Health Care inequality due to culture and race

David Castillo, 2023

“Overwhelming facts reveals that racial and cultural minority groups are more likely to receive
poorer quality health care than white Americans, even when factors such as insurance status are
controlled” (American College of Physicians 2010).

As the cpuntry’s population continues to grow and diversify, the health care system will have to
change and adjust to meet the needs of an increasingly multicultural patient base. The statistical
and anecdotal facts of racial injustice in American healthcare are undeniable.

Studies done since 2003 by ACP shows systemic in addition to clinical discrimination, health
practitioners, legislators, and normal citizens can no longer ignore the fact that America focuses
on the color of one’s skin and the national origin of one’s ancestors still largely determine the
quality of health care a consumer receives (American College of Physicians 2008; Urban
Institute (2005).

America thought that the issue of racial injustice and inequity was long gone, but it is shocking
that the vice still endures largely, not only in the common platforms, politics and socials, but in a
more critical issue like health care.

After controlling the differences among the races in socioeconomic status, health insurance,
access to health care and geographic differences, the statistical facts still demonstrates that
Blacks and Latinos still get lesser and substandard medical attention than their counterparts, the
whites, irrespective of whether those services are for treatment of cardiovascular disease, chronic
diseases, mental illness, child medical care or HIV/AIDS.

Comparing these minority groupings (African Americans, Native Americans, Asian Americans,
and Latinos) with the white Americans, they are more vulnerable to chronic illnesses, higher
mortality rates, and worst health effects (Bardach 2009). Among the disease-specific examples of
racial and ethnic disparities in the U.S. is the cancer incidence rate among Blacks that is 10
percent more than among the white Americans (Barrett, Dyer and Westpheling 2008; Kettl
2007).
Also, adult Blacks and Latinos are almost twice more than Whites prone to diabetic
complications. Although African Americans, Latinos and Native Americans suffer and succumb
to diabetes more often than then whites, research show the disease is not well handled among
minorities.

Paradoxically, Black, Native and Hispanic Americans have more medical attention services than
do whites for those undesirable medical attentions, for instance amputations, and cesarean
section among others. Although these are necessary attentions, they are considered undesirable
because a patient would rather avoid them if at all they had an option, for instance many patients
would prefer to keep a leg if it could be made healthy, rather than going for an amputation.

Undisputedly, ignoring these injustices would take the efforts of social scientists, researchers,
health care providers, legislators, environmentalists, clergy, and patients among others to
adequately attend to the matter (Lurie and Dubowitz 2007; Schlotthauer et al. 2008; Zuckerman
et al. 2008). Although the issue is multi-sided, this paper looks at the policy solutions available.

Lexically, health inequalities refer to the gap in the quality and accessibility of medical attention
among racial, ethnic, socio-economic groupings. Almost as long as there have been hospitals in
America, there have been racial disparities in the health care system.

The first hospital founded in the U.S. was the Pennsylvania General Hospital, established in
Philadelphia in 1751 from private funds, donated for the care of the less-fortunate and the
mentally unstable. In the beginning of its operations, records from Pennsylvania General did not
show that any patients other than whites were admitted for care.

The institution was, in fact called the “First Anglo Hospital” [1] in the U.S. nevertheless, historical
records reveals that the institution eventually began to admit non-Caucasian patients.

Beginning in 1825 and 1829 respectively, Pennsylvania General began to record the “color” and
“national origin” of admitted patients, confirming that the hospital at some point began offering
services to both Black and white patients (Baker et al. 1996).

In fact, before end of slavery in America, the judicial record reveals that African-Americans got
a significant healthcare whenever need be; their health influenced their monetary value as
property of slave-owners. After the Civil War, giving access to African Americans took on a
different dimension.

Waves of Blacks migrating from the south began to mount pressure on health care amenities to
serve Black and white patients the same. During the Reconstruction, racial segregation, surfaced
both within healthcare institution used by both the non-native American and white patients,
professional, and physicians, and in the structure of the hospital industry itself.

Martin Luther King, Jr. quotes that “Of all the forms of inequality, injustice in healthcare is the
most shocking and inhumane” (as cited in ACP 2004). Ever since overt racial disparities has
grown and still looms.

Arguably, health disparity starts shortly after conception. One pointer of a child’s healthy birth,
making other lifetime outcomes more probable to be successful, is whether mothers get early
medical care at pregnancy. 25% of African-American women do not receive prenatal attention at
the first trimester, while 11% of white women get none (American College of Physicians 2007;
Bach et al. 2004; Dorn et al. 2008).

For African-American women, 6% do not receive prenatal attention, but only 2% of white
women, one third the number of 27 blacks, get no or too-late care.

Considering infant mortality during the first year of life, there are 14 deaths for African-
American and six for native Americans/1,000 live births. However, proper prenatal care likely
could have prevented some of these deaths.

Infant mortality and morbidity are enduring, thus the high rate of African-American infant
mortality shows the probability of a similarly higher rate of black infants who survive with
unhealthy conditions that make school and lifetime success more difficult.

It is these disparities in pregnancy and childbirth, which are eventually reflected in racial
inequality (Winkleby et al. 1992).
Inequality of access to health care in the adequacy of care different cultural and racial groups get
can include:

 Difficulties with patient-practitioner communication. In delivering medical care,

communication is essential so as to administer proper and effectual treatment and
attention in disregard to racial group. As miscommunication could lead to inaccurate
analysis, wrong medication, and failure to get a follow-up attention. As Flores (2007)
describes, “Cross-cultural differences in information-seeking patterns, communication
styles, perceptions of health risk, and ideas about prevention of disease [have] an impact
on health.” In the US language barrier is even worse, especially among the non-natives
groups. Statistically, “less than half of non-English speakers who say they need an
interpreter during health care visits report having one. In addition, communication
barriers crop up from the lack of cultural understanding on the part of white providers for
their minority patients” (Halbert et al. 2006).
 Practitioner inequity. In some cases the medical care practitioners either unconsciously or
consciously attends to some racial patients in a different way than other patients. Some
studies show that racial minority patients are “less likely than whites to receive a kidney
transplant once on dialysis. Critics argue that certain diseases cluster by ethnicity and that
clinical decision making does not always reflect these differences” (Institute of Medicine
2004).
 Lack of preventive care. According to the 2009 National Healthcare Disparities Report,
“uninsured Americans are less likely to receive preventive services in health care, for
instance racial minorities are not regularly screened for colon cancer and the death rate
for colon cancer has increased among African Americans and Hispanic people”

Many people of colored skin are facing poor health care than whites from the cradle to the grave,
in terms of greater rates of infant mortality, chronic diseases and disability, and pre-mature
death” (Peterson and Yancy 2009). These health disparities take a significant human toll, but in
addition inflict a huge economic weight on America.

A recent research conducted shows that the direct health costs, that is, related with health
inequalities, extra costs of medical services incurred due to the greater burden of diseases
suffered by the minority groups-was more than US$250B in the period between 2003 and 2006.

Aggregating the indirect costs related with health inequalities, for instance foregone salaries and
yield and foregone tax revenue, the total costs of health inequalities for the country was
US$1.24B in the same duration (Kettl and Fesler, 2009).
With the inception of Obama administration, things are looking bright. With the enactment of the
Health Reform Law, this will see more than 32 million uninsured Americans, the majority being
the minorities get insurance coverage.

These laws will avert insurance companies from exploiting new enrollees and rejecting claims
due to the earlier conditions and more medical care providers will get more incentives to work in
“medically underserved communities, among other expected benefits. These legislations will
improve the current state of health care for people of colour, who are disproportionately un- and
under-insured and who face greater barriers than whites to receiving high-quality care, even
when insured” (Herbert et al. 2008).

A research commissioned by the Institute of Medicine (2002) estimated that: “over 886,000
deaths could have been prevented from 1991 to 2000 if African Americans had received the
same care as whites. The main differences were due to lack of insurance, inadequate insurance,
and poor service for the minority patients.”

References

ACP. (2004). Language Access in Health Care: Statement of Principles. ACP. Web.

American College of Physicians. (2008). Achieving Affordable Health Insurance Coverage for
all Within Seven Years: A Proposal from America’s Internists. Philadelphia: American College
of Physicians.

American College of Physicians. (2007). Achieving A High Performance Health Care System
With Universal Access: What The USA Can Learn From Other Countries, 2007. Philadelphia:
American College of Physicians.

American College of Physicians. (2006). Language Services for Patients with Limited English
Proficiency: Results of a National Survey of Internal Medicine Physicians. Philadelphia:
American College of Physicians.