The health and health care problems facing minority Americans are shocking. Communities of color are disproportionately represented among the ranks of the uninsured, which included 45 million Americans in 2003. With or without insurance, minorities have reduced access to quality, affordable health care. They experience higher rates of morbidity and mortality from diseases such as diabetes, cancer, cardiovascular disease, HIV/AIDS, asthma, obesity, and end-stage renal disease. For example, African-American men have the lowest life expectancy of all Americans (68.6 years compared to 75.0 years for white men), HIV/AIDS is the third leading cause of death for Hispanic men, and although African-American women experience lower rates of breast cancer incidence than white women do, they are more likely to die from the disease. These disparities in health status mean that racial and ethnic minorities are living sicker and dying younger.
Additionally, as innumerable studies and the prestigious Institute of Medicine have concluded, racial and ethnic minorities tend to receive inferior health care compared to their white counterparts. Even after controlling for such factors as health insurance, sex, age, income, education, hospital type and severity of disease, racial and ethnic minorities still experience a lower quality of health care than whites. This occurs across the full spectrum of disease categories and medical and surgical procedures. For example, minority patients are more likely to undergo amputation than white patients, and one study found race the strongest predictor of the receipt of drug therapy for HIV/AIDS patients.
What is the Bush administration doing to address these enormous obstacles preventing racial and ethnic minorities from living full and healthy lives? To close the gap between minorities and the general population, the Department of Health and Human Services has designated September 21, 2004, "Take a Loved One to the Doctor Day." The day is meant to encourage minorities to "take charge of their health" by visiting a health professional, making an appointment for a visit, attending a health event in the community, or helping a friend, neighbor, or family member do the same.
While it is important for all individuals to take charge of their health, including making appointments to ensure that they receive necessary check-ups and care, this initiative is a non-solution to a problem that demands national leadership. It reflects the Bush administration’s refusal to address structural problems, such as the enormous inequities within the health care system, and shifts blame to minorities. The Bush administration, with initiatives such as "Take a Loved One to the Doctor Day," is essentially telling racial and ethnic minorities that they bear responsibility for ending the problems they face. Absent from the administration’s approach is its own responsibility to understand and address the causes of inequities in health and health care.
"Take a Loved One to the Doctor Day" ignores some very fundamental explanations for why minority individuals do not go to the doctor. It does not recognize that racial and ethnic minorities are considerably overrepresented among the numbers of uninsured. It also does not acknowledge that some people may be unable to pay either for the initial visit or for recommended follow-up care, or that they may be forced to choose between paying for a doctor visit for themselves and putting food on the table for their children. It disregards the fact that, based on where they live, racial and ethnic minorities may not have access to a provider or may be unable to reach a provider due to a lack of transportation, lack of child care, or an inability to take time off from work. Also ignored are difficulties in patient-provider communication, which occur as a result of a lack of language interpreters or a lack of cultural competency among providers and staff. "Take a Loved One to the Doctor Day" also does not confront the mistrust of physicians and the health care system that many minorities feel, a mistrust that is not completely unwarranted given the legacy of segregated hospitals, patient "dumping," and the Tuskegee Syphilis Study.
Finally, "Take a Loved One to the Doctor Day" does not take into account the problems that minorities are likely to encounter once they actually access health care. Even at the best hospitals and with the most comprehensive health insurance, racial and ethnic minorities may face conscious and unconscious stereotyping and bias from providers and staff, which can lead to different treatment being offered and a lower quality of care.
Instead of acknowledging and proposing solutions to these significant stumbling blocks, many of which apply equally to the poor and uninsured of every race and ethnicity, the administration places the onus on individuals. Its underlying message is that minority individuals are lazy and ignorant about their health, and that the solution is motivation and education. In putting all of the responsibility (or irresponsibility) on individuals, the administration ignores inequities in the health care system and its own inaction.
Regrettably, this approach is not new for this administration. Despite embracing the rhetoric of eliminating racial and ethnic disparities, it has repeatedly done the opposite. Just last fall, officials at HHS rewrote significant portions of a national health care disparities report in order to discount evidence of inequities, downplay the severity of the problem, remove from the text any inference of prejudice on the part of providers, and focus on individual responsibility for disparities. And as recently as this summer, the Centers for Disease Control and Prevention announced its reorganization, which eliminated the Office of Minority Health. These actions by the administration have obscured the causes of disparities in health, and by extension, the reality of minority Americans and their experiences with the health care system in this country.
The Bush administration has said that it is dedicated to eliminating racial and ethnic disparities in health care and to ensuring quality health care for all Americans. So far, the actions needed to convert this from hollow rhetoric into meaningful concrete action have been absent.
Leonard S. Rubenstein is executive director of Physicians for Human Rights. Gretchen Borchelt is the Jonathan Fine Fellow at Physicians for Human Rights.
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