Health care disparities in America effects every American either directly or indirectly. It certainly impacts the poor, the underserved and the disenfranchised disproportionately. But, it also effects the affluent either personally or to the extent that it influences society as a whole. As defined by the Centers for Disease Control (CDC), health care disparities are an array of preventable differences due to the hardships of disease, injury, violence or anything that hinders socially disadvantaged groups from to attaining optimal health. This essay attempts to explain the factors contributing the health disparities, their impact and the challenges ahead. Moreover, it hopes to make the case that health care disparities are preventable and signals that even a larger societal problem exists, racism.
Poorer communities most often do not have access to excellent health care. During the 246 years of slavery in America and in the Jim Crow era which followed, this was by design. Before the Covid 19 Pandemic, when the national unemployment rate hovered around 3.8%, Blacks without jobs was double at about 6%. After the draconian business lockdowns and “stay at home” measures, national unemployment soared as high as 14%, even higher for Blacks (16%).
Dropping out of school is associated with many health and social conditions. The less educated are more prone to health risks: including diabetes, hypertension, asthma, obesity, heart disease, teenage pregnancy, substance abuse, gang involvement and physical inactivity.
Studies show that implicit biases in both the general population and in health care givers exists, leading to missed diagnosis and less than optimal treatment. One survey found that medical students believed that Blacks suffered less pain that Whites. Many students felt that there were biological and genetic differences between Blacks and Whites, though no scientific evidence exists to support this premise. According to the Journal of the American Medical Association (JAMA), cancer diagnoses and treatments vary between Blacks and Whites because of health disparities. Moreover, the New England Journal of Medicine cites that AIDS/HIV treatments differed among the races as well.
The bottom line is that low socioeconomic status based on lower income and lower education is associated with numerous health conditions, poor access to health care, poor utilization of health care, poorer quality of health care and shorter life spans. The cycle continues generation to generation. In the case of Blacks, 12 generations of health care disparities began with slavery when Blacks were treated slaves as property, commodities, as less than human, to be sold and bartered like cattle. Families were torn apart, ruthlessly never to be seen together again.
By law, slaves were not taught to read or write, assemble in large groups, nor travel without a pass. Even despite the Emancipation Proclamation (1862), the 13th Amendment to the Constitution (1865), Civil Rights Act (1964) and the Voting Rights Act (1965), segregation, racism and discrimination, and institutional social injustice continue to this day. The protests and rioting after numerous public deaths of Blacks at the hands of police show of the frustration of the Black people struggling for fairness, justice and common decency.
Furthermore, Blacks are justified in not trusting governments: local, state and federal. Case in point, in 1932 400 African American sharecroppers were told by the US Public Health Service that they were being treated for syphilis when they were not. Even after an effective treatment in the form of penicillin was discovered, the infected African American men were immorally not treated; leading to blindness, mental illness and death. Even in 2020, poor and affluent Blacks alike are the victims of health care disparities.
The future is uncertain. Racism in North America has been present even before 1619 when the first African slaves were brought across the Atlantic Ocean to Virginia. In contemporary times, before health care disparities can be solved, it must be acknowledged by the masses and by our leaders. Before implicit bias can be eliminated, it must be accepted and solving it must be a priority. Plato said it best when he stated that our leaders must be philosophers; and philosophers must be our leaders. Only when our leaders have knowledge, use their logic and make generous and wise decisions, will all citizens benefit.
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