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"Why Is HHS Obscuring a Health Care Gap?,"

by H. Jack Geiger Over the past four years my colleagues and I have read and reviewed more than a thousand careful, peer-reviewed studies documenting systematic deficiencies and inequities in the health care provided for African Americans, Hispanics, Native Americans and members of some Asian subgroups. The evidence is overwhelming. Unfortunately, the Department of Health and Human Services seems intent on papering it over.September/October 2004 issue of Poverty & Race

Over the past four years my colleagues and I have read and reviewed more than a thousand careful, peer-reviewed studies documenting systematic deficiencies and inequities in the health care provided for African Americans, Hispanics, Native Americans and members of some Asian subgroups. The evidence is overwhelming. Unfortunately, the Department of Health and Human Services seems intent on papering it over.

This is the only conclusion that can be drawn from HHS’s recent treatment of the first national report card on disparities in the diagnosis and treatment for this country’s most vulnerable populations. The department edited and rewrote the report’s summary until it reflected nothing close to reality.

The reality is this: If you are an African American man with one form of lung cancer, you are far less likely than a similarly ill white patient to receive a surgical procedure that would cut your chances of early death nearly in half, from 95 percent to 50 percent —even if you have the same health insurance coverage and are in the same hospital. If you are a Hispanic trauma victim with multiple bone fractures, you are less likely to be given adequate pain medication — or any at all. If you are a low-income or minority child with severe asthma, your chances of getting the most effective drug combinations are slimmer, and you endure repeated attacks of the disease and hospitalizations. Native Americans with diabetes, or Asian/Pacific Islanders with HIV-AIDS, all too often experience such disparities in care. The pattern extends over the full range of medical conditions.

The reasons are complex. Patients often mistrust the medical system because of perceived past discrimination. On the physicians’ side, poor communication, lack of cultural understanding, and subconscious negative racial and ethnic stereotyping can be involved. Much needs to be learned. But even though there are at least eight major reviews of all this evidence, including the Institute of Medicine’s landmark 2001 study, “Unequal Treatment,” there has been no overall national assessment of the scope of the problem. So it was a welcome development when Congress mandated HHS’s Agency for Healthcare Research and Quality (AHRQ), a body with an impeccable track record of expertise and honesty, to produce the first annual national report card on disparities.

The AHRQ did its job well. Its draft report was a clear and massive presentation of the data on disparities in care associated with race, ethnicity and socioeconomic status. Its summary was blunt, noting that such disparities are “national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions,” affecting health outcomes and entailing “a personal and societal price.”

After “review” by HHS, those truthful words are gone, as are most references to race and ethnicity, now described as problems that existed “in the past.” Prejudice is “not implied in any way.” Disparities are simply called “differences,” and — incredibly —”there is no implication that these differences result in adverse health outcomes.”

What of the thousand or more studies to the contrary? The new summary says: “Some studies and commentators have suggested that a gap exists between ideal health care and the actual health care that Americans sometimes receive.” Worse, the new summary begins with a short list of relatively minor health areas in which minority and poor populations do slightly better than the majority (because, an AHRQ spokesman said, “Secretary [Tommy] Thompson likes to focus on the positive.”)

There is a pattern here. A few weeks ago, all of the different institutes that make up the National Institutes of Health released their draft “strategic plans” to overcome racial and ethnic disparities in health status — the burdens of greater illness and shorter life expectancies of America’s minority populations. Disparities in health care obviously contribute to those burdens. But only three of the NIH’s 14 institutes even mentioned them.

A recent report by a panel of experts convened by Physicians for Human Rights recommended corrective steps to be taken by government at every level, as well as by the medical profession, hospitals, HMOs, community groups and civil rights organizations. But the federal government has an especially critical role to play in collecting and honestly analyzing data, supporting a more diverse health workforce, and ensuring enforcement of civil rights in the health care system. To avoid the truth, or cloak it in more comfortable words, is to abandon that responsibility.

The Rev. Martin Luther King Jr. understood what is at issue here. “Of all the forms of injustice,” he said, “discrimination in health care is the most cruel.”

H. Jack Geiger is Arthur C. Logan professor emeritus of community medicine at the City University of New York Medical School and a past president of Physicians for Human Rights. jgeiger@igc.org
 

Notes:

This article first appeared in the Jan. 27, 2004 Washington Post and is reprinted with the author's permission.

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