“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Martin Luther King Jr. in a speech to the Medical Committee for Human Rights, 1966

Today we observe the birthday of slain Civil Rights champion the Rev. Dr. Martin Luther King Jr. It is natural that many measure the impact of what Dr. King brought to citizens of the United States and the world by comparing conditions during the Civil Rights movement with conditions today.

I think many will agree that landmark legislation like the Civil Rights Act of 1964 and the Voting Rights Act of 1965 were stellar outcomes from the movement focusing America on equal treatment and mandating that certain unalienable rights be protected–not just for some, but for everyone.

However when we take a look at what Dr. King had to say about healthcare in the 1960s and compare our country’s statistics today, some fifty years later, have we improved? Are those unalienable rights to life, liberty and the pursuit of happiness protected?

Al Sharpton said “It’s an atrocity that in a country as powerful as the United States, people are falling ill, losing their homes and going bankrupt all because of a corrupt system that only benefits insurance conglomerates and those in their pockets. Why is it that the U.S. life expectancy today still lags behind 30 other nations? Why does a hard-working factory worker in the Midwest have to choose which finger to amputate because he could not control his diabetes in time? Why does a teenager in California have to die because her insurance company gave her the run around when she was seeking treatment for her aggressive cancer? And why are so many forced to travel to Mexico, Canada and England to get cheaper medicine and better treatment for their ailments?”

The 2010 Report on Healthcare Disparities reports four themes from that emphasize the need to accelerate progress if the nation is to achieve higher quality and more equitable health care in the near future.

  1. 1. Health care quality and access are suboptimal, especially for minority and low-income groups.
  2. 2. Quality is improving; access and disparities are not improving.
  3. 3. Urgent attention is warranted to ensure improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations, including:

  • o Cancer screening and management of diabetes.
  • o States in the central part of the country.
  • o Residents of inner-city and rural areas.
  • o Disparities in preventive services and access to care.

Progress is uneven with respect to eight national priority areas:

  • o Two are improving in quality: (1) Palliative and End-of-Life Care and (2) Patient and Family Engagement.
  • o Three are lagging: (3) Population Health, (4) Safety, and (5) Access.
  • o Three require more data to assess: (6) Care Coordination, (7) Overuse, and (8) Health System Infrastructure.
  • o All eight priority areas showed disparities related to race, ethnicity, and socioeconomic status.

Disparities in quality of care are common:

  • o Blacks and American Indians and Alaska Natives received worse care than Whites for about 40% of core measures.
  • o Asians received worse care than Whites for about 20% of core measures.
  • o Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
  • o Poor people received worse care than high-income people for about 80% of core measures.

This is a bleak report of circumstances and can be overwhelming unless we begin to peel these issues back one layer at a time and begin to make progress so that in the next fifty years we are not in this same position as a country.

The way I see the major causes of the healthcare disparities, they can be described as 1) Genetic causes or predisposition to illnesses, 2) Environmental causes of disease, 3) Education to prevent or maintain illness, and 4) Access to good healthcare. My ideas to close these disparities include the following:

Genetic causes or predisposition to certain illnesses

Closing the gap on genetic predisposition to certain illnesses is something that research scientists will have to explore and not something that we can change other to be informed about healthy practices and possible prevention. What will be paramount to obtaining the proper research of these diseases is to train scientists, researchers and policy officials with an inherent desire to repair these inequities. An example of a disease with genetic predisposition is African Americans and Sickle Cell Anemia.

Environmental causes of disease

Environmental causes of disease include many cases of Type 2 Diabetes and complications of diabetes, certain types of heart disease and hypertension. Let’s deal with this section in two major categories: diabetes and heart disease.

Type 2 diabetes, unlike Type 1, is usually caused by a significant gain in weight such that the body cannot produce enough insulin or what is called insulin resistance, whereby the insulin cannot be used efficiently by the body. If the causes of this type of diabetes are not diagnosed and treated in short order, it is likely that the patient will need to supplement or provide insulin to the body via insulin injections. Likewise, if the patient is able to lose weight and eat properly, in many cases the diabetes condition can be reversed.

In this case, the environment (with a lack of diabetes education, jobs/income to choose healthy foods, and access to healthcare), works to the detriment of ethnic minorities (because of the disparity in unemployment rate) and particularly the poor.

Heart disease and hypertension are other diseases that exist in large part because of poor food choices, a lack of exercise and education as well as conditions that often go untreated. Stress is another factor that worsens this disease and can exists under conditions of deciding whether to purchase medication or food; strained family relationships or stressful work environments.

It would seem that if our healthcare system spent more dollars on education and prevention, perhaps it would need fewer dollars to treat illness and disease. No one wants to develop diabetes or heart disease. And so it follows that if people knew how they could prevent certain diseases or manage them if they have already developed them, they would begin to transform their environment to include a healthy regimen. This is at least worth a study, in my opinion.

Education and Access to Quality Healthcare

Education in terms of providing understanding of the causes and treatments of the diseases found disproportionately in poor and minority communities is something that should be given increased budgetary consideration at health insurance companies and federal and state governments. It is my belief that if people are given understanding about the diseases that occur disproportionately in their community, they will do what is conceivably possible to avoid them. If they are able to avoid the diseases, and it is verified through access to physicians who verify this, then the dollars spent up front on education and prevention replace and reduce the dollars spent on treating diseases.

For example, if a person diagnosed with Type 2 diabetes is able to control her glucose in large part because she lost weight through a better diet and exercise routine of walking her dog, think of all the money saved (by the insurance company, governments, and the individual) from not treating Diabetic Ketoacidosis, or Neuropathy or Kidney Disease? Think of all the tax dollar revenue governments could collect through her income tax because she was able to continue working.

Not only does education and prevention help reduce healthcare disparities, but it makes good fiscal sense.

Share