and Medical Education in the United States”. The Keio Journal of Medicine, 53, 69-73. Jones, J. (1981). Bad Blood: The Tuskegee Syphilis Experiment – A Tragedy of Race and Medicine. New York, NY: The Free Press. Rust, G., Fryer, G.E., Phillips, R.L., et al. (2004) Modifiable Determinants of Healthcare Utilization Within the African-American Population. Journal of National Medical Association, 96, 1169 –1177. Schulman, K. A., Berlin, J. A., Harless, W., Kerner, J. F., Sistrunk, S., Gersh, B. J., et al. (1999). The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization. The New England Journal of Medicine, 340(8), 618-625. Segen, J. (2006). Access to health care. In Concise Dictionary of Modern Medicine (p. 421). New York, NY: McGraw-Hill. Spector, R. E. (2000). Cultural Diversity in Health and Illness. Upper Saddle River, NJ: Prentice Hall Health. Thomas, S. (1991). The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community. American Journal of Public Health, 81(11), 1498-1505 Van Ryn, M., & Burke, J., (2000). The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients. Social Sciences & Medicines, 50, 813– 828. Read More

y health care should be provided on a fair basis, irrespectively of color, age, income, sex or language. This is an important aspect of medical practice because evidence shows that practitioners tend to have biased attitude when it comes to diagnosing and observing black patients. For example, a study, which focused on interrelation of sex, race and physicians’ recommendation for cardiac catheterization, has established that patient’s sex and race are highly likely to affect the physician’s recommendation for a surgery (Schulman et al., 1999). Another study by Van Ryn and Burke (2000) found that physicians tend to rate blacks more negatively than whites.

It should be noted however, that such bias is not a result of deliberate efforts, but is rather a “result of subconscious perceptions… Subconscious bias occurs when a patient’s membership in a target group automatically activates a cultural stereotype in the physician’s memory regardless of the level of prejudice the physician has” (Shulman et al., pp. 624-625). Access to health care and its cost for the African Americans community is another aspect which requires attention. Access to health care is defined as the ability of a person to receive health care services.

Such ability is two-fold: on the one had it means availability of personnel and supplies and on the other hand it also implies ability to pay for those services (Segen, 2006). The notion of cost of health care can be subdivided into two separate notions: actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and health expenditures and fees, which is the amount charged, regardless of cost (Mondofacto, 1998). Relying on the above mentioned definitions we can identify barriers to health care both on the structural and system-wide levels.

The biggest structural obstacle to health care is poverty. Rust et al. (2004) has found poverty to be a significant factor in the overall low rate of health care utilization among Blacks. Needless to say that people who live below the poverty line often lack means of communication and transportation to be able to meet their appointments. On the system level the biggest barrier to health care provision is lack of healthcare providers, especially in rural and poor urban areas. Hospital bureaucracy is also a contributor to overall patient dissatisfaction and is one of the factors discouraging health care seeking behaviors.

Another example of a system-wide barrier to health care is lack of cultural competence of medical and health care personnel. Many African Americans do not have the same access to health care system as white people due to high cost of health care. Poverty rates among Blacks are higher than among white persons (DeNavas-Walt, Proctor & Lee, 2005). Poverty is a considerable factor because of patient inability to cover the cost of the health services received, or inability to purchase an insurance policy or make a co-payment.

Statistical data show that health insurance coverage is significantly lower for the Black community as compared to the white one. Health insurance coverage reaches 89.7% for Whites as opposed to 80.7% for Blacks. Conversely, 10.3% of the white population is not insured as opposed to 19.3% of the Black population. Attempting to rectify this disparity, government has extended its insurance programs to the African American community, which reflects statistically as 23.8% of government insured Whites versus 33.

4% of government insured Blacks (Bhandari, 2006). Among other factors which hinder access to health care for the African American community are income, geography, culture and previous personal experiences. For example, many blacks resent going to health care providers due to failure to comply with previously prescribed regimes, or having to wait for an appointment with the doctor or a general feeling of segregation or alienation (Spector, 2000). Statistical evidence confirms this trend, presenting a dramatic drop in the rates of utilization of medical services, doctor visits during the past 12 months and, resulting from this, frequency of prescribing medication (Bhandari, 2006).

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