Dying Too Often, Too Soon

When researchers analyzed data from 1991 to 2000 they discovered that more than 800,000 African Americans died during that decade because they didn't receive the same health care as their white counterparts.

According to the study, "The Health Impact of Resolving Racial Disparities: An Analysis of U.S. Mortality Data," age-adjusted mortality rates for white men and women averaged 29 percent and 24 percent lower, respectively, than those of blacks. The authors reported that though technological advances during the decade saved roughly 176,000 lives, five times more lives could be saved if racial disparities are erased.

Looking for Answers

Some of these disparities are the direct result of reduced access to health care. Blacks are more likely to be "uninsured, underinsured, and underserved," says David Satcher, former U.S. Surgeon General, current director of the National Center for Primary Care at Morehouse School of Medicine, and a study co-author.

When African Americans do receive care, it is often of lesser quality. "We have evidence that physicians treat blacks differentially in ways that disadvantage black patients," says Jay Kaufman, an epidemiologist at the University of North Carolina who studies health disparities. "Blacks are seen less often by specialists, receive less appropriate preventive care -- [for example] mammography and influenza vaccinations -- lower-quality/less intensive hospital care, fewer cardiovascular procedures, fewer lung resections for cancer, fewer kidney and bone marrow transplants, fewer orthopedic procedures, fewer antiretrovirals for HIV infection, fewer antidepressants for depression, fewer admissions for chest pain, lower-quality prenatal care."

Black women are in the vanguard of those receiving inferior health care, with greater incidence of and mortality from nearly every major disease, including diabetes, heart disease, HIV/AIDS, hypertension, and some forms of cancer:

* Diabetes rates have tripled among African Americans over the past three decades. Nearly 12 percent of black women over 20 and 25 percent of those over 55 have this condition.

* Forty percent of black women have high blood pressure.

* Black women are 69 percent more likely to have heart disease and heart attacks, and they have a 70 percent greater chance of dying of heart disease.

* Black women accounted for 69 percent of new HIV diagnoses from 2000 to 2003 and have a rate of HIV/AIDS infection that is 18 times higher than that of white women.

* Although cancer is the second-leading cause of death for all women, black women have the greatest number of deaths from cancer of the breast, colon, pancreas, and stomach.

"We're always at the bottom rung. We have the worst health of any group of women across most diseases and across all of the leading health indicators," says Lorraine Cole, head of the Black Women's Health Imperative. "We're dying too often, too soon, and unnecessarily."

The Root of the Problem

But lack of access to adequate health care isn't the only racial disparity. Others include

* Bad Habits: Some lifestyle factors, like smoking, alcohol abuse, and engaging in unprotected sex, may play a part in these statistics. "Sexually active people can and should take responsibility for their own health," says Janet C. Cleveland, deputy director for Prevention Programs of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention in Atlanta. "Women should talk to their male partners about sexual risks and sexual history, insist on condom use, and get tested for HIV with their partner on a regular basis."

* Education: According to the American Council on Education, only 45 percent of black women graduate from college in six years. (That number dips to just 16.3 percent for those who graduate in four years.) Without a college education, many African-American women are limited to working in industries that offer substandard health insurance coverage or no coverage at all.

* Environment: Many African Americans live in areas with high levels of pollution, which can contribute to a number of health conditions, including certain cancers.

* Nutrition: Many black women have poor nutritional habits because they live in neighborhoods that don't always offer affordable, healthy food options. The level of physical activity is also often lower in the African-American community than it should be. As a result, African-American women are more likely to be overweight or obese than white women. Excess weight has been linked to increased rates of diabetes, heart disease, hypertension, stroke, and certain cancers.

* Poverty: Though African Americans make up only 13 percent of the U.S. population, they account for 24 percent of the nation's poor. As a result, a number of black women have to make the difficult choice between medical necessities, such as annual physicals and prescriptions, and basics, such as food and rent.

Closing the Gap

The challenge, experts say, is to deliver comprehensive health care to everyone despite these disparities. The way to meet that challenge is by developing culturally sensitive programs that educate the public about their health care options, and going into the black community to places many black women frequent -- like churches, hair salons, and community centers -- to talk about the importance of disease screenings and following medication protocols.

Another part of the solution is addressing the need for cultural competency training within the health care field to foster trust in the system among minorities. The study's authors also call for more funding to deliver quality care to underserved populations.

Closing the gap in racial health disparities requires proactive efforts on a number of fronts. Says Janet Cleveland: "A comprehensive response from all sectors -- individuals, community and government -- is critical."

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