Today, there are still significant disparities in the quality of treatment and health outcomes of Caucasian and African-American populations in the United States. The Civil Rights Acts of 1957, 1960, 1964, 1968, and the Voting Rights Act of 1965 put an end to the Jim Crow Era and gave a new status to US Black people. However, they did not eradicate the system of institutionalized racism that persisted into the 21st century. As a result, African-Americans still have limited access to wealth, education, employment opportunities, and medical services (Yearby, 2018). This paper discusses health disparities between Caucasian and African-American populations and proposes interventions that could help tackle the problem.
Health Disparities: Facts and Numbers
Caucasian and African American households vary in social determinants of health. One such determinant is household income and net worth that is almost 13 greater in White families than in Black families (Yearby, 2018). The trend continues to exacerbate as, in the last three decades, the average Caucasian household net worth increased by $45,000 while the average African-American household lost $1,000 (Yearby, 2018). Given that US healthcare is not socialized and considered one of the most expensive in the world, it is a person’s wealth that often decides the timeliness and quality of medical help. Another manifestation of the centuries-old racist legacy is the ongoing residential segregation of Black people. As pointed out by Bailey et al. (2017), African-American people’s places of residence tend to be confined to neighborhoods and areas with high crime rates, air pollution, and poor access to medical health.
These factors translate into actual facts and numbers that show how disadvantaged minorities are when it comes to health. Black people’s infant mortality rate is 10.8 per 100,000 live births, which is two times higher than white people’s rate (Bailey et al.,2017). Per the proportion of the population reporting psychological distress, African-Americans only come second to Native Americans. Another concerning fact is that Black Americans are twice more likely to die from diabetes-related complications than Caucasians: 38.7 vs 19 per 100,000 people respectively.
Interventions
Removing racial disparities in US healthcare will require interventions at all levels. Bailey et al. (2017) suggest that some social determinants of health can be addressed outside clinical settings. More than two decades ago, the Atlanta Housing Authority collaborated with private philanthropists to rebuild communities and promote mixed-income development. The efforts included creating jobs and introducing a comprehensive cradle-to-college curriculum. These changes helped the residents become more stable and provide sufficient education for their children (Bailey et al., 2017). The New York City Housing and Neighborhood Study confirmed that housing mobility that allows minorities to leave their deprived neighborhoods results in long-term social and health benefits. A significant number of participants even reported a relief in their chronic conditions, which not only improved their quality of life but also lightened the national burden of disease.
Inarguably, the healthcare system itself should also be reformed to bridge the gap between White and Black people’s health outcomes. Wasserman et al. (2019) claim that the Affordable Care Act (ACA) was probably one of the most profound pieces of legislation that changed the US healthcare system. Many uninsured individuals were finally able to obtain insurance, with the sharpest increases in the insurance rates observed in poor, underprivileged, and Black communities (Wasserman et al., 2019).
Yet, the question remains as to whether the ACA will account for more efficient and affordable care in the long term. A surge in the number of insured residents may mean a greater workload for existing health facilities, especially for those in underprivileged neighborhoods. For this reason, Wasserman et al. (2019) argue that the ACA should be accompanied by other measures such as the patient-centered medical home model. The model is still being developed, and if it is done successfully, the new approach will have the potential to reduce costs while improving the accessibility of health care. The concept revolves around increased communication between clinicians and patients and extended office hours to ensure that no one remains unattended.
There are measures that may be undertaken at the hospital level. Bartolome et al. (2016) report the changes that helped to reduce the incidence of hypertension in Black populations, which are especially at risk of developing the said condition. In particular, Bartolome et al. (2016) reinvented the healthcare delivery process to get a better hold of hypertension in the population and made adjustments to therapeutic communication. Their plan involved two-week blood pressure follow-ups and group appointments accompanied by patient education to make sure that individuals receive the necessary support.
As for communication strategies, Bartolome et al. (2016) proved the efficiency of culturally tailored communication guides that draw on recent research and acknowledge cultural and health beliefs. Yearby (2018) expresses a similar opinion about intercultural communication, emphasizing the need for “cultural humility” in healthcare workers. The said kind of humility allows care providers to be more accepting of other cultures and abstain from imposing their own views. As a result of the intervention, Bartolome et al. (2016) were able to increase the share of controlled hypertension cases from 76% to 85% and narrow the racial gap from 6.5% to 2.8%.
However, for health workers to be able to implement the changes, they need to be trained for the future. Bailey et al. (2017) state that medical schools brush over the racial aspects of health care. While race is discussed, racism barely ever makes part of conversations, let alone comes to the forefront when talking about racial disparities. It is true that many medical schools now make diversity and cultural competency training a part of their curriculum. However, such classes are often too brief or diverted to online to save time for other subjects. Bailey et al. (2017) claim that New Zealand and Canada provide good examples of integrating structural competency, cultural humility, and cultural safety in healthcare delivery.
Conclusion
Structural racial discrimination is pervasive: it operates on the societal level and provides the members of the privileged group with resources, often at the expense of the minorities. Recent statistics show that African-Americans do not enjoy the same level of healthcare as Caucasians do. Moreover, some social determinants of health further deprive them of receiving medical help. To address the disparities, measures need to be taken at various levels. Firstly, changing communities and facilitating housing mobility may help Black populations. Further improvement may be achieved through legislation such as the ACA and patient-care models. Locally, hospitals can make adjustments to the healthcare delivery process and therapeutic communication. Education needs to play an instrumentation role in closing the gap.
References
Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389(10077), 1453-1463.
Bartolome, R. E., Chen, A., Handler, J., Platt, S. T., & Gould, B. (2016). Population care management and team-based approach to reduce racial disparities among African Americans/blacks with hypertension. The Permanente Journal, 20(1), 53-59.
Wasserman, J., Palmer, R. C., Gomez, M. M., Berzon, R., Ibrahim, S. A., & Ayanian, J. Z. (2019). Advancing health services research to eliminate health care disparities. American Journal of Public Health, 109(S1), S64-S69.
Yearby, R. (2018). Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. American Journal of Economics and Sociology, 77(3-4), 1113-1152.
