Health Disparities – Understanding the Issues Within the African American Community

introduction

The purpose of this series of articles is to provide a contextual understanding of the prevalent health problems facing the African American community. Henceforth, and for the sake of brevity, the term “Black” and/or minority will be used interchangeably with African American. Additionally, the term “white” is or will be substituted for Caucasian or majority.

The papers contain charts and diagrams that should be self-explanatory and help the reader see and better understand the issue of health inequalities.

Going forward, closing health inequalities or any other equality gap requires maintaining the following principle: “The ability to address and solve a problem begins with the desire and willingness to gain knowledge and understanding; to take the necessary measures and have the courage to stand firm and take the necessary measures to solve the problem at hand.”

The beginning

There is an ongoing major debate about access to and availability of health care. The uniqueness of the debate on this topic is based on a simple but complex question: “Is health care a right or a privilege? Depending on your economic philosophy, political orientation and social position, the answer to the dominant question will be different. Another dependent variable is the cultural identity factors along with your general social orientation and personal value-belief system.

The preamble to the United States Constitution contains the words “… that all men and (women) are created equal.” Equality and parity are noble, absolute panaceas. Directly related to access to and/or delivery of healthcare, it may simply presuppose the ability to pay for the services desired. For background and familiarity purposes, here are some of the more common business, revenue, and related operational terms associated with healthcare. Conditions ranging from, but not limited to, co-pay, deductible, refund, neediness, self-pay, denial, pre-existence, etc.

Historically, the majority of American citizens receive health care benefits through their employer-sponsored insurance package programs. These offerings differ from the so-called old indemnity programs, Health Maintenance Organizations (HMO’s) and now the latest and greatest package offering Health Savings Accounts (HSA’s). We must not forget the federal programs like Title 19 and Title 20, Medicare and Medicaid respectively. Briefly Medicare is the health insurance program for “seniors”. The Medicare offering consists of Parts A, B, and D. These benefit plans provide outpatient, inpatient, and prescription drug benefits. Medicaid, on the other hand, is a government-run program with a significant financial subsidy from the federal government. Medicaid is often identified or recognized as a health benefit for those in need and children.

knowledge acquisition

For our and future purposes, and as defined by the World Health Organization, health is a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. In a careful and quick review of the definition; Everyone would desire complete physical, mental and social well-being. Because we live in a highly structured or multi-layered society, with different classes, economic and social levels, this “complete” social well-being will be extremely difficult to achieve.

Note chart (1) which shows the different levels of spending within the US health care system. Hospitals account for the most significant portion of dollars spent on direct patient care, totaling 30%. The next largest percentage is Other Expenses at 25%. This essentially represents diagnostic services such as CT, MRI scans, etc. Only 21% is actually spent on medical and clinical services.

Looking at demographics, there is no direct data showing these white versus black spending. Based on the charts (2-3), one might assume that whites spend more on health care than blacks, based solely on the difference in life expectancy between men and women in 2004.

Combine this data with the fact that blacks’ overall unemployment or underemployment rate is typically two and sometimes three times that of whites. For reflection, remember that the majority of American citizens gain access to health care through their employer-sponsored health care offerings. Thus, when blacks are more or more likely not to be employed, black health, indices, and life expectancy will be much lower than their white counterparts.

In addition, it is very common that black people often enter the health care system much later after the detection of diseases. In other words, black people often do without or do not have the financial means to access family doctors to set up a so-called medical home.

GPs do routine or basic check-ups like blood pressure, prostate, gynecological, mammograms to rule out breast cancer. Due to these limited examples, the early detection of diseases often goes undetected and therefore treatment cannot be initiated. Note diagram (4) which depicts the matrix for the Continuum of Care.

For example, therapy may begin with medication needed to correct high blood pressure, or as it is often referred to as high blood pressure. The identification of other cardiovascular problems can be detected along with the detection of “sugar”. While many blacks have the financial means to access the system, either through social orientation or a lack of knowledge or outright ignorance, the decision to use the healthcare system is ignored.

Series 2: Black and Medical Education