A report in the March/April issue of the journal Health Affairs estimates that 83,570 excess African American deaths occur each year as a direct result of health care disparities between Blacks and whites. The report, whose lead author is former Surgeon General David Satcher, points to “pervasive inequalities in America’s social, economic and health care systems.” It indicts the for-profit health system for failing to provide basic services to a huge segment of the U.S. population.
Comparing data from 1960 and 2000, the study reveals that, while there has been some progress in decreasing the Black-white gap in civil rights, housing, education, and income since 1960, Black Americans continue to have a significantly higher mortality rate than white Americans. African Americans had a 41 percent higher rate of death from all causes than whites of the same age in 2002, a gap that has barely changed since 1960.
In addition, mortality rates worsened for African American infants and men 35 and older. Although mortality rates improved for African American women, some specialists don’t see this as particularly encouraging, since infant mortality is a direct reflection on the mother’s state of health.
According to the report, of the 83,000-plus excess deaths among Black men in 2000, 10,472 were in the 45 to 54 age group. The overall mortality rate for that group in 2000 was 1,060 per 100,000 for Black men, double the rate of 503 per 100,000 for white men. In 1960, the rates were 1,625 for Black men and 932 for white men in that age group.
The report identified four factors that contribute to the gap between Black and white males: improvements in health care access have consistently excluded non-elderly, non-disabled adult men; Black men have not experienced the same improvements in income as their white counterparts; gun-related deaths spiked upward between 1983 and 1995; and communities of color are disproportionately affected with HIV infections. All of these factors are negatively impacted by the bottom line of health care inequity.
In an interview with the World, Dr. Adewale Troutman, director of the Louisville, Ky., Metro Health Department and co-author of the report, discussed some of the study’s implications. He pointed out that inequality in health care has a historical basis in slavery. The unacceptable structural and systemic health inequities in the African American community today are a direct legacy of the “slavery health deficit,” he said.
African Americans lag behind white Americans on nearly every health indicator, including life expectancy, death rates, infant mortality, low birth weight, and disease, Troutman noted.
Lack of health insurance and lack of equal access to a single standard of high quality health care, as well as lack of equal representation of African American physicians in African American communities, all factor into a deficient health care delivery system for African Americans, he said.
Troutman drew a distinction between “disparity” and “inequity.” Using the term “inequity,” he said, “makes it clearer that the issue is social injustice [and] political imbalance, and historical factors that lead to inequality.”
“We are more used to talking about economic inequity, housing inequity, but when it come to health we start talking about disparity as if somehow it is just an accident of nature that we have these disparate numbers,” Troutman said. “I think ‘inequities’ adequately reflects the nature of the social, political and economic injustice that’s associated with this whole issue of Black folks dying way before their time in extreme excess numbers.”
Pointing to the combined role of race and class in health disparities, he suggested that even when you allow for class differences, disparity in service still exists. That leads to the conclusion that neither class nor race is the single determining factor in health care disparities, he said.
The phrase “health care system” is a misnomer for what is really a “sick care system,” he commented, pointing out that the U.S. spends between $1.6 and $1.7 trillion per year on health care, but only a very small fraction of that on prevention.
Troutman supports the call for a single-payer, universal health care system that will provide all necessary care, including preventive care, to every American. Citing many shortcomings in Medicaid or Medicare, such as co-payments and limited coverage, Troutman sees a better model in Canada’s national health system.
Troutman also advocates personal responsibility, invoking the Black Power-era concept of “liberation lifestyle.” Liberation lifestyle, he said, means “eating right … abstinence from [excessive] drinking, not doing drugs, healthy eating habits, responsible sexual behavior, properly managing stress, etc.”
A very important element of liberation lifestyle is “not only doing the things we should be doing to protect ourselves and our family as individuals,” but “being an activist” for political change and political empowerment, he said. “All those things fit into today’s dynamics when it comes to creating health equity.”