“Of all the forms of inequality, injustice in health care is the most shocking and inhumane” Martin Luther King Jr., 1966.
While five decades have passed since Dr. King highlighted the need to address health disparities, many differences in outcomes have continued to grow. Dana Goldman, director of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California has studied disparities. In a recent New York Times article he provided his expertise on the issue:
Many researchers believe the gap in life spans from lower- to upper-income Americans started widening about 40 years ago, when income inequality began to grow. The broad adoption of medication for high blood pressure in the 1950s led to a major improvement for black men, erasing a big part of the gap with whites. . . Earlier in the 20th century, trends in life spans were of declining disparities, some experts say, because improvements in public health, such as the invention of the polio vaccine and improved sanitation, benefited rich and poor alike.
Health disparities exist along racial, ethnic, geographic, immigration status, sexual orientation, and gender lines as well. The group distinctions are evidenced by the information the Centers for Disease Control and Prevention collect. The CDC gathers data on the causes of these disparities as the first step toward eliminating them. Illuminating statics from the CDC that demonstrate the realities of the human tragedy at the heart of health iniquity include:
Non-hispanic black women are more likely to be diagnosed with advanced stage breast cancer compared to white women and have the highest rate of mortality.
Cardiovascular disease is the leading cause of death in the United States. Non-Hispanic black adults are at least 50% more likely to die of heart disease or stroke prematurely (i.e., before age 75 years) than their non-Hispanic white counterparts.
The prevalence of adult diabetes is higher among Hispanics, non-Hispanic blacks, and those of other or mixed races than among Asians and non-Hispanic whites. Prevalence is also higher among adults without college degrees and those with lower household incomes.
The infant mortality rate for non-Hispanic blacks is more than double the rate for non-Hispanic whites. Rates also vary geographically, with higher rates in the South and Midwest than in other parts of the country.
Men are far more likely to commit suicide than women, regardless of age or race/ethnicity, with overall rates nearly four times those of women. For both men and women, suicide rates are highest among American Indians/Alaska Natives and non-Hispanic whites.
Hispanic males age 20 or younger have the highest prevalence of obesity compared to non-Hispanic whites and non-Hispanic blacks.
These health inequities not only affect individuals or specific populations but they also impact the overall health status and health care costs facing our nation. Ethnic disparities in health care cost this nation more than $6 billion per year—a staggering amount in light of the fact that many conditions are preventable. For many ethnic minorities, chronic health conditions significantly impact their quality of life. A reduction in one’s quality of life influences personal, familial, and community wellness. It also reduces an individual’s ability to contribute to the economy and ultimate well-being of the nation. - Cheryl Woods Giscombe and Nalo Hamilton from their article on health disparities.
The NIH has created an infographic that further illustrates sex and gender differences in health outcomes:
While the sheer size of the problem can seem overwhelming, USC Price School of Public Policy Professor LaVonna Lewis indicates, “There is evidence that having someone who speaks the same language or understands the culture of the population makes a difference in terms of getting to better health outcomes.” The evidence speaks to the need to educate, recruit, and retain diverse clinicians. I will be highlighting the importance of inclusiveness in healthcare in an upcoming post.
To see how the Department of Health and Human Services plans to improve outcomes see their Action Plan to Reduce Racial and Ethnic Health Disparities. The NIH has also prioritized tackling health iniquities, “The Census Bureau predicts that racial and ethnic minority populations in the U.S. will grow to become half of the U.S. population in three decades. NIH has a research agenda in place to address the increasing health needs of racial and ethnic minorities, rural and urban poor, and other medically underserved populations in the midst of efforts to strengthen the healthcare system and improve access to care for millions of Americans. Eliminating health disparities is a priority for the NIH and involving diverse communities and partners will be critical in its effort directed at achieving health equity in America.” For more information, see the National Institute on Minority Health and Health Disparities.
Dana Goldman was recently appointed as Distinguished Professor by USC President C. L. Max Nikias. Dr. Goldman is the Leonard D. Schaeffer Director’s Chair and Professor of Pharmacy, Public Policy, and Economics. A nationally-recognized health economist, he is the author of more than 200 articles and book chapters on healthcare. He is a health policy advisor to the Congressional Budget Office and serves on several editorial boards, including Health Affairs and the American Journal of Managed Care. He is also a founding editor of the Forum for Health Economics and Policy.
As the founding director of the USC Leonard D. Schaeffer Center for Health Policy & Economics, he has molded the USC Schaeffer Center into one of the leading centers in the field of health policy. With over 100 affiliated faculty and staff, the Center unites scholars and experts from around the world to impact current health policy.
In 2009, he was elected to the National Academy of Medicine in recognition of his professional achievement and commitment to service. He was also the first recipient of the MetLife Foundation Silver Scholar Award, which honors his research on defining the value of healthy aging. Among other awards, he is also a past recipient of the National Institute for Health Care Management Research Foundation award, and the Eugene Garfield Economic Impact Prize.