Aging

Home Page
The ZOOMER trademark
About Us
Editor Bio
Opinion Points
Contact Us

Not Every Race a Wellness Winner
Dr. David J. Demko, gerontologist
AgeVenture News Service 03-27-03

Center for Advancement of HealthThe fact that our nation's drive toward better healthcare has been a proverbial "long and winding road" comes as no surprise. What that road has been winding or avoiding is the issue of race in health care. As a delegate to President Reagan's 1980 White House Conference on Aging, gerontologists like me were becoming keenly aware of the racial inequities in American healthcare. As a case in point, open-angle glaucoma in Blacks develops earlier, more rapidly, and is more responsive to laser surgery. This is not true for other minority groups. Knowledge is power, indeed. Doctors can be empowered to recommend treatment programs, depending on the patient’s race. The glaucoma I spoke of is 600 percent more common in Blacks than in Whites. This demonstrates that millions of minority elders can be spared from unnecessary blindness.

Much like Henry Kisinger's fabled "Domino Theory", apathy toward minority health issues resulted in medical ignorance about minority health risks. Ignorance allowed for the absence of a racially equitable health policy. Not addressing this issue means that health, wellness, and longevity are not equal opportunity events. Native Americans and Blacks have an on-average life-expectancy that precludes them living long enough to qualify for social benefits such as social security or medicare.

Cancers, cardiovascular diseases, diabetes, osteoporosis, glaucom, and on and on. The list of inequities is as long as the road that brought to this point in time. Now days, new knowledge about minority health risks, medical treatments, and wellness strategies is extensive and growing. You might think being armed with such an abundance of minority health that medical providers would be rushing out to make much needed health care accommodations. Ironically, just when common is about to sense prevail, the PC police arrest that progress, insisting that knowledge be kept locked away from anyone who might misuse it. Yes, there are people sitting with so much leisure time on their wringing hands, they pass the time making of lists. List of things that can go wrong in order to protect the Joe Public from himself. Only problem is, the people we're trying to protect are needlessly suffering.

Recently, two leaders, Jessie C. Gruman and Stephen B. Thomas, one a healthcare expert and the other a minority health expert respectively, weighed in on the issue of race and health care. Dr. Gruman is president of the nonprofit Center for the Advancement of Health in Washington, DC. Dr. Thomas is director of the Center for Minority Health at the University of Pittsburgh’s Graduate School of Public Health. Clearly, taking race into consideration carries major advantages to saving minority lives. Some call this common sense, others call it racism. Is it racist to come to the rescue of minority health risks, or is it racist to ignore medical science resulting in the racial inequality of health, wellness, and longevity. See what these experts have to say. Their thoughts are timely, drammatic, controversial, and spectacular all at once.

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 and patients, those for whom this knowledge could prevent people from becoming patients, say Thomas and Gruman. 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 know absolutely that behavior matters; that prevention works. Unfortunately, the lag in turning knowledge into action seems to be longer for minorities.

As a case in point, the prestigious Institute of Medicine released a report in 2002 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 among 4 million Medicare managed care recipients,
  • African Americans were less likely than whites to receive
    1. breast cancer screening, 63 vs. 70 percent,
    2. diabetic eye exams, 44 vs. 50 percent,
    3. beta blockers, 64 vs. 74 percent, and
    4. mental illness follow-up, 33 vs. 54 percent.
  • Black and Hispanic children receive fewer standard asthma medications than similarly sick white children.
  • Compared to 6 percent of Whites, diabetes strikes 10 percent of non-Hispanic blacks,
    10 percent of Mexican Americans and 9 percent of American Indians.
  • Blacks with HIV infection are less likely than whites to receive the most effective 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.
Image credit: Center for the Advancement of Health.