On MLK Day, never forget his view: ‘Injustice in health is the most shocking …’

mlk-300x207With the nation taking a holiday to celebrate the remarkable life of the Rev. Dr. Martin Luther King and his pioneering push for Americans’ civil rights, it may be worth remembering that his far-reaching visions of equality and social justice were deeply unpopular in their time, as was he.

King infuriated many, including in medicine and health care, observing, for example, that:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”

Racial disparities in the quality, safety, and accessibility of health care, alas, have not disappeared in this country, even with the power of voices like King’s demanding change.

The reasons why are stubborn, sad, complex, and unacceptable, as they were detailed recently in the New York Times “Upshot” column by Austin Frakt, the director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System, an associate professor with Boston University’s School of Public Health, and a senior research scientist with the Harvard T.H. Chan School of Public Health. As he reported:

“Put simply, people of color receive less care — and often worse care — than white Americans. Reasons includes lower rates of health coverage; communication barriers; and racial stereotyping based on false beliefs. Predictably, their health outcomes are worse than those of whites. African-American patients tend to receive lower-quality health services, including for cancer, HIV, prenatal care and preventive care, vast research shows. They are also less likely to receive treatment for cardiovascular disease, and they are more likely to have unnecessary limb amputations. As part of ‘The 1619 Project,’ Evelynn Hammonds, a historian of science at Harvard, told Jeneen Interlandi of The New York Times: ‘There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.’”

There have been improvements, notably in health coverage that black Americans could secure as a breakthrough result of the Affordable Care Act, the landmark health legislation passed in the time of Barack Obama, the nation’s first black president.

As the nonpartisan, independent Commonwealth Fund reported:

“The ACA’s coverage expansions have led to historic reductions in racial disparities in access to health care since 2013, but progress has stalled and, in some cases, eroded since 2016. The gap between black and white adult uninsured rates dropped by 4.1 percentage points, while the difference between Hispanic and white uninsured rates fell 9.4 points. Disparities narrowed in both states that expanded Medicaid eligibility and in those that did not. In expansion states, all three groups had better overall access to care than they did in non-expansion states, and there were generally smaller differences between whites and the two minority groups. Five years after the ACA’s implementation, black adults living in states that expanded Medicaid report coverage rates and access to care measures as good as or better than what white adults in non-expansion states report. While black working-age adults have benefited significantly from Medicaid expansion, they disproportionately (46%) reside in the 15 states that haven’t yet expanded their programs.”

Black Americans, though, hold deeply pessimistic views of their place now in the country, especially under the current administration, and they have “fears about whether their children will have a fair shot to succeed and a belief that white Americans don’t fully appreciate the discrimination that black people experience,” the Washington Post reported, based on its recent poll with Ipsos.

Still, the survey respondents expressed optimism about their own lives.

This persistent resilience, other notable researchers have found, has meant that African Americans — even while struggling with equally bad or worse economic conditions combined with racism — have not succumbed, as whites and especially white men have, to what many have dubbed an “epidemic of deaths of despair.” On the other hand, it may be that racism and shattered expectations of racially entitled privilege is a big part of the “despair” that affects poorer, less educated whites?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of treatments and prescription medications, too many of which turn out to be dangerous drugs.

As they deal with crushing illness and injury, too many patients also get ground down by a cash-laden health care system that has grown too big and too callous to see how it subjects patients to needless, dehumanizing care. It, sadly, is afflicted with racism, sexism, ageism, homophobia, and other negative biases and blindness that detract from the best efforts of so many fine doctors, nurses, and other caregivers. They and we have come to consider health care not a privilege for the rich and few but a right for all Americans.

We need to recognize the system’s many problems, to call them out, and to ensure they stop and do not recur. But as a man of faith, Dr. King also showed the nation that compassion must accompany condemnation. The pursuit of justice must itself be just and without rancor. It always must be nonviolent. A half century and more have passed since his death. But we have much to reflect and act on if we and this country really hope to advance to the mountaintop goals to which Dr. King made us so aspire.

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