Race for Health Care Equality Dr. Stephen Thomas and Dr. Jessie Gruman. special to AgeVenture News Service (03-25-03) One of the frustrating aspects of health care is that in so many areas of medicine we know what works but we don’t quite get that information to doctors or to patients -- or, more precisely, to those for whom this knowledge could prevent people from becoming patients We know that smoking-cessation programs are cheap and they help people quit. We know that even half an hour a day of walking is good for the heart and good for weight control. We know that flu shots in October improve the chances of an elderly person making it to March. We don’t know everything yet about the role of genes in our health or how to prevent Alzheimer’s Disease, but we know absolutely that behavior matters; that prevention works. The lag in turning knowledge into action, particularly when it comes to prevention, seems to be even longer for some groups in society than for others. One year ago this month, the prestigious Institute of Medicine released a report focusing attention on the fact that minorities in America are, on the whole, in worse health than whites, even after adjusting for differences in income, education and insurance coverage. One contributor to this difference appears to be that health care services are unequally distributed, even among those who do have good insurance coverage. Disparities are aggravated by differences in socio-economic status but persist even in well educated people who are not poor. Recent studies, show, for example: Among 4 million Medicare managed care recipients, African Americans were less likely than whites to receive breast cancer screening (62.9% vs. 70.2%), diabetic eye exams (43.6% vs. 50.4%), beta blockers (64.1% vs. 73.8%), and mental illness follow-up (33.2% vs. 54.0%). Not only in public health clinics but in private practice as well, black and Hispanic children receive fewer standard asthma medications than similarly sick white children. Diabetes strikes 10.8 percent of non-Hispanic blacks, 10.6 percent of Mexican Americans and 9.0 percent of American Indians, compared with 6.2 percent of whites. Blacks with HIV infection are less likely than whites to receive the most effective and up-to-date therapies. To fix a problem, however, you first need to describe it, and doing so could put insurers and health plans in a double bind stickier than duct tape on plastic sheeting. If the insurers are to address the disparities effectively, they have to know more about the people in their plans – who they are, where they live, what language they speak and how they identify themselves racially. Yet compiling this kind of information could just as easily be used to deny services or even coverage – a form of racial profiling that could make your doctor’s office seem like the New Jersey Turnpike. This is the dilemma facing one of the nation’s biggest health insurers, Aetna Inc., which has 14 million people in its health plan and has decided to identify new members by race. “There are reasonable concerns about gathering data, but that’s not reason enough not to do it,” Aetna chairman John Rowe was quoted as saying. “We can’t provide interventions for people at risk if we don’t know who they are. We came to the view that not doing this was the racist approach.” It is in the interest of health plans to keep costs down in order to attract customers, just as it is in the interest of customers to stay healthy and pay less for coverage. The quandary lies in the bottom-line imperative: while knowing the racial makeup of its customers, an insurance company can design effective prevention program, but at the same time it could exclude people at high risk of becoming sick – and expensive to cover. Thus, the same information that defines the critical national problem of racial disparities in health is the same information that could justify not doing anything about it. The Aetna initiative is bold, particularly coming from an industry that hasn’t always made minority health a top priority. But the commitment does have the potential to actually right some wrongs by translating knowledge of who is being served into how they are being served. Dr. Thomas is one of the nation's leading researchers into health disparities among minorities. Dr. Gruman is president of the nonprofit Center for the Advancement of Health in Washington, which translates research on health and behavior into policy and practice. Read more AgeVenture Headlines. Read more lifestyle features in AgeVenture Lifestyles. AgeVenture News Service, www.demko.com BACK TO TOP