HEALTH
Racial Health Care Disparities in the U.S. The oft-proclaimed “best health care system in the world” isn’t accessible to all Americans BY MOHAMMED MOINUDDIN
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he Great Depression of the 1930s, which caused severe socioeconomic stress throughout the U.S., precipitated the surfacing and escalation of longstanding racial tensions between Whites and Blacks. During the ensuing massive unemployment, poverty, diseases and political unrest, crime and violence increased exponentially. Politicians tried hard to lessen the racial tension that continued throughout the 1930s. In 1938, Frederick Keppel (president, Carnegie Corporation) invited Swedish Nobellaureate Gunnar Myrdal (professor of sociology, University of Stockholm) to prepare a report on Black-White friction. After traveling all over the country to talk to various communities and their leaders and interview people in responsible positions, he wrote and published his approximately 1,400-page “An American Dilemma: The Negro Problem and Modern Democracy” (1944). In this book, which became a well-known reference on racism, he wrote, “Area for area, class for class, Negroes cannot get the same advantage in the way of prevention and care of disease that Whites can. Discrimination increases Negro sickness and death both directly and indirectly, and manifests itself, both consciously and unconsciously” (p. 172). For the first time, many Americans became aware of racial preference in health care. The Civil Rights Act of 1964 (Title VI) further raised consciousness among health care workers so much that by the 1980s and 1990s, the number of racial disparity-related articles appearing in the medical literature reached more than 200 on the subject of heart disease alone. Congress took note, and in 1999 assigned the Institute of Medicine (IOM, now the National Academy of Medicine) to specifically assess the differences in health care due to bias, discrimination and stereotyping, in addition to the known causes, and to recommend how to intervene and eliminate them. Consequently, IOM appointed a 15-member commission composed of physicians, lawyers, nurses, psychologists, sociologists, scientists, health administrators and economists. They spent three years reviewing data from medical literature, interviewing the authors to validate their observations, traveling nationwide to talk with community and organization leaders and conducting several 50 ISLAMIC HORIZONS JANUARY/FEBRUARY 2021
workshops. Another panel of 11 experts then reviewed this report. After two IOM-appointed experts reviewed it once again, it was published: “Unequal Treatment — Confronting Racial and Ethnic Disparities in Health Care” (https://www. ncbi.nlm.nih.gov/books/NBK220358/). A summary of this rigorously scrutinized report on Black-White health care disparities is provided below. Cardiovascular Diseases. Heart disease, the number one cause of death in the U.S., has the most data as regards health care disparities. The IOC found that Blacks are less likely to undergo cardiac catheterization (a “gold standard” invasive procedure that diagnoses coronary artery disease) when the disease is clinically suspected. If they undergo catheterization, they are less likely to receive revascularizing procedures such as angioplasty, stenting and atherectomy, or drugs such as beta-blockers (commonly used for angina) or thrombolytic therapy (clot dissolving medication) and Aspirin (used for prophylaxis). A meta-analysis of 25 studies showed that these differences were due to known factors, bias and discrimination. In 2000, the New England Journal of Medicine and Social Science and Medicine published two studies that identified bias, discrimination and stereotyping as the causes of health care disparities, in addition to known factors. Between 1993-95, they studied 938 patients at the Cleveland VA Hospital for cardiac catheterization. The cardiology fellows would present patient data in the patient`s absence to a panel of cardiologists and heart surgeons. Race was not specified. When the staff physicians were unaware of the patients’ race, no difference was found with reference to the incidence of catheterization. This impressive study emphasized the role of race in clinical decision-making. Kidney Diseases. The incidence of end-stage kidney disease and diabetes is higher among Blacks and Native Americans, and yet they are less likely to receive kidney transplants or be put on the waiting list. When they are, their waiting period is longer. In one dialysis center where 67% of the patients were Black, 64% of those who received kidney transplant were White. Within the first year of dialysis, in a national sample 30% of Whites and 13.5% of Blacks were placed on the transplant list. The reasons for such a disparity included patient preferences, biologic factors such as immunologic problems, disease severity and bias. It was
