One More River to Cross—Looking Back, Moving Forward: TODAY’S CHALLENGES

Today, here at the promise of daybreak of a new century, our nation’s medical profession faces both old and new challenges. The unscrambling of the human genome, advances in transplantation, the emergence of electronic patient management systems and myriad other 21 st-century medical technologies all herald a new era in cutting-edge healthcare. At the same time, the stalwart march of technology gives rise to new questions about opportunities for minority physician training and uncertainties about how American patients will access and speak the language of new medical innovations.

In today’s healthcare system, the interposition of managed care and thick layers of insurance bureaucracy displace the “house call doctor” of yesterday. And while the cost of maintaining this system—at last count $1.3 trillion a year—continues to climb, the number of uninsured Americans continues to soar. viagra online pharmacy

In the midst of this glistening but troubled river moves an old and menacing phantom called “health disparities.” At every level of the U.S. health system—whether we measure morbidity and mortality rates, or healthcare access and quality, or the socioeconomic conditions that often underpin health disparities—the result is almost always the same: blacks live sicker and die younger than their white counterparts.

In today’s health system, we also face the demographic reality that the U.S. population is dynami­cally shifting and, by mid-century, whites will constitute a racial minority. We have known for some time now that our Hispanic, Asian and Native-American brothers and sisters are also experiencing serious health inequities. And many of our poor white brothers and sisters suffer a health disparity problem as well.

What is unmistakably clear is that our health system is heading for a three-way collision among the marvels of scientific achievement, the changing face of the American populace and the lingering ghost of social inequality. This is where “looking back” helps us to understand our current situation more clearly and helps guide our steps into the future. levitra plus

UNEQUAL HEALTH & UNEQUAL TREATMENT

Historically, from its inception in 1895, the National Medical Association has been the nation’s foremost advocate for parity and justice in healthcare, the leading representative of African-American physicians and a principal guardian of the health status of African-American patients.

Our media often portray health disparities as a phenomenon discovered fairly recently, but a “look back” tells a different story.

At Emancipation, in 1865, President Lincoln observed that the health of the four million newly freed people was worse than it was a century earlier at the founding of the nation. By 1940, almost a century later, Time Magazine reported that the persistence of higher Negro mortality rates was “America’s #1 health problem.” And by 1985—two decades after the desegregation of the nation’s hospitals under Title VI—Health Secretary Margaret Heckler coined the term “excess deaths” to describe the nation’s exceedingly high black mortality.

Since then, we began using a new term—”health disparities”—whenever we talk about this ongoing national crisis.

Today, African Americans lead the nation in 10 of the top 15 leading causes of death, including the highest mortality rates in heart disease, HIV/AIDS, diabetes, stroke and end-stage renal disease (ESRD). The black-white mortality gap exists at virtually every age level: black babies are more than twice as likely to die before their first birthday as white infants. On average, white men outlive black men by seven years. And white women outlive black women by a half decade. At the doorstep of our nation’s capital, if you catch a Metro train from the low-income black wards of Washington, DC to the middle-class white suburbs of Arlington across the Potomac, life expectancy soars two full decades—from 57 years to 77 years—just by crossing a river.

I should also point out that the black-white mortality gap in heart disease, cancer and was higher in 2000 than it was in 1950. This suggests that we may be going in the wrong direction!

And so “rewinding the tape” tells us a great deal about the scope, severity and astonishing durability of our centuries-old health disparity problem.

We’ve also learned over the years that there are many dimensions to this problem, including the persistent inequities in socioeconomic status; the limited capacities of health promotion and disease prevention programs; the sharp differences in insurance coverage; and, perhaps most disturbing, the chronic problem of unequal treatment in the healthcare system.

Somehow, we have learned to design robots that dispense medicine to hospital floors and that assist in surgical procedures, but we have not yet learned to successfully deliver high-quality healthcare to all of our nation’s citizens regardless of race or ethnicity.

There have been at least eight major studies and independent reviews confirming healthcare inequality, most notably the Institute of Medicine’s 2002 report, appropriately titled “Unequal Treatment.” This report found that even when you control for such factors as insurance, education and severity of illness, African Americans still receive inferior care.

These disparities exist in treatments for heart disease, cancer, stroke, diabetes, ESRD, asthma, pneumonia and AIDS. Disparities even arise from such routine clinical procedures as history-taking, physical examination and pain management.

A 2004 report by the Sullivan Commission on Diversity in the Healthcare Workforce summed it up this way: “If you are a racial or ethnic minority in America, there is a concrete and historically familiar risk that you will be subject to substandard diagnosis and treatment, which may result in poor health outcomes, including death.”

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