Black History Month Reflections: Race and Health

LCHC Chief Medical Officer Kiame Mahaniah, MD, on health disparities.

by Kiame Mahaniah, MD, Chief Medical Officer of Lynn Community Health Center

Race, despite being 300 years removed from emancipation, despite being 50 years removed from the Civil Rights era, despite being 7 years into the presidency of our first president with black heritage, continues to be a defining feature of life in America.  From a physician’s perspective, a saddening fact is that race also defines health.

In 2002, at Congress’ behest, the Institute of Medicine (IOM) released a report[1] that, amongst other shocking findings, documented disparities in the quality of care accessed by African Americans as compared to White Americans.   They posited several reasons.   Poverty is undeniably linked to lower outcomes in treatment of chronic diseases such as diabetes but also in rates of cancer detection and treatment.   Geography, in many ways, is destiny: where you live (not only which state or city but also which side of the tracks in a town) dramatically influences the quality of the care to which you have access and that you receive.  Linguisticand cultural barriers also contribute to the disparity, not to mention a patient’s mistrust of the healthcare system.

Yet, even when controlling for income, social class and level of education, clinical outcomes were poorer amongst African Americans.  One of the most striking studies[2] showed that, for the same symptoms objectively calling for heart surgery, doctors recommended surgery less often for African Americans.  Particularly disturbing was how often African American women did not get the appropriate recommendation.  In medicine, as in many other parts of our society, being black, female and poor is a reverse trifecta.

Unfortunately, despite the robust nature of the data that underlies the IOM report, disparities continue today.  Health disparities are not limited to African Americans or black communities.  Being poor leads to disparities as well as not being fluent in English, being Latino and, for some measures, being a woman.  In short, the provision of health care does not escape the fact that we live in a society that has a strong history of discrimination against particular physical attributes, whether because of ingrained system or individual bias.

[1] IOM, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2002

[2] Schulman, K.A., Berlin, J.A., Harless, W., Kerner, J.F., Sistrunk, S., Gersh, B.J., Dube, R., Taleghani, C.K., Burke, J.E., Williams, S., Eisenberg, J., Escarce, J.J., Ayers, W. (1999). The effect of race and sex on physicians’ recommendations for cardiac catherization. New England Journal of Medicine 340:618-626.