Despite Advances

Conflict and misunderstandings between racial groups have been in the headlines recently. Disparate police treatment of black and white people has garnered the attention, but public health experts have long been concerned with a different kind of inequality.

Health Inequality

Research published in a recent New England Journal of Medicine suggests that the battle for offer black people and white people the same quality of care continues, although progress has been made. Namely, insurers in the Western United States seem to have closed the racial gap between patients.

The reasons for this are unknown. The scientists behind the study have suggested that it might be linked to changes made by Kaiser Permanente, a major insurer in the region. It focused on helping older adults better manage their chronic conditions — diseases like diabetes and hypertensions.

Those changes also emphasized greater communication between doctors and patients, not to mention electronic health records and the drugs available to treat these illnesses.

Dr. Marshall Chin of the University of Chicago  wrote an editorial for the journal. He emphasized the work that remains to reduce health disparities across the country — not just the West.

“There clearly are some success stories,” he said. “We now know a fair amount about what works to help reduce disparities. But we need the will to widely implement those things. . . . The way that our health care system is set up is that it rewards procedures, but it does not reward prevention.”

Another report published in the same issue looked at racial differences in hospitals. It, too, had good news. From 2005 to 2010, differences in treatment dropped or disappeared.

The researchers agreed, though, that changing these disparities requires more than changes to hospitals or health care system. It requires actually altering the society in which we live, and the opportunities available to all of us to live healthy lives.

Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor, was the lead researcher in the first study. He put the findings into a broader context.

“People need to be able to buy healthy food, and have places to exercise, and be able to afford copays on their prescriptions,” he said.

Finally, it looks as though the actual Medicare health plans that senior citizens choose can make a difference in their health. African-Americans were more likely to enroll in plans where patients did worse than average in taking care of their chronic conditions.

The unfortunate news is that we’re still reading studies about health inequality between racial groups in 2014. But the good news is that effective countermeasures seem to exist. Doctors need to treat all patients with the same proven techniques, regardless of socioeconomic status, and they need to focus on preventative care, which can stop these problems from cropping up in the first place.

The story of medical progress over the last several decades has been fascinating. While major diseases have been all but wiped out (polio, for example), other problems have become scarily prevalent (obesity). These issues have not affected all sectors of society in the same way, which makes addressing them firmly and quickly of the utmost importance.

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