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February 10, 2005

Wisconsin professor details race disparities in health care

Scott Daugherty

The color of your skin does have an effect, sometimes dramatically, on the type and quality of care received from health care professionals. Race also plays a strong role in indicating your life span, types of diseases and infant mortality rates. But the data is often “paradoxical,” said David Williams, a professor of sociology at the University of Wisconsin.

In every category of determining health — except mental health —American-born blacks and other American-born minorities have significantly poorer health than American-born whites. Meanwhile, all newly arrived immigrants have better health than those born in this country.

Professor Williams, last week, gave a lecture “Racial Disparities in Health: Challenges & Opportunities,” at the Harvard School of Public Health. The lecture is the opening salvo in the school’s three-part symposium, “Diversity and Public Health.”

According to Williams more research has to be done and the results need be translated into public policy.

“We must improve the health of the disadvantaged more rapidly than other groups,” he said.

Williams emphasized that past efforts have been ineffective at closing the health gap.

“What we have done over the last 50 years has done little to reduce the disparity and we have done much, including the civil rights revolution,” he said. “Racial disparities are persistent over time.”

More research is needed, in part, due to the complexity of the issues being examined and the lack of trustworthy data from which to begin an investigation. Williams pointed out the difficulty in relying on existing data by recognizing that black Americans were undercounted in the national census by at least 13 percent.

Also, he showed data that indicates classification of race, upon death, is unreliable for people of color. These data are used for most calculations on life expectancy and determining comparative rates of illness.

The complexity of the issue is entwined with our concept of race. Williams emphasized that race is a social category, “race is the pigment of our imagination.” He quickly added that although race is a social construct, “we must acknowledge racial differences in order to move forward.”

“Race still continues to matter for health, even when income is equal,” Williams said. And in showing another flaw in basic data gathering, Williams explained that while means testing (gathering information on income levels) is often employed it ignores the question of wealth.

Adding to the complexity is the paradoxical nature of some of the data. According to Williams, as black men increase their socio-economic status their levels of stress increase and their health deteriorates. In contrast, when black women increase their socio-economic status their stress levels decline and health improves. In addition, he noted that while black Americans have higher rates of hypertension than white Americans do, black Africans have lower rates than white or black Americans do.

Williams says that these seemingly contradictory results call for more research to identify how environmental factors interact with genetic expressions.

While acknowledging that the sources of racial disparities in health care are many, Williams still says racial discrimination plays a significant role.

“Racism continues to affect health, not only interpersonally, but systematic and institutional forms of racism,” he commented.

Williams notes that the worst urban context in which whites reside is better than the average for the black community. To bolster his point he refers to a 1991 segregation index which has the old Republic of South Africa having an index value of .90 while Detroit has a value of .85 and NYC is at .81 while the U.S. as a whole has a value of .66. He also referred to a survey that showed that only 1 in 5 white people would be willing to say that black people are hardworking.

Williams suggests that much of the disparity in health care treatment arise from unconscious discrimination. He goes on to explain a universal human trait, “when one holds a negative stereotype about a group and meets someone who fits that stereotype, you will discriminate.”

And the factors that increase the use of stereotypes are the same ones that doctors work under, for example, a short amount of time, stress, etc. All you need, according to Williams, is the presence of stereotypes — no matter what kind — in order to unconsciously discriminate.

“You do not need intent,” he concluded.

Socio-economic status is only one measure to be used in understanding disparity, because when it is factored in, race still matters.

“That racial discrimination in health is largely pervasive and persistent over time reflects larger social inequalities in society,” he concluded.

The one aspect of health that seems to have no negative racial component is mental health. According to Williams blacks have lower rates of all mental illnesses, except depression in black youth and that, this lower rate of mental illness, might be due to, “black communities mobilizing resources [family, church, etc.] to confront ills.”

 

 

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