"Racial Disparities in Health Care"November/December 2010 issue of Poverty & Race
Racial Disparities in Health Care
Washington’s “Eastside,” separated from Seattle by Lake Washington, is home to some of the state’s wealthiest and healthiest communities, and historically it has been predominantly white. Yet people of color represent a growing force in the Eastside. Across the state and the nation, people of color face racial disparities in health and health care that leave them living sicker and dying younger. Washington’s Eastside is not immune to these disparities.
Our report explored the health care challenges faced by communities of color in the Eastside city of Bellevue. Bellevue, Washington sits across Lake Washington from Seattle, close to Microsoft’s base in Redmond. It is the state’s fifth largest city, with a population of 118,100. Based on a survey, focus groups and key informant interviews, we find that people of color face a number of cost, language and transportation barriers to quality health care. Although insurance status and income play a role in the experiences of people of color in Bellevue, many of the barriers identified in our study cannot be attributed solely to these factors.
People of Color Live Sicker and Die YoungerAs noted, racial disparities in health and health care persist throughout the United States. Across a range of measures, people of color bear an excess share of disease. For instance, American Indians and Alaska Native adults are more than twice as likely as white adults to have diabetes, and they have the country’s highest death rates from the disease. Latinos are also much more likely than whites to develop diabetes. And African/African-American men are 50% more likely than white men to be diagnosed with prostate cancer and more than twice as likely to die from the disease.
Racial disparities in health reflect factors both inside and outside the health care system, including structural racism that compromises the living conditions of people of color. People of color face particular barriers to living healthy lives, more frequently working in hazardous jobs, being exposed to environmental pollutants, and living in neighborhoods with no access to affordable, nutritious food. On top of these challenges, people of color are more likely to go uninsured, face cost barriers to care, have no regular doctor, and receive lower-quality treatment.
Washington’s King County is not immune to health disparities. African Americans and American Indians/Alaska Natives have higher death rates from cancer and heart disease than do whites, and they have the lowest life expectancy of all groups, even when sex is taken into account. Latino adults are the least likely to report themselves in excellent or very good health.
People of color in King County also face obstacles to health care. African Americans are twice as likely and Latinos three times as likely as whites to be uninsured, and members of both groups are also more likely than whites to go without dental care and avoid health care due to cost. Although County public health statistics show that residents of Bellevue generally are less likely to go uninsured, lack dental care, or have avoidable hospitalizations, it is unlikely that people of color fare as well as other Bellevue residents.
MethodologyA survey, six key informant interviews and two focus groups were used to develop the findings.
The SurveyThe survey focuses on four themes: quality of care, financial access, language access, and transportation. The survey instrument was two pages and was available in English, Spanish and Mandarin. The surveyors collected 136 surveys from people of color, those who checked off at least one of the following ethnicities: African/African-American, American Indian/Alaska Native, Asian/Pacific Islander, Latino, and Middle Eastern/South Asian.
All surveys were collected in Bellevue, and within seven miles of the city’s downtown. Sites for survey collection were selected based on likely aggregation of people of color/immigrants. These sites included, but were not limited to, churches, hospitals, clinics, food banks, apartment complexes, malls, public parks, and organizations serving people of color and immigrants. In some cases, respondents completed the survey on their own. In other cases, survey collectors interviewed respondents and completed the survey based on their responses. The survey form also asked respondents if they were willing to be contacted for a follow-up key informant interview.
Key Informant InterviewsSix key informant interviews were conducted to gain more in-depth responses to the questions raised in the survey. Those agreeing to a follow-up interview were selected if they reported difficulties accessing health care on the Eastside. The interviews were conducted at key informants’ homes and consisted both of questions relating to health status, experiences in the clinical setting, family life and
job status. The key informants ranged in age from 20 to 64. Most were women. They include interviewees who are Latino, Middle Eastern and African-American, respectively. The results of these interviews are included as “sidebars” in our full report.
Focus GroupsThe two focus groups included Latino participants and were conducted in Spanish. The first focus group was held in a community center in Bellevue. It included five participants, all women with children. The second focus group was held in the home of a community member and was attended by ten members of a church in the Bellevue/Redmond area.
Next StepsAs rules and policies are written to implement and enact the Patient Protection and Affordable Care Act (PPACA) in states and in Washington, DC, people of color have much at stake. Washington CAN! is building on the findings of this study to push for specific policies that improve health outcomes for communities of color, such as language access services in medical settings, better data collection by race and ethnicity, funding for Indian Health Services, and defending vital health coverage programs that are facing budget cuts. These advocacy and organizing efforts continue, but have already demonstrated some success. For example, in 2010, Washington CAN! was at the forefront of a successful effort to eliminate the wasteful brokerage system for medical interpreters and improve the quality and availability of interpreter services in the state.
For further information, and to obtain a copy of the full report, contact Will Pittz at Washington CAN!, firstname.lastname@example.org
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