Jan 16 2013
Comments

Time to Understand and Eliminate the Destructive Racial Disparities that Plague Our Health Care System

Gaurdia Elane Banister, RN, PhD, is executive director of the Institute for Patient Care at the Massachusetts General Hospital in Boston, and an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program. This post is part of the "Health Care in 2013" series.

file

Historically, it seems that we are a country that takes a step forward only to take two steps back. Consider that May will mark 59 years since our schools were desegregated, yet it required the efforts of the National Guard to allow the “Little Rock Nine” entry into Central High School three years after this declaration. In July we will mark 49 years since President Johnson signed the Civil Rights Act of 1964, one-month after which the bodies of three civil rights workers were found in shallow grave. And, of course, the 20th of this month will mark four years since we inaugurated our first African-American President of the United States, though our health care system is still woefully deficient in providing care to minority groups.

The Affordable Care Act, in many ways, addresses the grave disparities that exist in health care due to race and ethnicity. Extending coverage to the nearly 46 million uninsured Americans—more than half of whom are minorities—will address a serious need, but this act alone will not begin to resolve the larger issue at hand.

Simply put, some health care providers treat minorities differently. The various rationalizations for minority groups’ inferior health standing—including lack of access or insurance, refusal to seek treatment, and so forth—have proven to be somewhat faulty. Instead, it seems that the fact that the rate of hospitalization for minority patients is more than three times that of white patients is not, in fact, due to lifestyle choices, but instead is attributable to egregious discrepancies in the management of these patients’ physiological needs as compared to their non-Hispanic White counterparts. Unsurprisingly, there exists a strong correlation between this racial disparity and minority groups’ higher mortality rates.

As a people, we tend to believe in individual responsibility and control, and we maintain our faith that hard work and perseverance will ultimately offer an equitable return for our efforts. While admirable, we also have little interest in learning from other countries and have developed a health care system in which the consumer has little sovereignty in decision-making. Meanwhile, we seem to develop an increasingly high tolerance for inequality as we focus on our own personal struggles.

In the past 20 years, the Hispanic population of the U.S. has more than doubled in size; meanwhile, the minority population in aggregate grew at 11 times the rate of the non-Hispanic White population. Today, the racial and ethnic makeup of our country looks vastly different than it did during the years of Thurgood Marshall, President Johnson, or the “Little Rock Nine,” and this evolution is guaranteed to accelerate. In fact, though only five U.S. states are majority-minority states at present, it seems more than likely that racial and ethnic minorities will become the majority of the population before we reach the mid-century mark. Seem implausible? Consider that in 2011, 50.4 percent of children younger than 1 year (in the U.S.) were neither single-race White nor Hispanic—indicating a 49.5 percent increase since the previous year.

As it becomes increasingly evident that the demographic of the U.S. is tipping the scales, I would like to see our country leverage the opportunities that are on the horizon and resolve to more comprehensively understand and eliminate the destructive racial disparities that plague our health care system. Furthermore, I believe that it is imperative that the providers delivering care reflect and represent the patient population that they serve. These providers should also be in leadership positions to influence and lead change.

Tags: Barriers to care: cultural, gender and racial, Disparities, Executive Nurse Fellows, Health Care in 2013, Human Capital, Nurses, Nursing, Underserved populations, Voices from the Field