People often profess that in recent years we have become a color-blind society. Three health care studies reveal we have not. Those that are honest with themselves know they are not blind to color.
When any of us walk into a room, we observe color. We see reds, browns, blacks, yellows, and whites. When observing other individuals, we notice what doctors detect; we see their largest organ, the skin. People, physicians included, notice darkness or light; they see hues. A plethora of color enters the eye and when it does, there is an emotional response. Animals react to shades and tints; humans do too.
People, health care professionals, also react to sound. They listen to a voice; the tone, the tenor, and the timbre; all are invasive. Conclusions are drawn. Assumptions are made. People judge. They presume to know the educational background, socio-economic status, and professional eminence of those that they encounter. Intellect is also thought to be implicit. However, it is not.
America wants to think of itself as a melting pot, as a nation that does not discriminate against its people. America is not a simple stew; people are not created or treated equally, medically, or otherwise. Evidence demonstrates there is much bigotry, innocuous as it may be. Even those that profess to “do no harm,” do much to hurt those they think less of.
On Thursday, August 18, 2005, the New England Journal of Medicine released the results of three topical studies. These reports showed that Black citizens receive far less medical care than their White counterparts do. The quality of the care they receive is also lower. Accomplished Black citizens are often treated as less than, merely because of their color. Medical professionals admittedly make erroneous assumptions; appearances unwittingly influence much in medicine.
The good news, if there is any, is since the 1990s there has been marginal improvement. Black citizenry is more likely to receive less costly treatments, such as mammograms and diabetes testing, than they did in the past. In 2005, some of the more sophisticated drugs prescribed for heart ailments are given to Blacks. This too is novel.
Though there are improvements in the health care afforded to African-Americans, the disparity is still vast. This inequality has been evident since the beginning of time; that fact is distressing. According to the findings of these three surveys, Black Americans are less likely to receive heart or back surgeries. Candidates for joint replacement are often light in color.
The three studies released were quite comprehensive; circumstances were not artificial. Researchers looked at more than a million patient records. It needs to be noted that these studies assessed Blacks and Whites that have, essentially, the same access to insurance coverage and health care.
Most of the patients studied had Medicare coverage. For the purposes of this study, Medicare coverage is a plus; Medicare consistently tracks racial groups allowing for a more accurate assessment.
One of the studies revealed white men are treated well, better than all others. White men are the most likely recipients of surgical care. Caucasians as a group fare well. Whites were the most likely to receive any of the nine most sophisticated surgeries. Coronary bypass grafts, angioplasties, or total knee replacements are common among the privileged. Less “advantaged” white people also receive these treatments in greater numbers than Negroes. These procedures are rarely recommended for black men or women. Expensive operations occur among the elite. In this case, “elites” are not persons of wealth; they are those that are white.
A second study found, after a heart attack, black women receive the less-than-adequate care. These women are not given drugs to dissolve blockages in blood vessels. Beta-blocker drugs and open- heart surgery are not prescribed to women of darker color. These “privileges” are reserved for the fortunate few, those whose skin tone is other than Black.
This second study revealed that, on average, 20 percent of black women had coronary bypass grafts Approximately 27 percent of white men were given the same. White women were attended to 23 percent of the time, and the treatment was prescribed to black men 21 percent of the time. Evidence shows that being a black woman in need, indeed, can be deadly. [Citation from earlier review.]
There was only one study offering an optimistic trend. This investigation examined Medicare managed-care plans; it assessed the treatment prescribed and the outcomes. In this survey, researchers discovered that the disparities between racial groups decreased significantly when routine tests were considered. Patients receiving mammograms, eye exams, cholesterol, or blood sugar tests, were treated more fairly. Nevertheless, gaps remained. In two cases, they got worse.
Though Blacks and Whites are each likely to have their blood-sugar and cholesterol checked, Black people are far less likely to have their levels treated with concern. Doctors do not work with the same intent when dealing with African-American patients. Negroes are less likely to have their blood levels under control.
Boston internist, and one of the authors of this study, Dr. Trivedi said, “It’s relatively less complicated to order the right test or prescribe the right medication than it is to follow a patient to see if you got the right results.” Trivedi expressed his concern stating, health agencies, individual hospitals, and medical associations need to track racial disparities among their patients. He expanded his thought by saying; these institutions need to collect specific racial data. “That information could lead to efforts that are far more effective.” It could. However, based on history, one wonders, will the information be collected, and if it is, will it be considered. Currently, the level of care is reflective of the level of concern.
In a recent, interview on the News Hour, Dr. Ashish Jha of the Harvard School of Public Health, the author of another study published in the New England Journal, discussed this disproportionate inequity. He said, “We have known for over 20 years that blacks and whites receive very different health care within our health care system.” He asserted that, “in the late ’80s, early ’90s there were substantial efforts both by the federal government as well as by state governments to try to reduce these disparities.” Yet, he concluded, “When you take these three studies together . . . what you see is that the gaps in care between whites and blacks persist. In many areas they’re getting worse.” This news is disheartening.
Dr. Jha reflected, “in a few small areas we see glimmers of hope, but overall blacks and whites continue to receive very different health care in this country.” This is no surprise to the Black population; it is not a surprise to this author either. Too often, I have spoken with Whites that prefer to believe that we have a colorblind society; I know that this is mere fancy. Others know this too.
Ponder the words of Dr. David Satcher. He is the former U.S. Surgeon General, now interim President of the Morehouse School of Medicine in Atlanta; he is an African-American. Satcher sadly stated, “My reaction is one of great disappointment; the health care system, which should be a major part of the solution to health disparities in this country, is still a major part of the problem.” Satcher is not without hope, he offers, “We shouldn’t give the impression that it’s hopeless, we should redouble our efforts.”
Dr. Satcher expresses his agreement with study author Dr. Jha, stating these findings are “a major call to action.” The former Surgeon General said, “the area of bias and discrimination; [it] is a part of our history, a part of our lives. And while it’s very unfortunate to find that it affects the health care profession also, we do know that this is one of the areas of concern.”
During this same interview, Dr. Jha chimed in, “You know, I think too many doctors still are not aware of the fact that we treat whites and blacks differently in our health care system. So there has to be a concerted effort to do a much better job of educating physicians about the quality of care they provide.”
Dr. Satcher added, “Yeah, in fact there were studies discussed in the Institute of Medicine report where there was very good evidence the fact that white patients and black patients were looked at differently by some white physicians, when compared to others.” He continued, “It has been clearly documented that there are differences in the way physicians respond to patients based on race in many cases.”
Satcher bemoaned that these differences are seen in other parts of our society. He expressed his dissatisfaction, saying, “It is most disappointing when you see it in medicine. It is most unacceptable, and I think we should make that point very clear that it’s unacceptable.”
Would that not be nice; however, how can we mandate perception?
People see what they wish to see, believe what they think that they know. Humans reject the idea that they are emotional. They rationalize; affirming what they wish to think is true. Individuals think that they know the facts while ignoring the same.
Daily life demonstrates that America is not a melting pot. Citizens in this country are not colorblind! Evidence shows there is prejudgment, even among physicians.
For instance, many emergency room physicians act as though black patients are coming into the hospital merely trying to get drugs. That these citizens may be experiencing a sickle cell crisis is not considered.
Cheryl Killion, a registered nurse and director of Hampton University’s Health Disparities Reduction Program discussed this dilemma and other findings. She said racial health-care disparities have been centuries in the making, “Some of the gaps are as wide as they were post-slavery.” Ms. Killion said, “The problems are huge. It’s probably too early to say definitively if the programs are working or not, but these studies are a good starting point.”
In evaluating the situation, Black trauma surgeon, Dr. David Gore, also serving the Hampton population, declared a need for Black health-care providers. He avowed that without physicians of color to treat those persons of similar racial and ethnic backgrounds the gaps are likely to persist, despite all our best efforts. Dr. Gore acknowledged, “People of the same culture seem better able to explain complex health information to people of the same culture,” he said. “I don’t think we have the manpower to solve the problem right now.”
“Segregation, discrimination and racism are some of the core factors that permeate the health [care]system,” said Ms. Killion. “But because Americans hold the profession in such high regard, believing that doctors will do no harm, it’s hard to accept that these factors still affect who gets what kind of care.” Yet, it does.
Doctors are not demigods; they are people. Physicians see colors and react to these emotionally, just as all of society does. I believe sensitivity and awareness are the solution; denial has not eliminated the centuries’ long dilemma. We, as individuals and as a community, must acknowledge that there are people of all colors and they need to be attended to equally.
For those that prefer to puruse the references directly . . .
- Race Gap Persists In Health Care, Three Studies Say Blacks Get Fewer Tests, Less Therapy and Medicine, By Rob Stein, Washington Post
- Blacks still trail whites in health care, The Washington Post and Chicago Tribune
- Blacks still lag whites, Knight Ridder Tribune Business News, Joy Buchanan
- New Study Shows African-American Seniors Receive Fewer Life-Saving Surgeries than Whites, Harvard School of Public Health, Wednesday, August 17, 2005
- Black Medicare Bias Found by Researchers, By William J. Cromie. HARVARD GAZETTE ARCHIVES.
- Separate?”Perhaps, Unequal? Physicians Treating Black and White Medicare Patients Center for Studying Health System Changes
- Study Suggests Racial Discrimination Harms Health, University of California, Irvine
- Public Health issues report on racial and ethnic discrimination in health care
- African-Americans receive less aggressive heart attack treatment, By Jim Steele. Wake Forest University Baptist Medical Center.
- African Americans Half as Likely to Receive Surgery for Esophageal Cancer American Society of Clinical Oncology
- Understanding and Addressing Racial Disparities in Health Care, By David R. Williams, Ph.D., M.P.H., and Toni D. Rucker, Ph.D.. HEALTH CARE FINANCING REVIEW/Summer 2000/Volume 21, Number 4.