Monday, February 11, 2008

Reality check: health disparities

I'll just warn you right up front: election season is getting to me.

We Americans may all be created equal, but substantial -- and shameful, in my view -- disparities in health status exist in the United States. Racial and ethnic minority groups, as well as rural and other underserved populations, bear a disproportionate burden of cancer, heart disease, and myriad other health problems. They have less access to health care, and when they do manage to get care, it's of lower quality.

Yes, it's complicated, and yes, there are lots of factors that contribute. But there's just no getting around the hard numbers on this one. Just to give you an idea of what we're talking about, according to the 2006 National Healthcare Disparities Report:
  • Hispanics received poorer-quality care than non-Hispanic Whites* for 77% of core measures. Blacks* received poorer care than Whites* for 72% of core measures. American Indians and Alaska Natives are behind by a mere 41%. What are the "core measures"? Oh, silly little things like whether a woman gets breast cancer screening, or whether kids get dental care.
  • Here's a shocker: across the board, poor people had worse access to care than the well-off. You really should check out the graph--it's a plain solid bar, representing 100%.
  • Health care providers were less likely to inform obese Blacks and Mexican Americans, along with people with less than a high-school education, that they were overweight. These are populations with a higher prevalence of Type 2 (adult-onset) diabetes--perhaps those who could most benefit from a little counseling on this point.
The list goes on. Those who want to learn more can check out the National Partnership for Action To End Health Disparities. Meanwhile, here's a question you might want to keep in mind as we learn more about the candidates' plans for health care reform: Is it really acceptable for the richest country in the world to allow this kind of inequity?

When you hear people say that we don't, and won't, and can't allow health care rationing, and that choice is the most important thing, please remember these statistics. We absolutely do ration health care in this country. We just don't talk about the criteria we use to decide who gets it and who doesn't. People who are on the "don't" list don't have any choices at all.

*That's the Feds' classification.

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