Introduction
Cardiovascular disease is one of the areas where disparities in health as determined by race have been well documented. Of particular concern is the fact that racism or racial segregation is not restricted to the individual but easily extends to vital social institutions; whereby the individual is defined by race even in the provision of housing, education, and health.
Consequently, to successfully solve the issue of this disparity, far-reaching changes have to be made to the system as a whole. However, it is also prudent to define such disparities and to identify specific institutions, issues, or practices so as to accurately target them for maximum results.
Race and health
Williams R. David (1999) Race, Socioeconomic Status, and Health the Added Effects of Racism and Discrimination: Annals New York Academy of Sciences: Vol. 896, pages 173-188
At the time of publication of this paper, the author David R. Williams, Ph.D., M.P.H. was a member of the University of Michigan, Department of Sociology and Survey Research Center, Institute for Social Research.
In this paper, the author explores the manner in which race and the socioeconomic status of an individual are related; he, therefore, tries to explore both the historical legacy of racism and the implications thereof on the general health of minority groups in the United States of America. The author argues that racism has been institutionalized; a good example is a residential segregation that prevented African-Americans from acquiring good quality education and health services.
Historical factors
In the United States, the racial background of an individual is an important factor in determining the health of an individual. Such has been shown by the outlining of the native American population as having a specific predilection for a certain type of morbidity and resultant mortality; for example, compared to the white population, they have a higher incidence of diabetes, flu, and liver cirrhosis; with these effects being more profound among the population living within or near reservations. On the other hand, while Hispanic Americans have a lower mortality rate than whites, they have higher death rates for HIV/AIDS and diabetes.
Race, as an issue in the united states, is not restricted to the biology or the genetics of the individual; however, it transcends into the economic status, political power, and resource distribution; may it not be forgotten that for a long time, and varying periods in various parts of the country, race was taken as a major factor to determine the welfare of the individual in respect to how much the government was willing to invest in such an individual; this also affected the population.
For such determination to be possible there had to be a way of categorizing different individuals into discreet racial groups, and such was heavily built on the racial construct of the time. As such, some members of the society were deemed to be inferior to others thus justifying their unequal treatment.
The formal practice of racism is a bygone era in the United States, and everyone is viewed as equally deserving to receive proper and full services as paid for by society. However, personal racial sentiments, prejudices, and stereotypes remain among a section of Americans; such include stereotypes about African-Americans for example that they are inherently lazy, violent, and unintelligent. Although these sentiments are not voiced openly (and can only be accessed through a survey where anonymity is guaranteed), they may have a significant effect on how people from a minority racial background are treated in the system.
Race and disparity
The question, however, is how the racial background of a person affects his/her health. The first mechanism is by the restriction of such a person vis-à-vis attainment of the highest possible educational and/or career status; this effectively lowers the socioeconomic status of the person and thus his/her ability to access good quality and reliable healthcare services.
A good example of this is in the policy of residential segregation developed in the early 20th century; this resulted in the restriction of housing for African-Americans to the least desirable sections of a city. The effects of this are being felt to this day; since a good number of them are still living in this situation. Additionally, such practices, although now illegal, are still being practiced in some quarters under the guise of equal opportunities. Such segregation has affected the quality of education received by this population; this is through poor funding and the fact that there is a concentration of poverty in the classroom parallel to a similar concentration in the neighborhood.
There are many other examples where the effects of past segregation and those of present inequalities had led to individuals from a minority background attaining a lower socioeconomic status than their majority contemporaries. The combination of having a lower purchasing power, living in poor housing, exposure to urban hazards, poverty, lack of access to social amenities and poor education eventually results in a disparity in health between this group and those not afflicted with a similar situation.
Understanding how race causes the disparity
David R. Williams, Ph.D., M.P.H., and Toni D. Rucker, Ph.D. (2000): Understanding and Addressing Racial Disparities in Health Care. Health Care Financing Review 2000/Volume 21, Number 4 75
At the time of publication of this paper, the authors were members of the University of Michigan, the Department of Health and Human Services.
In this paper, the authors try to explore the role of the institutions in determining the health of an individual and a population vis-à-vis the racial disparity in health that exists in the United States. They take into account that while medical care may not be the only determinant of health in an individual, it plays an important part in such determination; this is especially so in preventive interventions and management of the chronic disease.
As such, the availability and the quality of medical care will be an important contributor to the disparity in health between people of different racial backgrounds. Access, in particular, is an important factor; people from a minority background find it relatively harder to access medical care than their white contemporaries. This is caused in part by the fact that they suffer from a higher rate of unemployment, inability to get well-paying jobs, and lack of health insurance.
Differences have also been shown in the way medical treatments and procedures are done between the different races; as such, a disparity occurs even in situations where the socioeconomic status of a person has no effect on the access to the services such as Medicare and the Veterans Health Administration System. These differences may have an adverse effect on the health of people from a minority race.
Racism in the healthcare system
As mentioned before, overt racism is over in the United States; indeed, some of the practices of the past are illegal. However, what now exists is a more subtle form involving a laissez-faire approach towards tackling issues that are causing health disparity. As such, it is important to recognize that the healthcare system cannot exist in a vacuum; as such, if discrimination is rife in the society at large, then it is likely to affect the sector also. The key to solving the problem is to move away from the perception that racism is a problem of individual aberrant behavior but that of a widespread societal issue.
On the other hand, it is also prudent to note that while there are cases where medical personnel exhibit discretionary racist behavior, most other discrimination can be accounted for by the influence of stereotypes resulting in an unconscious reaction by people who do not necessarily have a racist point of view.
Race and cardiovascular disease
Davis M. Andrew, Lisa M. Vinci, Tochi M. Okwuosa, Ayana R. Chase, and Elbert S. Huang (2007): Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions. Medical Care Research and Review, 2007; 64(5 Suppl): 29S–100S.
At the time of publication, the authors were members of the University of Chicago.
The disparity in cardiovascular health vis-à-vis has been widely recognized and documented. For example, African-American males carry double to triple the risk of dying from heart disease at any age compared to their white contemporaries. This disparity can be accounted for, at least in part, by differences in cardiovascular disease prevention interventions and treatment. This is mainly from the fact that interventions to reduce this disparity as targeted at the healthcare service provision points have largely been successful.
Risk factors
As a starting point, African-American men have been shown to carry a significantly higher risk of developing vascular disease, such as hypertension; and also carry a higher risk of this developing into a serious condition involving other organs and the heart. This population also has a higher probability of developing dyslipidemia and tends not to adhere strictly to the pharmaceutical and lifestyle regime aimed at reducing or reversing this condition.
On the other hand, while the rate of tobacco consumption is similar among whites, blacks, and lower in Hispanics, the former is more likely to be offered assistance in quitting than the latter two; and as such, the blacks and Hispanics are more likely to suffer from cardiovascular ill-effects of smoking. Finally, among women, the black and Hispanic portions tend to have a lower level of physical activity than their white counterparts; and tend therefore to develop obesity with the accompanying cardiovascular involvement more easily.
The disparity in healthcare services provision
Risk factors alone cannot explain the disparity between cardiovascular health along racial and ethnic lines; this is mainly from the fact that these disparities occur even in situations where the effects socioeconomic status of the have been minimized, for example in Medicare.
In this case, the authors have reviewed various publications and studies where there have been significant differences in the procedures in all but a few areas of cardiac health. For example, in regards to the application of new technology, the minority population tends to receive the new treatment later than whites. This lack of access can be attributed to the inability of these people to afford visits to specialists or high-end healthcare facilities. There also are differences in the detail of follow-up of a patient who has been treated for a heart condition between minority and white populations in the United States.
Reducing health disparities: The role of medicare
California Health Advocates (2003): Medicare Needs to Play Key Role in Eliminating Health Disparities.
The California Health Advocates is a non-profit organization whose primary goal to Medicare beneficiary advocacy and education for Californians. The organization has several offices located in Sacramento, Los Angeles, Oakland, and Santa Ana.
Of major concern in the issue of health disparity between whites and people from a racial or ethnic minority is the fact that even in the face of comparable socioeconomic status as determined by factors such as insurance and income, the latter always tend to receive lower-quality healthcare services than the former. This disparity is even present among beneficiaries of Medicare; although its implementation has gone a long way in mitigating some of the wide gaps that existed before.
A good example of how this implementation reduced disparity is the desegregation of hospitals by enforcing compliance with the civil rights act of 1964; as a result, as many as 1000 such facilities were desegregated within 6 months. Additionally, the sheer amount of data collected during its operation has allowed for the discovery and analyses of the disparities; thus enabling the application of interventions. However, noble as these contributions may be, the Medicare population still has significant levels of disparity affecting people from ethnic and racial minority origin; this is also true in the context of cardiovascular disease where for example, over 65% of the African-Americans Medicare beneficiaries live with hypertension compared to the 50% among their white contemporaries.
Additionally, minority beneficiaries also experience differences in the way cardiovascular disease is handled; thus putting them at a higher risk of developing adverse outcomes to the conditions. For example, they are less likely to receive angioplasty at about 60% of the white; or bypass surgery at about 50% compared also to white beneficiaries. They also receive less rigorous follow-up after a cardiac episode. They stand a lower chance of receiving routine therapy aimed at restoring proper circulation to vital organs after a heart attack.
This disparity is projected to increase in the face of increasing diversity among this population. Currently, minorities account for about 18% of the total Medicare population; this is projected to increase to 28% by the year 2030.
Being the largest purchaser and regulator of healthcare, Medicare has the opportunity, the responsibility, and the ability to reduce disparities in health among the diverse people that it serves. This can be achieved through influencing policies and implementing programs aimed specifically at this issue.
Some of the interventions that Medicare can implement to reduce disparity include improvement of quality and access; education of medical staff on issues of cultural competence and sensitivity; taking deliberate steps to reduce disparity as an independent and important issue, and having healthcare providers take responsibility for reducing these racial and ethnic disparities.
Although Medicare is not the sole source of healthcare, it holds a dominant position with its 9 million beneficiaries; therefore, it can take a leading role in setting the pace for other bodies, thus triggering a market-wide transformation. For this, it has both the responsibility and the ability.