In Massachusetts, pervasive health care disparities lay bare a troubling reality—one that our society is often uncomfortable discussing: By many common health measures, race still plays a dramatically powerful role in limiting one’s life opportunities.
African American women are four times more likely to die of cervical cancer and African Americans are twice as likely to die of diabetes than whites. Asthma mortality rates are three times higher among African Americans and four times higher among Hispanics than among whites. Infant mortality is double in African Americans than whites. HIV/AIDS rates among African Americans is 13 times higher and among Hispanics 8 times higher than whites.
Some point out that these rates are determined by environmental and economic reasons—and have nothing to do with the quality of care received by those patients. These disparities are real and are part of the important conversation about environmental justice, an issue I care deeply about. [see link to my bill summary below] But disparities within health care also lead to different health ‘results.’
Access to care is one the most obvious disparity. Lack of insurance, limited insurance (high deductibles and co-pays) and coverage exclusions all result in diminished use of the health care system by minorities. 34% of Latinos in the US and 19% of African Americans lack health care—compared to 13% of non-Latino whites. A greater proportion of minorities rely on Medicaid for their care because of their lower income levels. Medicaid cost-containment efforts –prior authorization, generic substitution, co-payments and caps—have the unintended consequence of limiting care in some areas, particularly in the area of prescription drug use.
These higher numbers of uninsured and underinsured minorities leads to the foreseeable outcome that treatment for chronic disease and more pernicious ailments will begin later, be more advanced and thus with less ability to protect quality of life.
Research shows that health disparities also emerge from providers-based ‘blind spots’. Underprescribing medication for chronic disease management, low levels of cultural literacy by doctors, and communication barriers all reduce a doctor’s ability to guarantee the same level of care of minority patients. A conference I attended recently discussed the documented cases of underprescribing asthma medication to inner-city youth, the underprescription of anti-psychotics to African American youth, the underprescription of cardiovascular drugs to African Americans and Hispanics and most disturbing, the underprescription of drugs used for pain. .
Patient adherence to disease management regimens, too, are also critical to understanding the reasons for disparities. Lower levels of health literacy and language barriers introduce barriers to health care access—like poorer adherence to prescribed treatment-- but these are just part of the problem. Poor rapport with providers, too, contributes to poorer health performance.
So what gives? Well, at my level—that is to say, in the legislature, a number of us have asked ourselves what can be done to “mind the gap.” In particular, what we can do to close this divide is front on my mind this week: Legislation I have filed with Rep. Byron Rushing of Boston and with the real leadership of Camille Watson and everyone at Health Care for All. [Download section_by_section_summary.pdf ] What’s it do? Promotes increased access by employing proven methods to reduce disparities in care, like expanding the number of community health workers (‘promotores de salud’), improving reimbursement procedures for language interpreter services, and creating a disparities grant program for community health centers.
Further, we try to promote health literacy and increase workforce diversity in the health care professions, as well as coordinate data collection more effectively to keep collecting important facts about our Massachusetts family.
We’re years away from ending the disparity gap. But I believe we can follow the lead of other states and private players in this health care reform drama to improve everyone’s care.
If you are interested, you can provide written testimony to the Committee on Public Health by mail at: Joint Committee on Public Health, State House Room 130, Boston, MA 02133. You may also email testimony to Daniel Delaney at Daniel.Delaney@state.ma.us. The public hearing will be on May 16th at 10:00am in State House room A-1