Race and Healthcare

EDITOR'S NOTE: This is the second in a series of three stories by Sally Lehrman, a veteran journalist and Expert Fellow of the Institute for Justice and Journalism at the University of Southern California's Annenberg School for Communication. This story focuses on health issues related to racial and ethnic identity.

Hoping to find out why adult-onset diabetes strikes Native Americans three times as often as whites, government researchers are narrowing in on a gene prevalent in Pima Indians. Concerned about the high rate among African Americans, Howard University scientists are collecting DNA samples from West Africans with the disease.

But the push to find genetic differences and develop targeted medicines won't ease sharp disparities in health status between whites and other racial groups in the United States, insist some social scientists and health specialists. While acknowledging that biology may be an important contributor to disease susceptibility and severity, they say social factors are key to bridging the gap. Dozens of genes may be involved in diabetes, for example, but they act in concert with our ability to get exercise, find healthy food and see a sympathetic doctor for the medical care we need. They say racism -- not race -- is what makes people of color more sick.

"There is undue emphasis on genetics at the expense of societal factors," says Barbara Koenig, a Stanford University anthropologist who studies contemporary biomedicine. "If you look at the history of improvements in life expectancy in the industrialized West, the things that made the most difference in terms of overall health status were not medical interventions, but those in the social domain."

Social stratification, residential segregation and neglect all contribute to the higher rates of disease and death among U.S. ethnic and racial minorities, says Carmen Nevarez, medical director of the Public Health Institute in Oakland, Calif. The roots of obesity -- and diabetes -- are easy to see among her own young, urban clients, she points out. Without a nearby grocery store, these teenagers have few options other than a bag of Cheetos for a cheap, easy breakfast. They have no structured exercise in school, and are afraid to walk outdoors for fear of being arrested or caught in gang crossfire.

Racial Health Divide

But the most critical social factor may be the health care system itself, conclude medical and public health experts at the Institute of Medicine. In a comprehensive analysis of 100 studies on treatment and outcome differences by race, they conclude that biological differences in susceptibility and disease severity aren't enough to explain the racial health divide. Instead, their recent book-length report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare," blames a pattern of lower-quality service stemming from cost-containment pressures, clinical bureaucracy, inconveniently located hospitals, and other factors, including unconscious biases held by doctors.

"Even with the same symptoms and stage of the disease, differences persist," says Brian Smedley, project director for the study, which also controls for insurance coverage and ability to pay. The committee found stark inequalities in preventive care, diagnostics and treatment no matter what the disease, and these in turn connected to higher rates of mortality. Blacks and Latinos who arrived at hospitals with the same severity of heart disease, for example, received catheterization or bypass surgery less often. African Americans with a colorectal tumor were 41 percent less likely than whites to receive major treatment such as cutting out the cancerous cells.

In one comprehensive study of 1.7 million patients, African Americans received major therapeutic procedures less often than whites in 37 of 77 conditions, according to the report. In contrast, minority patients underwent limb amputations in greater proportions and were given anti-psychotic medications more often. "Clearly, these disparities are unacceptable and they require a comprehensive response to correct them," Smedley says.