One of the things that first drew me to medicine was that health problems touched all people. It doesn't matter if you're rich or poor, young or old, black or white, college-educated or didn't finish high school, everyone gets sick at some point. As a doctor, I focus more on diseases than demographics. But over the course of my career, I've come to see how much your income, race, and education can matter in determining whether you get sick and what treatment you get as a result. The perfectly equal care I dreamed of providing as a medical student isn't the reality for most patients in most health systems.
Minorities Really Do Have Worse Health
- Even though heart disease is the leading cause of death in the U.S., it's more deadly if you're African-American. The CDC found that blacks are 50 percent more likely to die from heart disease before 75 than a similar person who's white.
- If you're African-American or Hispanic, you're far more likely than someone who's Asian or white to have diabetes, to be overweight or obese, and to have high blood pressure.
- If you're African-American, your child is twice as likely to die as an infant than if you're white.
- Blacks live an average of four years less than their white counterparts.
- Minorities were much more likely than whites to describe their health as either "fair" or "poor," the two lowest ratings on the scale used to rate health.
"Maybe they just don't care about their health"
This is an issue I want to address because I've heard it from a few people. They ask me, "Couldn't it just be that these minority groups don't care as much about their health as I do? Maybe being healthy just isn't as important to them." The problem is, we've found that the health care system doesn't treat people equally, even if they have the exact same symptoms when they come in for help. Sometimes this is the result of outright bias, like racism, but more often it's a reflection of an unconscious bias that a medical provider might hold. That bias can affect what they think is going on with a patient, what the best care is, and how likely they think the patient is to actually follow their recommendations.
Several studies have shown that ethnic and racial minorities end up with worse care for the same types of health issues. For example, one study showed that minorities receive less pain medications for problems like kidney stones or broken legs than their non-minority counterparts. And it's not just racial minorities who suffer. Studies have shown time and again that women, who are often treated like minorities in our medical system, receive less helpful care when they present with a heart attack because their symptoms don't match the symptoms men usually present with. Another study found that women with similar heart disease risk factors to men get less helpful counseling from their doctor about avoiding heart disease.
It's Not Just A Matter of Race
- LGBTQ individuals also often experience discrimination in medical settings, substandard care and, ultimately, often end up doing worse when diagnosed with the same diseases as straight Americans.
- Studies have regularly shown that people with lower levels of education who have trouble reading and understanding health information also have worse health, likely because we as doctors often do a poor job of explaining their health problems to them and making it clear why taking medications or changing lifestyle is important.
- People with physical disabilities are often treated differently by the system. Studies have shown that adults with a disability are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities.
Without a doubt, the statistics about how race can affect health are shocking, but it can be easy to think the issue is someone else's problem. But that's not the way health care works. Poor health in one part of the system affects us all. While many will make an economic argument here, that sicker minorities increase the price we all pay for health care, I think the problem is much deeper than that.
When we participate in a system that says allows some people to be treated worse based on their race, gender, sexual orientation, literacy, or physical ability, we're really saying that it's okay to deprive people of high quality health care based on factors that are out of their control. And while you might be on the "majority" side right now, that might change for you or someone you love. Ultimately, what we want when we face health challenges is a just medical system that cares deeply and equally for the people it seeks to help.
So how do you take action? Even doing something as small as learning about inequalities in the health system is important. You can get involved with a local health advocacy organization or start your own group based on discrimination you might have experienced and advocate for change. Every step towards making the system more equal matters, no matter how big or small.