This paper discusses the racial disparities currently present in the United States healthcare system and the associated financial and socioeconomic burdens these disparities place on United States citizens. An understanding of the history and definition of racial disparities in the United States Healthcare system is necessary prior to beginning this discussion. Racial disparities have been present in the United Sates Healthcare system since the earliest periods of America's history. Racially segregated healthcare systems can be traced all the way back to slavery. These are the same problems currently being experience by minorities today. It is critical to the United Sates economy that these disparities be eliminated. Eliminating racial disparities in the healthcare system between the years of 2003 and 2006 would have reduced the cost of healthcare in America by $229.4 billion dollars. The figure is much higher when it is coupled with the socioeconomic costs related to disparities. The African American's community experiences a higher mortality rate than any other United States Citizens from heart disease, cancer, cerebrovascular disease, and HIV/AIDS.
These disparities are often linked to socioeconomic factors such as education, lower incomes, and the disproportionately higher representation of these minorities in lower socioeconomic groups. Some possible solutions to the problem are, the Access for All America Act, requiring healthcare workers to participate in cross-cultural education programs, Evidence-Based Cost Control, offering providers economic rewards, and providing interpreters for patients.Explaining the need for reducing or eradicating racial disparities
There is a documented history of racial disparity in the United States Health Care system, these disparities impose massive financial and socioeconomic burdens on U.S. citizens and need to be reduced or eliminated. Although there are, many definitions of what racial disparities in healthcare consist of; the two most accepted definitions are those of the National Institutes of Health and the Institute of Medicine. The National Institutes of Health defines health disparities as the "differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States." The National Institutes of Health and the Institute of Medicine define disparities as "Differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention (Weisfeld,Perlman, 2005).
Racial segregated healthcare is not new in America it can be traced back to the beginning of slavery. Plantation healthcare systems were set up not to protect the lives of the slaves but instead to insure the investment of the plantation owner. The emergency of theories such as Polygenism, and movements such as anthropometry, phrenology, and craniometry (theories that different groups of human beings were descended from different species) in the early 1800's only helped to reinforce racial disparities that carried through all parts of the society including healthcare.
These disparities were reinforced with the passage of the Jim Crow in the years between 1876 and 1965. These laws mandated separate but equal facilities for minorities (primarily Blacks) and whites making it illegal for minority physicians to practice or receive education in white facilities. As a response to these laws minority physician created their own medical facilities and colleges which furthered increased racial disparities by creating separate but and not equal medical facilities for minorities.
To make matters worse, the United States Census Bureau predicts that by 2050 the minority population will equal or exceed the white population. If these racial disparities have not been eliminated or at the least reduced by 2050, it could spell disaster for not only the United Stated healthcare system, but for the economy as a whole. According to a study conducted by the Joint Center for Political and Economic Studies between the years of "2003 and 2006 the combined direct and indirect cost of health disparities in the United States was $1.24 trillion dollars" (Laveist, Gaskin & Richard, 2009).To understand how significant this figure is, it is more than India's GDP for 2008. This figure is equal to "309.3 billion dollars lost annually to the United States economy" (Laviest, Gaskin & Richard, 2009).
Part of this $1.24 trillion dollar figure attributed to racial disparity is due to indirect costs." 957.5 billion dollars of these costs are due to premature deaths, the remaining $50.3 billion dollars results from illness" (Laviest, Gaskin & Richard, 2009) African Americans account for most of this indirect costs attributed to racial disparities. 77% of this cost is attributed to African Americans, while the rest of the cost is 22.3 % for Hispanics and 0.03% for Asians" (Laviest, Gaskin & Richard, 2009). As for the indirect costs attributed to illness, once again the figures for African American's as compared to Hispanics are astounding. African American's account for "73% of the costs associated with illness while Hispanics account for 27.2%" (Laviest, Gaskin & Richard, 2009).
In addition to the financial costs, related to racial disparities there are also socioeconomic factors that contribute to the problem as well. Many recent studies have concluded that blacks not only have a lower life expectancy than whites do but they also spend a greater portion of their lives in bad health. These disparities create financial burdens on American citizens but the loss of life also creates socioeconomic burdens by violating America's sense of racial equity and justice as well as the human potential that is lost with these lives.
There are many socioeconomic factors associated with racial disparities in healthcare. Among the most significant factors are the level of education and the income of the patient. The lower the level of education found within a specific minority group the more racial disparities will affect their ability to receive quality healthcare and the worse their healthcare outcomes will be. The lower the patient's income the higher the chance they will experience racial disparity in their healthcare. The main reason for this is that lower income individuals are often forced to seek out healthcare option in their neighborhoods. The quality of this healthcare may not be as good as the healthcare found in higher income areas.
In addition, individuals in lower socioeconomic groups may not have access to health insurance and may be unable to pay for needed healthcare. Moreover, their diets may not be conducive to good health and they may not practice good health behaviors such as protected sex and monitoring health conditions such as diabetes and high blood pressure. They may also feel that their lack of education and income does not allow them the same autonomy over their lives as people in higher socioeconomic groups. Another part of the problem is that these minority groups are disproportionately represented in lower socioeconomic groups.
The question then becomes how does the United States reduce or eliminate these disparities. There have been many studies conducted on possible solution to the problem. Dr. Julius Richmond, who was the Surgeon General and Assistant Secretary for Health, started the Healthy People initiative in 1979 in the United States Department of Health and Human Services. He released a Surgeon General's Report called Healthy People, which laid the groundwork for Healthy People 1990.Healthy People 2010 identifies a set of 10-year health objectives to achieve during the first decade of the 21st century. The second goal is "to eliminate health disparities that occur by race and ethnicity, gender, education, income, geographic location, disability status, or sexual orientation" (Healthy People, 2007).
In response to this goals many potential solutions have been sugessted. Among these is the Access for All Americans Act. On July 23, 2008, Senator Bernard Sanders introduced a bill to Congress entitled the Access for All America Act. The act hopes to achieve the following goals: access to comprehensive primary health care services for all Americans, improved primary care delivery through an expansion of the community health centers and the creation of National Health Service Corps programs (S.486 - Access for All America Act, 2009).
Congress made the following findings in conjunction to this bill: Providing health coverage for all Americans will be incomplete if access to services is not improved. Currently almost 60,000,000 Americans, both insured and uninsured, have inadequate access to primary care due to a shortage of physicians and other providers in their community. Community Health Centers already accomplishes these goals and has done so over the past 40 years while serving over 17,000,000 Americans. Community health centers, also known as Federally Qualified Health Centers, (FQHCs) have been found to more than pay for themselves by providing coordinated, comprehensive medical, dental, behavioral health, and prescription drug services that reduce unnecessary emergency room visits, ambulatory-sensitive hospitalizations, and avoidable specialty care. The Lewin Group found that providing access to a medical home such as a community health center for every American would produce health care savings of $60,700,000,000 per annum. This is more than 7 times the subsidy needed to sustain the 1,100 current health centers and to create 3,700 new health centers to accomplish full access (S.486 - Access for All America Act, 2009).
In addition to the Access for All American's Act, other possible solutions to this problem are cross-cultural education programs. These programs help professionals developed and improve their awareness of how cultural and social factors influence healthcare. Cross-cultural education can be divided into three theoretical approaches the first focusing on cultural sensitivities, the second focusing on a multicultural approach, and finally a cross-cultural approach. These approaches help healthcare workers to develop knowledge of the cultural and behavioral aspects of minority healthcare while building effective communication strategies with their minority patients.
Other possible solutions are developing educational programs geared towards teaching patients self-advocacy. Self-advocacy will encouraging patients to demand quality healthcare from their providers eliminating disparities attached to poor quality healthcare. Requiring healthcare providers to create evidence-based practice guidelines would encourage providers to develop evidence-based practice guidelines to improve and standardize care. Government regulatory agencies could require health care institution to publish these guidelines. This would allow them to be reviewed by professionals in the field. Practices whose guidelines are not backed up by evidence would no longer be given differential treatment in administrative or legal procedures involving their health plans. In addition, providers could be given economic rewards for time spent encouraging patients and their families to practice good healthcare, and finally interpreters can be provided to reduce language barriers that make it difficult for patients to understand doctor recommendation and give informed consent for procedures that need to be performed.
It is unlikely, that any one of these suggestions alone will be able to reduce or eliminate the racial disparities that currently exist in the United Sates Health care system. It is more likely that a combination of these suggestions will need to be crafted together to form a cohesive solution to the overall problem. There are many organizations currently working on developing such a program.
The racial disparities currently present in the United States healthcare system and the associated financial and socioeconomic burdens place tremendous burdens on United States citizens. The United States has a long history of racial disparity that can be traced all the way back to slavery. The emergence of theories such as Polygenism, and movements such as anthropometry, phrenology, and craniometry (theories that different groups of human beings were descended from different species) in the early 1800's as well as the Jim Crow laws enacted between the years of 1876 and 1965 only helped to reinforce these disparities. It is critical that the disparities caused by this racial history be eliminated or a at least reduced in the near future. The US Census Bureau predicts that by 2050 the minority population will equal or exceed the white population. 309.3 billion dollars is lost annually to the United States economy due to racial disparities in the American healthcare. Part of the $1.24 trillion dollar' figure attributed to racial disparity is due to indirect costs." 957.5 billion dollars of these costs can be attributed to premature deaths, the remaining $50.3 billion dollars results from illness such as diabetes and high blood pressure.
- Boyle, E. H. (2002). Female Genital Cutting. Baltimore: The Johns Hopkins University Press.
- Debelle, J. B. (June 17, 1995 ). Education and debate Female genital mutilation in Britan. British Medical Journal , 310:1590-1592.
- Kent, C. (1996). "Dangerous, deadly, scarring:' AMA efforts advance ban on female circumcision. American Medical News , pg 3(2).
- Morris, K. (2006). Issues on Femal genital mutation/cutting--progress and parallels.(medical trends). The Lancet , S64(2).
- Skaine, R. (2005). Female Genital Mutilation Legal, Cultural and Medical Issues . North Carolina: McGarland and Company Publishers.