The COVID-19 pandemic has made it more apparent than ever that significant health disparities exist in America. Health outcomes have long been known to be poorer in communities of color and this current medical crisis has served to exacerbate and expose that systemic imbalance and inequality. Depending on one’s race in America, a person can have quite different experiences and opportunities when it comes to the way they receive and have access to healthcare as well as the quality of care received.
What are Health Disparities?
The Kaiser Family Foundation defines health disparities as “a higher burden of illness, injury, disability, or mortality experienced by one group relative to another.” Health disparities can be due to a number of factors. A particular race or sex may be more genetically predisposed to certain diseases. For instance, sickle-cell disease is more prevalent in people of African descent and Tay-sachs disease is more common amongst people with eastern European ancestry.
Other health disparities exist because of a variety of social factors such as where and how people live, work and play. The diets of different cultures or regions can be more or less likely to lead to illness. Typical occupations of one group versus another (blue collar vs white collar jobs for instance) can influence the likelihood of being injured on the job or exposed to hazardous materials. Some neighborhoods are more likely to expose their residents to environmental pollutants, have less access to healthcare, have less access to outdoor spaces for exercise and recreation and have less access to healthy, quality food.
Why Do Racial Health Disparities Exist?
Statistics have consistently shown that black Americans have shorter life spans and suffer at a greater rate from serious diseases like heart disease, high blood pressure, infectious diseases and diabetes than their white counterparts of the same age. Why do these disparities exist?
Lack of health insurance. Black workers are more likely than white workers to be without health insurance. This may be due to having a job that does not provide insurance, or simply not being able to afford the premiums. Being uninsured leads many to avoid seeking out healthcare until it becomes a critical situation. At that point, they are likely to end up in the emergency room, which leads to much poorer outcomes than if they had been seen earlier for preventive care.
Unequal care. Black neighborhoods frequently have fewer healthcare providers available. That means longer wait times and more difficulty getting to a provider’s office. When blacks do go to the doctor or hospital to seek care, studies have shown that due to conscious or subconscious bias, they may not be listened to in the same way or receive the same quality of care that patients of other races do.
More stressful and dangerous jobs. One study found that in Marion County, Indiana, blacks were twice as likely as whites to contract coronavirus. Much of this increased transmission can be explained by a couple of job statistics. 1. Black workers have jobs that are less likely to have a work-from-home option during the pandemic; and 2. Jobs held by black workers are more likely to be part of the front-line “essential” workforce. The coronavirus has provided just one particularly striking example of how influential one’s occupation can be on health, but stressful and physical jobs are always a disparity issue.
Community disinvestment. Communities of color, particularly black communities, have had a history of years of disinvestment. Because they don’t have the same economic and political influence that more affluent white communities tend to have, they have often been unable to keep air and water polluting industries out of their neighborhoods. They have been discriminated against by banks when trying to obtain housing and business loans, sending their communities into a downward spiral of disinvestment and decay. Most groceries choose to operate in higher-income localities, leaving black neighborhoods with a “food desert” of mostly unhealthy fast food options and convenience stores.
How Can Health Disparities Be Addressed?
Educate healthcare professionals. Many doctors, nurses and other associated care providers are not aware of how bias may be affecting their demeanor, attitudes or quality of care. It can be a sensitive issue for professionals in the industry who believe they always have every patient’s best interests at heart to acknowledge their potential blind spots. Communication workshops and sensitivity training designed around caring for diverse audiences should be embraced by hospitals and medical schools.
Recruit more blacks to the healthcare field. The medical profession as a whole needs to do a better job of providing outreach to black students in the form of internships and mentoring, to encourage them to join the medical profession at all levels and in a variety of capacities. The industry particularly needs more black leadership, doctors and counselors.
Improved access. There need to be more community health facilities located in black neighborhoods. Particularly in neighborhoods where there are a large number of people without cars, everyone ideally should be within a few miles of a healthcare facility. Medicaid needs to be expanded to cover more of the population living just above the poverty line and not currently eligible for Medicaid, but unable to afford private insurance. The practice of assigning nurses and physician assistants to patients for follow-up and preventive care needs to be expanded. This will keep many of the most vulnerable from falling through the cracks.
Fixing healthcare disparities is a long-term initiative that will require many years of reeducation and rethinking to address. It will take the will and commitment of the highest levels of government on down to every hospital administrator, doctor, nurse, receptionist and everyone in between.
References:
https://uwci.org/understanding-roots-of-racism-part-1-health-recap-and-resources/
