Race plays a too negative and persistent role in health care in DC and elsewhere

Boston_University_Medical_Center-300x184Racial and economic disparities not only persist in American health care, they do so to the measurable detriment of millions. Have they become so common and accepted that too many ignore them and their harms?

The Boston Globe, as part of its series on race relations, has reported that “segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white.” The newspaper explained:

The reasons are complex. More whites live near [renowned academic medical centers like Massachusetts General Hospital — aka MGH]. Certain lower-cost health insurance plans generally don’t pay for care at Harvard Medical School’s high-priced academic medical centers, including Dana-Farber and MGH. And some blacks are uncomfortable at mostly white institutions — or those institutions may not make them feel welcome — a divide compounded by a dearth of black physicians. All of this creates likely disadvantages for blacks, who suffer far worse health overall than whites because of poverty and environmental reasons — a gap city planners recently said is persistent and growing. Some black leaders worry that blacks are handicapped because they don’t have, or don’t believe they have, the same array of health care choices.

Racial disparities in Boston may be a cause for greater concern because Massachusetts pioneered providing health insurance coverage to as many of its citizens as possible. But even when blacks are insured and could go to some of the city’s world-class medical facilities, they don’t. They prefer hospitals that historically welcomed black patients. And they report at higher than expected rates that if they do cross familiar lines, their experiences can be poor. As the Globe has reported:

Eleven percent of black Bostonians reported being mistreated by health care professionals because of their race in the city’s health care survey in 2013, compared to 2.5 percent of white residents. Those numbers have barely budged over a decade.

Mass General and other name institutions in Boston say they have worked hard to improve their relationships with communities of color. Some well-known hospitals in the metropolitan area have good standing with blacks and Latinos, because they’re surrounded or near their communities and over time have become good neighbors. But patients take sharp notice that elite medical centers in Boston (as they self-reported to the newspaper) have few doctors and specialists of color on their staffs.

Still, in Boston, at least, the Globe has reported that the hospitals that most serve blacks and Latinos, institutions like Boston Medical Center (shown above) rate in reasonable fashion on quality and access measures.

For Washingtonians, that has become less true — especially as United Medical Center (UMC), the District of Columbia’s only public hospital and a major provider of health care for residents of the nation’s capital living east of the Anacostia River, plunges into a deepening fiscal and care crisis.

District officials have been asked to come up with $17 million in a new taxpayer subsidy of the beleaguered hospital, so it can settle a long, painful labor dispute with its nurses, repay Uncle Sam for disputed Medicare charges, and hire a medical group associated with George Washington University to bolster emergency services. The hospital also must cover a $2 million crater in patient revenue due to the negative attention it has received for its problematic caregiving.

UMC was forced to shut its nursery and obstetrics services after regulators and news reports uncovered what were deemed to be serious medical errors in the treatment of pregnant women and newborns. Hospital officials for weeks have insisted they could fix problems and restart needed care for expectant mothers and newborns.

In a session closed to the public, however, the hospital’s board decided it could not go forward with the cost of any fixes and restarting the obstetrics and nursery care, especially given the hospital’s other fiscal woes.

The tumult at the Southeast Washington institution — including a running drama over the highly paid and politically well-connected consulting firm that was supposed to turn UMC around — can’t inspire much confidence in the capital’s communities of color about the hospitals and medical centers that offer them care. The various independent government and nonprofit groups that rate such facilities also keep giving the facilities poor reviews.

In my practice, I see the major harms that patients suffer while seeking medical services and their struggles to not only afford but to access medical care. Separate and unequal medical care is simply unacceptable — in Topeka, Kansas (birthplace of Brown versus Board of Education), Washington, D.C., or Boston.

DC politicians may try to put a brave face on their closing of UMC’s obstetrics and nursery services, arguing that the hospital didn’t serve that many women and women of color. But burdening expectant mothers even a little more is an issue that public health leaders in the District and across the country need to think hard about, given the nationwide, abysmal maternal death rates — especially for black women.

NPR recently put a human face on the toll this is taking, telling the story of Shalon Irving, a 36-year-old an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, what public radio called “the pre-eminent public health institution in the U.S.” As NPR has reported, three weeks after giving birth, Irving collapsed and died of complications from high blood pressure. “Even Shalon’s many advantages — her B.A. in sociology, her two master’s degrees and dual-subject Ph.D., her gold-plated insurance and rock-solid support system — had not been enough to ensure her survival. If a village this powerful hadn’t been able to protect her, was any black woman safe?”

Some researchers say that all too prevalent racism creates such constant stress for American minorities that their health suffers accordingly. This is a woe needing constant combating. It’s also worth noting that political tensions and harsh rhetoric associated with the debates over U.S. immigration policies are creating deep distress in immigrant communities of Latinos, Asians, and Muslims, with the Henry J. Kaiser Family Foundation reporting on its recent research that:

Increased fears are having significant negative effects on the health and well-being of children that have lifelong consequences. Parents and pediatricians reported that children are manifesting fears in many ways. They described behavioral changes, such as problems sleeping and eating; psychosomatic symptoms, such as headaches and stomach aches; and mental health issues, such as depression and anxiety. Parents and pediatricians also felt that fears are negatively affecting children’s behavior and performance in school. Pediatricians uniformly expressed significant concerns about the long-term health consequences of the current environment for children. They pointed to longstanding research on the damaging effects of toxic stress on physical and mental health over the lifespan. They also expressed concerns about negative effects on children’s growth and development, and felt that the current environment is compounding social and environmental challenges that have negative impacts on health.

This is not good. We clearly have a long way to go to live up to the American dream, including of a fair, accessible, safe, and excellent health care system.

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