ARCHIVES OF LEAD STORIES
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.”
Back
to Lead Story Archives
Home
Page
