The Health Challenges of African-Americans - Term Paper Example

An Outline of the Health Challenges of African-Americans and a Discussion of the Approaches to these Challenges Inequality in health is a feature of the United States healthcare system. Although this country is the wealthiest, most powerful and arguably the most developed country in the world, access to healthcare is unevenly distributed. Accordingly, there are many repercussions of this unequal access and health ramifications of persistent inequality in the United States are most evident among minority groups. African-Americans in particular face a variety of health challenges in the United States and this essay will address some of the most important health issues facing African-Americans today as well as discuss and critique the current approaches to these challenges. Inequality in health status has plagued the minority population in the United States for more than fifty years. Despite rampant inequalities, there is no single root cause for the disparities. While class differences play a major role in the delivery of health care in the United States, race is also an important issue which needs to be properly explored. Seeking to address the particular health challenges facing African-Americans living in the most prosperous country on the planet, this essay will explore the particular health issues afflicting African-Americans and look at the approaches presently in place to solve the question of persistent health inequality in America today. Introduction In the United States, health insurance coverage ensures that there is financial means by which basic health care can be accessed (Paulin and Dietz, 1995). Individual comprehensive health insurance plans depend on an individuals’ age, level of employment, residency, and race/ethnicity. Studies have shown that African-Americans do not receive the same care even if they have the same government funded insurance as their white counterparts, such as Medicare. For example, in a study conducted by the Brown and Harvard Medical Schools, researchers found that there were significant racial disparities within Medicare plans. In addition, they found that the quality of care was a factor concerning race and ethnicity among Medicare beneficiaries. This suggests that in addition to access to care, quality of care is different among ethnic groups. To this extent, racial difference in coverage may influence health disparities and inequities within the healthcare system (Williams J., 2005). Medicare is a federal government funded insurance program for disabled young adults, persons above the age of 65, and those with permanent disabilities who become eligible for Social Security. A racial difference in coverage among Medicare beneficiaries has also been found to influence difference in supplemental care. In a study by the Kaiser Family Foundation, it was discovered that 18% of African-Americans, 11% of Hispanic/Latinos and 11% of white Medicare beneficiaries lacked supplemental coverage that was necessary for additional services that were not provided by Medicare (Paulin and Dietz, 1995; LaVeist et al., 2000). In a study by the Kaiser Family Foundation, researcher found that a racial divide in the coverage of insurance among Americans between the ages of 55 and 64 was prevalent. Data collected in 2006 illustrated that 23% of Native Americans and 19% of African Americans between the ages of 55 and 64 were uninsured. From the same study, it was found that 10% of the white population in the same age group was also not insured. Because the majority of the uninsured in this age group are not able to pay for their medical coverage when they qualify for Medicare at the age of 65, this disparity will result in an increase of Medicare costs (Garcia, 2007). Medicaid is a national state-run health program that is designed to provide health care for low-income children, working families, and people with disabilities. In other words, it provides health care insurance to those who would otherwise likely be uninsured. Medicaid can be an important option for racial and ethnic minorities who are disproportionately more likely than whites to rely on such a program. Without this program, the number of uninsured people who belong to racial and ethnic minority groups would certainly be higher. A number of studies have documented that factors such as discrimination, bias, language barriers, and preferences about health care also contributes to racial and ethnic health disparities. However, it is important to note that no single factor contributes more to health disparities in health and healthcare than the issue of access to health care (Smedley et al, 2002). In 2007, the Kaiser Family Foundation set out to analyze multiple research findings from various independent studies which were conducted in the U.S. on health insurance and race. Researchers found that health insurance was the largest independent factor that resulted in racial disparities. It accounted for 42% of the disparity in terms of access to healthcare that occurred between African-Americans and whites and also resulted in about 20% of the disparity that occurs between Hispanics and whites (Kaiser Family Foundation, 2007). Health Disparities among African-Americans in the United States Today, 1 in 3 Americans identify themselves as Hispanic, African-American, Native American, Asian America or Pacific Islander. It is predicted that by the year 2050, more than half of the American population will be identified as minorities. Over the last fifty years, the United States has made efforts to ensure the improvement of health and health care access for all Americans. In the early 1960s, the United States established policies and programs aimed at expanding the access of healthcare to all citizens. These polices and programs did result in expanding access to health care for low-income families, the disabled and the poor, through Medicaid, Medicare and the 1964 Civil Rights Act. However, disparities in health and healthcare continue to exist among minority populations in the United States. For a country which came into existence based on the premise of equality for all, the United States seems, from a health-perspective, to have ignored one of the very principals under which it was founded (Dunlop, et al., 2003; Gans, 1995). In 1985, the United States Department of Health and Human Services released a landmark report on racial health disparities in the United States entitled, “Secretary’s Task Force Report on Black and Minority Health.” This report revealed significant gaps in the health status among Americans of diverse racial and ethnic groups. This was the first national report to document health disparities between majority and minority populations in the United States. Because of this landmark report, the State of Ohio established the first Office of Minority Health, charged with addressing the plethora of minority health issues in America today. Currently, there are 43 State Offices of Minority Health and Multicultural Health across the country. Although these offices exist throughout the United States, health disparities among minority populations continue to persist (DHSS Report of the Secretarys Task Force on Black and Minority Health, 1986). Accordingly, a number of studies have shown that minority populations have higher mortality rates and diseases such as cancer, HIV/AIDS, and cardiovascular disorders when compared to their white counterparts. Data collected from independent studies over the years has concluded that African-Americans have the worst health outcomes when compared to other minority populations in America. For example, African-Americans have the highest cancer incidences rates and the survival rate for African-American females who suffer from breast cancer is half that of white females. Such disparities are often ignored by the U.S. healthcare system because the system is inefficient in addressing the causal factors which result in health disparities. Not addressing the factors which lead to health disparities further propagates the bridge between the minority and the majority in relation to health outcomes (Fiscella and Williams, 2004; Whittle, et al., 1997). Over the past few decades, the United States has seen extraordinary advances in medicine and medical technology. This has resulted in improved health and healthcare services for U.S. citizens as a collective, thereby, increasing life expectancy, the improvement of health outcomes, and a better overall quality of life. However, certain groups have not benefited equally from these advances. In other words, they have yet to experience equity in health, health care services, and an increase in life expectancy. For example, disease, disability, and death have disproportionately affected racial and ethnic minority populations throughout the U.S. This phenomenon is defined as health disparities, which are also known as health inequalities. Simply stated, health disparities are “population-specific differences in the presence of disease, health outcomes, or access to health care”. This includes differences in access to as well as the quality of health and health care services across racial, ethnic, gender, age, and socioeconomic groups. Other factors include differences in preventive and diagnostic services. Pursuing health equity then is referred to as the absence of health disparities or differences in health care, health care services and health outcomes among specific racial and ethnic groups (Families USA, 2008; DHSS Healthy People 2010, 2000; Brennan, 2008). It has been well documented that racial and ethnic biases in health care services exist. In one study, 17 percent of the Hispanic population and 16 percent of the African-Americans population reported having fair or poor health, while 10 percent of the white population reported the same. In another study, when compared to white children, African-American children were less likely to have access to quality health care services. Moreover, according to the United States Department of Health and Human Services, infant death rates among Native Americans and Alaska Natives have been reported to be higher when compared to white Americans. Consequently, our public health system does not adequately address the health care needs of minority populations, which in turn leads to health disparities and inequities (DHSS, National Healthcare Disparities Report, 2005). A number of studies have shown that lower income individuals have less access to healthcare when compared to that of middle or higher income individuals. Moreover, studies have shown that economic disparities can also be found in healthcare insurance coverage. In addition to the level of access and health insurance coverage, age, ethnicity, the level of an individuals education and health care provider bias are factors that result in health disparities (Doty and Holmgren, 2004; Fiscella and Williams, 2004; LaVeist and Carroll 2002). In one study, it was found that 17% of the Hispanic population and 16% of the African-American population reported having fair or poor health, while only 10% of the white population reported the same findings. In another study, in which the focus was assessing healthcare in children, researchers discovered that when compared to white children, African-American children were less likely to have access to quality healthcare services. Further, when Native American infants were compared to white American infants and Alaskan Native infants, it was concluded that white American infants had the lowest death rates, compared to these two indigenous groups (Ayanian et al 1995). In another study which focused on assessing health disparities, researchers concluded that despite improvement in the quality of care, blacks fared worse than whites when it came to controlling blood pressure, blood sugar and cholesterol levels. In another study, 430,000 patients from 151 healthcare plans were analyzed. This study concluded that disparities existed in the kind of healthcare that the minority population received. This included both high and low quality Medicare plans. This suggests that blacks fare worse from a health perspective because they receive care from lower quality healthcare providers (Maynard et al, 1986). Cancer continues to be one of the most persistent diseases in the American population. Due to this, extensive efforts have been put into place to ensure that patients receive the best healthcare available. It is however devastating to see that these efforts have not crossed racial lines and racial disparities with respect to cancer treatment continue to reflect health disparities for minority populations. According to a study that was conducted between 1992 and 2002, the U.S. black population has continued to receive inferior cancer treatment compared to that of whites with the same government health insurance policy. The fact that these inequalities have remained at the same level for over ten years illustrates persistent disparities and inequities in all areas of the medical field. However, Aetna Insurance has managed to address these issues by radicalizing the entire healthcare system in order to tailor solutions specifically to address health disparities (Garcia, 2003; Business Wire, 2005). In another study, the American Journal of Preventive Medicine undertook a substantial quantitative analysis of the infant mortality rates between black and white infants and found that a disparity in this important social indicator does in fact exist. Accordingly, this respected journal found that the black-white infant mortality ratio has persisted for decades and has even increased in recent times. In 1960, the black-white infant mortality ratio stood a 2.0, but twenty years later this figure had risen to 2.4. Why such a disparity? What are the causes of such dramatic differences in the likelihood that a newborn black child would not live to see his or her first birthday in comparison to a white child? This study determined that while a variety of factors can account for this disparity, low birth weight remains the most prominent cause of a higher infant mortality rate amongst black babies. In fact, black babies in America have a 300% greater likelihood of being born with a low birthrate relative to their white counterparts. The US Center for Disease Control and Prevention found a variety of socio-economic causes for the phenomenon of low birth weight, including poverty, poor nutrition, a lack of knowledge about pregnancy and the challenges associated with it, and access to proper medical facilities. The disparity in black-white successful birth ratios in America thus can be attributed to social forces and socio-economic differences amongst black and white Americans (Carmichal and Iyasu 1997; Kogan 1998) Studies have also shown that racial disparities in the health system may occur as a result of inherited biological make up. This suggests that the predisposition to certain disease is then responsible for some of the trends we observe in today’s U.S. health systems. This has been the catalyst for research on generic susceptibility to various diseases such as hypertension and diabetes, which are two to three times more prevalent in African-Americans than among whites. However, a study conducted by LaVeist found that there was no basis to this theory. A West African population was assessed for predisposition of certain diseases. It was found that they experienced a lower predisposition to these diseases when compared to their American counterparts. Therefore, if genetics were truly to blame, the lower prevalence rate would not have been observed in the West African population (Wallerstein, 2003; LaVeist et al., 2000). Approaches to Addressing the Health Challenges of African-Americans There has been growing interest in racial and ethnic disparities and the utilization of preventive health services and medical procedures. Since the Healthy People 2010 Initiative, there have been a number of attempts to develop interventions that decrease the occurrences of health disparities and health inequities in healthcare. These interventions have included cultural competency programs, screenings, and community-based outreach for minority populations, as well as programs to enhance patient-provider communications. Most of these programs have failed to include a needs assessment component, although this is typically the first step in the development of effective interventions, because it provides a description of the problem and its origins (Krien, et al., 2002). In a 1999 landmark study entitled Race, Ethnicity and Medical Care: A Survey of Public Perceptions and Experiences, conducted by the Kaiser Family Foundation, researchers assessed the publics’ perception about racial and ethnic biases in the U.S. healthcare system. Accordingly, this was the first national research study to do so. In a follow up study, researchers sought to address various health disparities that occur as a result of socioeconomic inequities (Kaiser Foundation, 2007). The aim of these studies was an attempt to understand the differences that occur in the health system by virtue of race (Kaiser Family Foundation, 1999; Bluestein, et al., 2000). The Federal Healthy People 2000 Initiative, which was led by the U.S. Department of Health and Human Services, set health improvement goals for the United States. This included goals to eliminate health disparities among minority populations. These disparities include differences that occur by gender, race/ ethnicity, education level, income level, geographic location, and disability. Health disparities that occur as a result of disabilities have been widely documented. Disparities that occur as a result of differences in gender, education level, income level, geographic location, sexual orientation, race/ethnicity, have also been widely documented. However, very few of these studies have examined the impact of these cumulative effects because of multiple factors (Krein, et al., 2002). The Healthy People 2010 Initiative has been instrumental in increasing awareness about health disparities and inequities in the health community. Consequently, various attempts have been made to develop interventions that are designed to decrease the occurrence of health disparities and inequalities in health and healthcare. These interventions have included cultural competency initiatives, health literacy programs designed to enhance patient-provider communications, and population specific outreach activities. However, most of the programs implemented have failed, largely because of poor needs assessments (Fiscelle, et al., 2004). Concluding remarks The United States has the most advanced medical care in the world. However, medical care in the U.S. is very expensive and unevenly distributed. While personal bias and racism can influence health inequities, research has shown that societal and institutional racism has also accounted for some of these disparities (Maynard et al., 1986). Individuals who work in the health care system who have prejudices towards certain races contribute to some of the racial disparities that occur in the health care delivery system. Although this is significant, more often, institutions, government, and insurance companies are the root cause of health inequities because of ethnicity and race (Baker et al 1996). Moreover, individual factors such as social economic status can determine the health care options that are available to an individual (Bonilla-Silva, 1997). Poverty is prevalent among African-Americans, Hispanics, and Native Americans in the United States. Life expectancy is distinctly shorter among these minority groups. In fact, there is a gap of more than five years in the life expectancies between the African-American population and the white American population. Many illnesses and disease are likely to be more prevalent further down the social ladder in all societies. Poor or low-income groups are at twice the risk of experiencing a serious illness as well as premature deaths when compared to the upper strata group. These findings are not restricted to the poor population, but tend to cut across the social gradient in health and can even affect the middle class. If legislation and policy formulation does not successful address these inequities, it is inevitable that these disparities will continue to exist and affect not only the poor but the middle class as well (Gans, 1995). African-Americans in the United States continue to face a variety of health-related challenges including high rates of general mortality, infant mortality, cancer, hypertension and HIV and AIDS, among others. Access to proper healthcare is essential to alleviating the major challenges facing African-Americans today. A few initiatives aimed at addressing these problems have been initiated but major changes to the overall health of African-Americans have yet to be fully implemented. As the most prosperous country in the world, the United States must take stronger steps at addressing the major health challenges facing its minority populations. References Ayanian, John Z., Joel S. Weissman, Scott Chasan-Taber, and Arnold M. Epstein. 1999. Quality of Care by Race and Gender for Congestive Heart Failure and Pneumonia. Medical Care Review 37(12):1260-9. Brennan, Ramirez LK, Baker. EA, and Metzler, M. 2003. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Business Wire. 2005. Aetna Awards $2.25 Million in Grants to Address Racial and Ethnic Disparities and End-of-Life Care. Business Wire. Carmichael Suzan L. and Solomon Iyasu. “Changes in the black-white infant mortality gap from 1983 to 1991 in the United States”, American Journal of Preventive Medicine 15.3 (1998): 220-227. Doty, M. M. and A. L. Holmgren. 2004. Unequal access: insurance instability among low-income workers and minorities. Issue Brief Commonwealth Fund (729): 1-6. Dunlop, Dorothy D., Jing Song, Larry M. Manheim, and Rowland W. Chang. 2003. Racial Disparities in Joint Replacement Use among Older Adults. Medical Care 41(2):288-98. Families USA. September, 2008. An Unequal Burden:The True Cost of High Deductible Health Plans for Communities of Color Issue Brief From Minority Health Initiative. Washington, DC. Fiscella, Kevin and Williams, David R. 2004. Health Disparities Based on Socioeconomic Inequities: Implications for Urban Health Care. Academic Medicine 79(12):1139-1147. Gans, Herbert. 1995. The War Against the Poor: The Underclass and Poverty Policy. New York: BasicBooks. Garcia, Richard S. 2003. The Misuse of Race in Medical Diagnosis. Chronicle of Higher Education 49(35). Kaiser Family Foundation. 1999. Race, Ethnicity and Medical Care: A Survey of Public Perceptions and Experiences. Menlo Park, CA: The Henry J. Kaiser Family Foundation. Kaiser Family Foundation. 2007. Key Facts: Race, Ethnicity and Medical Care, Update. Menlo Park, CA: The Henry J. Kaiser Family Foundation. Kogan, M D. Social causes of low birth weight. US Centers for Disease Control and Prevention 88.11 (1997): 611–615. LaVeist, Thomas, Kim J. Nickerson, and Janice V. Bowie. 2000. Attitudes About Racism, Medical Mistrust, and Satisfaction With Care Among African American and White Cardiac Patients. Medical Care Research and Review 57(Supplement 1):146-61. LaVeist, T. A. and T. Carroll. 2002. Race of physician and satisfaction with care among African-American patients. Journal of National Medical Association 94(11): 937-43. Mayberry, Robert M., Fatima Mili, and Elizabeth Ofili. 2000. Racial and Ethnic Differences in Access to Medical Care: A Synthesis of the Literature. Medical Care Research and Review 57:108-45. Maynard, Charles, Lloyd D. Fisher, Eugene R. Passamani, and Thomas Pullum. 1986. Blacks in the Coronary Artery Surgery Study (CASS): Race and Clinical Decision Making. American Journal of Public Health 76(12):1446-48. Paulin, Goeffrey D. and Elizabeth M. Dietz. 1995. Health Insurance Coverage for Families With Children. Monthly Labor Review 118(August):13-23. Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson (editors). 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. U.S. Department of Health and Human Services. 2000. Healthy People 2000. Washington, DC. U.S. Department of Health and Human Services. 2010. Healthy People 2010. Washington, DC. U.S. Department of Health and Human Services. 1985. Report of the Secretarys Task Force on Black and Minority Health. Washington, DC: U.S. Department of Health and Human Services (1):63-86. Wallerstein N, Duran B. 2003. The Conceptual, Historical and Practice Roots of Community Based Participatory Research and Related Participatory Traditions. San Francisco: Jossey-Bass (27)52. Whittle, Jeff, Joseph Conigliaro, C. B. Good, and Monica Joswiak. 1997. Do Patient Preferences Contribute to Racial Differences in Cardiovascular Procedure Use? Journal of General Internal Medicine 12(5):267-73. Williams, David R. and Toni D. Rucker. 2000. Understanding and Addressing Racial Disparities in Health Care. Health Care Financing Review 21(4):75-90. Read More