Race, despite being 300 years removed from emancipation, despite being 50 years removed from the Civil Rights era, despite being 7 years into the presidency of our first president with black heritage, continues to be a defining feature of life in America. From a physician’s perspective, a saddening fact is that race also defines health.
In 2002, at Congress’ behest, the Institute of Medicine (IOM) released a report that, amongst other shocking findings, documented disparities in the quality of care accessed by African Americans as compared to White Americans. They posited several reasons. Poverty is undeniably linked to lower outcomes in treatment of chronic diseases such as diabetes but also in rates of cancer detection and treatment. Geography, in many ways, is destiny: where you live (not only which state or city but also which side of the tracks in a town) dramatically influences the quality of the care to which you have access and that you receive. Linguisticand cultural barriers also contribute to the disparity, not to mention a patient’s mistrust of the healthcare system.
Yet, even when controlling for income, social class and level of education, clinical outcomes were poorer amongst African Americans. One of the most striking studies showed that, for the same symptoms objectively calling for heart surgery, doctors recommended surgery less often for African Americans. Particularly disturbing was how often African American women did not get the appropriate recommendation. In medicine, as in many other parts of our society, being black, female and poor is a reverse trifecta.
Unfortunately, despite the robust nature of the data that underlies the IOM report, disparities continue today. Health disparities are not limited to African Americans or black communities. Being poor leads to disparities as well as not being fluent in English, being Latino and, for some measures, being a woman. In short, the provision of health care does not escape the fact that we live in a society that has a strong history of discrimination against particular physical attributes, whether because of ingrained system or individual bias.
As citizens, we carry a responsibility for our society. Whether conservative or liberal, we would all like the more impersonal aspects of the system to be fair. Should you die a more painful death simply because you live in Lynn instead of Brookline? Should your child suffer and die from an asthma complication only because you are black? Most of us would passionately argue that such differences are not consistent with the America we want for ourselves, for our children, for posterity. It’s up to us, individually and collectively, to fight the causes of those disparities.
Justice does not roll down like waters by itself; it needs agents, supporters fighting for the cause. What will you be doing in the next five minutes, in the next month, or the next year to promote fairness and eliminate disparities?