Health Care/Joan Retsinas

Health Through Prism of Race

In a thoughtful speech—without fiery platitudes or anodyne reassurances—Sen. Barack Obama began a conversation on race that needs to continue.

Admittedly, many Americans—mostly whites ones—feel that the conversation is no longer necessary. After all, 53 years after Emmett Till, a black teenager from Chicago, was brutalized and murdered in Mississippi for whistling at a white woman, Americans can rejoice: We have transcended the overt bigotry of genocidal intentions. No more cross-burnings. No more lynchings. No more Jim Crow laws. Today race is not a bar to lunch counters or public buses. It is not a bar to Congress, the Cabinet, even the Presidency. On the other hand, many Americans (more white Americans than black) have no clue who Emmett Till was. Today’s Generation X may well consider race no longer divisive.

The cleavage, though, remains.

Look at health through the prism of race, and you see the cleavage.

African-Americans suffer disproportionately from stroke, diabetes, cancer, asthma. The statistical gaps range from minor to major. Here are few numbers: For women, the age-adjusted prevalence of colon/rectal cancer per 100,00 population is 54 cases for black women, 43.3 for white women. For men, the rates for prostate cancer are 251.3 for black men, 167.8 for white men, for cancer of the lung, 108.2 versus 72.8, for colon/rectal cancer, 68.3 versus 58.9. Black children are more likely to have asthma. Black babies are more likely to be born at a low birth weight. Black men are 10 times more likely to die from hypertension than white men under age 65. Sixty percent of children, ages one to five, with elevated blood levels for lead were black. The gap is long-standing. The federal Centers for Disease Control and Prevention has been tracking it for years.

The gap extends to health care. African-Americans are disproportionately—that word again—likely to be enrolled in Medicaid. They are more likely to be treated in the public hospitals and clinics that have been hemorrhaging under years of fiscal conservatism. In general, African-Americans fare worse in getting preventive care (50% of black people over age 65 are vaccinated against influenza, versus 69% of white. The pneumonia vaccination rates are 37% versus 60%.) When they are treated for cancer, they fare worse than their white counterparts. The gap shows up even in dental care: 25.1% of black children have untreated caries, versus 14.4% of white children. []

Statistics, though, are a preamble to the more complicated discussion of explanations. Biology is not the explanation. Race is more a social construct than a biological divide. Indeed, many Americans are mixtures of disparate ethnicities. So while some diseases may be linked to ethnicity (e.g., sickle cell anemia, Tay-Sachs disease and neural tube defects), physicians don’t generally trace heart disease, cancer, asthma, diabetes or prematurity to ethnic roots.

The explanations are complex. “Health status” is embedded in a social nexus of income, education, housing and occupation. African-Americans as a whole are not just sicker, but they are poorer, less educated, less likely to live in safe neighborhoods, less likely to be employed in stable jobs (with employer-provided health insurance). Any solution to health disparities will have to address the larger nexus.

That is hard. Whatever politicos promise in this season of promises, there is no magic bullet that will quickly redress the disparity in income, remake public education, revamp housing programs, institute universal health insurance. But until we give all Americans, whatever their color, the foundation for a wonderful life, race will remain a divisive cleavage.

This campaign season, the country is engaged in multiple conversations: the teetering economy, the imploding housing market, the wars overseas, the health insurance system. In all these conversations, race is a sub-text.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, May 1, 2008

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