The Health Of Our Care – “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane”

Martin Luther King, jr. spoke before the 1966 National Convention of the Medical Committee for Human Rights held in Chicago. In that speech he said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

In 1966, the difference in life expectancy for blacks was about 7 years shorter than for whites. The difference between black men and white women was 14 years. (from the 2006 report to Congress on Life Expectancy) Those are national averages. I have read that life expectancy for blacks in the South in 1966 was 17 years less than whites living in the South. (I have not been able to check that statistic, however, I have checked all the other statistics by that writer, and they have all been correct. I assume, therefore, that this figure is also accurate.)

According to the Census Bureau’s statistics, for people born in 2007, blacks in the U.S. will live 5 years less than whites, on average. (from the Census Bureau’s Statistical Abstract of the United States, 2011)

So, I guess we’ve made some progress. But I would have hoped that in 45 years we would have made more progress than just gaining 2 years of health equality.

There are a myriad of causes: income disparity, social and cultural influences, genetics. But there can be no doubt that disparity in healthcare still plays a huge role.

In 2004, the Department of Health and Human Resources reported that the vast majority (48%) of uninsured in the U.S. were whites. However, although blacks make up about 12% of the population, they represent 15% of the uninsured. Hispanics are even more disproportionally represented among the uninsured. In 2004, Hispanics made up 14% of the population, but were 30% of the uninsured. By 2006, those numbers had risen to 20% uninsured for blacks, and 34% for people of Hispanic origin.

Unfortunately, lack of insurance is just part of the problem. Racial discrepancies also exist in the care that is given. Numerous studies have found differences in care even when insurance status and income is accounted for. In the January issue of Obesity, researchers report that blacks are far less likely to receive weight reduction and exercise counseling from their doctors than white patients. Researchers from MD Anderson found that while 74% of white women diagnosed with breast cancer received radiation after a lumpectomy, just 65% of black women were treated with radiation. (presented at the 2008 ASCO Breast Cancer Symposium) A study at Columbia University found racial disparities for patients with hepatocellular carcinoma. Blacks were much less likely to receive liver transplants than white patients. (from the journal Cancer) And in another study published in Cancer, researchers from Dana Farber found that for women diagnosed with breast cancer, black women were 9% less likely than white women to have a mastectomy or lumpectomy, 10% less likely to receive hormonal treatments, and 13% less likely to be given chemotherapy. Hispanic women were less likely to receive hormonal treatments. These disparities in treatment persisted even after accounting for differences in insurance and socio-economic levels.

These are just a few of the studies documenting the ongoing racial disparity in healthcare in this country. Social and economic differences affect insurance and access to good care. There are obviously deeply ingrained perceptions and misperceptions among some doctors and other healthcare workers. And there are social and cultural differences at work among both doctors and patients.

Yes, there have been improvements since the 1960s. Blacks no longer have to enter the hospital through the back door and, if they are treated at all, be treated by a doctor who cannot have privileges at that hospital because he is not white.

But we can – we must – do better.

We must make policy choices that are fair to all, regardless of race. We must do more to insure that doctors treat patients based on their illness or symptoms, rather than on preconceived ideas about what a white person or a black person should be told.

And we, as the people who utilize the healthcare system, must do better for ourselves. We must make more effort to overcome our discomfort – whether cultural, familial, or simply personal – over talking about our health and sensitive issues. It is our responsibility to seek care when we need it. It is also our responsibility to make healthier choices for ourselves. And it is our responsibility to demand from our leaders equal access to equal healthcare.

We can – we must – do better. “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”


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