HEALTH CARE: Economic Crisis Worsens Racial and Ethnic Health Disparities

The rising rates of unemployment and the growing numbers of uninsured people are exacerbating health disparities in low income and minority communities that already suffer from barriers to care and high rates of chronic disease. The Kaiser Family Foundation recently a hosted a webcast moderated by Cara James, Ph.D, the Foundation's Senior Policy Analyst on Race, Ethnicity, and Healthcare, to look at these all-too familiar patterns.

Howard University economist Dr. William Spriggs sketched out the economic backdrop. Nationally, the unemployment rate in February was 8.1 percent. For blacks, it's above 13 percent, and in Latino communities it ranges from 8 to 14 percent. Joblessness is a double-whammy, because it often means people also lose employer-sponsored health insurance. African-Americans are more likely to be on Medicaid, which is being squeezed in many states by the economic crisis (although the stimulus funds will help somewhat). African-Americans (even those with relatively high incomes) are being disproportionately hit by the mortgage and foreclosure crisis.

Adrienne Hahn, a senior attorney at Consumers Union, emphasized that we know that the uninsured get less care and suffer worse health outcomes (see the Moral Case for Reform on page 4). For African-American communities, already burdened by high rates of such conditions as diabetes, heart disease, and cancer, having a source of regular care to manage chronic disease is crucial. She said:

We know that minorities have higher rates of being uninsured. African-Americans, Latinos, and Asians have a higher propensity of being uninsured compared to whites. And we know that folks that are uninsured don't receive the same level of care as those that are insured. So, we're seeing them cutting back on care, reducing their medications, not visiting their providers more frequently, even for those folks who have chronic conditions.

Dr. Lauren Smith, the medical director of the Massachusetts Department of Public Health, pointed out how poverty shapes the environment and neighborhoods, which in turn create more obstacles to good public health.

The impact of social factors on the development of illness and the patterns of illness really is one that we are very aware of in the Department of Public Health and has well established in the literature in the terms of exposures to substandard housing, to differential rates of environmental air pollution and other kinds of exposures. The kinds of burdens of disease that low-income and minority folks carry with them before they even enter the healthcare system, even when they are insured.

Those things speak to the issues that the other panelists have raised in terms of what kind of neighborhood can you afford to be in, what kind of access to thingst hat promote health like physical activity in a safe environment, access to grocery stores. What's the proportion of liquor stores and fast food restaurants in your neighborhood? Advertisement for smoking and alcohol, those things are all what we would call the social factors that have a direct relationship both to the complex interplay of race and income in our communities.

So I would say that anything that has an adverse impact on the overall sort of social environment we know is going to ultimately have an impact on health because those social factors are such important drivers of health and well-being.

It's particularly worrying now, she said, when recession-driven budget cuts in her own state are affecting everything from tobacco prevention programs to services for the mentally retarded. And even though Massachusetts is the only state to have moved toward covering everybody, in really tough times like these even a $10 co-pay for a drug or doctor's visit can be tough to afford. And in the long run, it's not good health care, good policy, or good economics if people skimping on routine care or management of their conditions end up in the emergency room.

The speakers praised the funds for Medicaid and COBRA subsidies in the stimulus, as well as the Obama administration's expansion of the state children health insurance program. But they agreed that those steps were miniscule given the scope of the problem. The solution, they said, is comprehensive national health care reform that will meet the needs of all Americans, of all races and all incomes.