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the Past and Present Health Disparities between Races and Their Causes

Health disparities between African Americans and
Whites have been prevalent in the United States for decades and are still
evident today. Health disparities have no clear unit of measurement and will be
addressed further in the parameters of life expectancy and infant mortality
rates. Relics of the racist past of the United States seem to be the foundation
of these differences. The causes of health disparities vary between social,
economic, environmental, and institutional factors. Even when adjusted for
certain factors, the differences between White and Black health exists, and some
aspects of the high African American mortality rates do directly correlate with

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Prior to 1964, many US hospitals were segregated in
some form; this includes hospitals that were only for patients of a specific
race and hospitals that cared for patients by floor or wing separated by race.
Research done by Paul Cornely, of Howard University, found that in the 1960s, 31%
of Southern hospitals did not accept colored patients and 47% of hospitals were
segregated either by floor or hall (Reynolds 711). Medical offices in the Southern
states had separate waiting rooms, and White patients would receive attention
before a colored patient would (Williams 14). In an interview with Mabel
Williams, a former cook, maid and nurse’s aide at a segregated hospital in
North Carolina, she describes the conditions of a specific hospital where White
patients resided in the upper levels of the hospital and colored patients were
kept in the basement (Williams 11). She described that the basement halls had
cement floors with plumbing out in the open (Williams 12). Children born to
African American mothers were kept in a utility room, where bedpans were washed
and needles sterilized, instead of a nursery (Williams 12). As a maid, she
cleaned all floors and therefore saw the contrast and felt it in her work.  In the basement, she could care for the babies
taking them in and out of the “nursery”, but could not do the same for the White
newborns upstairs (Williams 12). She said that as a maid and nurse’s aide she was
allowed to perform injections and other medical procedures that on upper level
floors only registered nurses could do (Williams 14).

Racist treatment not only applied to patients, but
also to the hospital staff. Black doctors and nurses were not given the same
access to materials and rights as White professionals, and often minority
applicants would not be admitted into nursing and residency programs (Reynolds
710). Williams stated that only one Black doctor worked in her hospital and he
was only ever seen in the basement (Williams 13). There was a White doctor who
was also assigned to do work in the basement but vocalized his racist attitudes
towards his Black patients in front of the nurses (Williams 14). Her
description of the hospital’s atmosphere appeared negative and hopeless for patients
of color (Williams).

With limitations on African American participation in
medical training programs, it is clear to see why “Black only” hospitals with
only colored professionals were considered inferior in quality. Segregated
hospitals with White professionals were no better for African American health,
as seen with the statistics of the time. The infant mortality rates (1 death
per 1,000 live births) were 22.9 for White newborns and 44.3 for Black newborns
(US Department 6). During the 1960s, the life expectancy for a White adult was
70.6 years but only 63.6 years for a Black adult (National Vital Statistics

As discussed previously, the health care system of the
1960s demonstrated extreme racism in terms of patient care and contained segregated
hospitals legally. This all changed in 1965 with the passing of Social Security
amendments that created Medicare (Quadagno 68). Medicare provided specific
guidelines that forced hospitals to treat patients fairly, regardless of race,
color, or national origin in terms of care and location of admittance (American
Journal of Public Health). Patients had to be admitted into hospitals, rooms,
floors, and wings despite their race (American Journal of Public Health). Employees
of hospitals, including medical staff and volunteers, had to be granted full
privileges despite their race (American Journal of Public Health). The
recruitment and selection of trainees had to be a nondiscriminatory process (American
Journal of Public Health). If a hospital had an additional building for the
purpose of separating patients, the hospital had to change the purpose of the
secondary building or close it (American Journal of Public Health). Over a
six-month period, the entire health system had changed and hospitals quickly
began admitting and hiring without the bias of race (Quadagno 69). In
comparison to other Civil Rights events, the desegregation of hospitals was
fast paced and overall uneventful (Quadagno 69). Historians say there were no
riots, mobs or confrontations with the police during this process (Sternberg).
When further delving into the Medicare legislation, it is obvious that money
was the cause of the change; hospitals that did not comply with Medicare
guidelines would not receive federal funds (Quadagno 69). The program was
successful due to the copious amounts of volunteers and civil rights workers that
would inspect hospitals to guarantee their compliance with the legislation
(Sternberg). With hospitals under surveillance and willing to comply, the health
system became desegregated—that
is, on paper.

In the year 2000, hospitals had been desegregated for
35 years and would lead one to believe that health disparities were, therefore,
eradicated. This, however, was not the case. In the year 2000, infant mortality
rates were 5.7 for White births and 13.5 for African American births
(Department of Health 3). The life expectancy for a White adult was 77.3 years
and 71.8 years for an African American adult (National Vital Statistics
System). The life expectancy for White adults in 1960 was 7 years greater than
for African Americans, yet in 2000 the life expectancy for White adults was 5.5
years greater than for African Americans. This 2.5-year difference in the gap
between races does not reflect the changes made by the health system. What is
even more shocking is the increase in infant mortality ratios went from 1.93 in
1960 to 2.36 in 2000. African American newborns were dying at a higher rate.

Health disparities, as measured by life expectancy,
happen “from cradle to grave” (Anderson 16). When comparing the life expectancy
at birth, age 12 months, age 4, mid-life of age 25-46, age 65, or age 75,
African American life expectancy is always less than the life expectancy of their
White counterparts (Anderson 15). Even at its smallest ratio at age 75, White
life expectancy is still 0.6 years greater than for African Americans (National
Vital Statistics System). This trend continues when comparing mortality rates
by race for the top killing diseases in the United States. The death rate for heart
disease (per 100,000) for White Americans is 236.7 while for African Americans
the rate increases to 308.4; the racial ratio being 1.30 (Williams et al. 128).
The cancer mortality rate (per 100,000) for White Americans is 199.3, but for
African Americans the rate is 255.1, a racial ratio of 1.28 (Williams et al.
128). In addition, stroke mortality (per 100,000 cases) is 58 in Whites and 80
in African Americans reaching a racial ratio of 1.38 (Williams et al. 128).
With medical facilities no longer segregated, what are the causes for such
drastic differences in mortality due to race?

Evaluating health disparities has no clear measuring
unit and therefore there in no one obvious answer to explain the current state
and the “death gap” between races (Ansell). The following are possible theories
that have led to the staggering differences in health between Whites and Blacks
in America.

America’s racist past has led to current residential
segregation. Even though laws have been passed to prevent landlords and real
estate agents from denying housing to residents due to race or ethnicity,
residential segregation is still widely present in the US (Anderson 10). This
includes locations such as Kansas City, Birmingham, Boston, Nashville,
Cincinnati, Louisville, Detroit, Cleveland, etc. (Kent and Frohlich). These areas are considered segregated because 80%
or more of the residents living there are of one race (Kent and Frohlich). Areas segregated by race often include a greater
percentage of families in poverty (Badger). As poverty rates increase, tax
money available to the area decreases, diminishing resources; chain businesses
choose not to open stores in such locations, tax funded establishments such as
schools and hospitals lose resources, and educated professionals choose not to
find employment in such areas (Anderson 11). These factors cause the hospitals
and other medical facilities to become less capable of providing adequate care.
Residents will go to the medical facility closest to where they live; if one
happens to be living in an impoverished neighborhood, chances are the hospital
will reflect this in its care and staff. Living in segregated, impoverished
areas is bad for one’s health due to lack of access to adequate healthcare, in
terms of it being difficult to find a physician or facility; lack of access to
low-cost fruits and vegetables, due to chain supermarkets not opening in the
area making it difficult for such residents to maintain a healthy diet; and
being surrounded by environmental toxins such as violence and crime, pollution,
or poor construction (Anderson 11). These disparities exist in both urban and
nonurban environments; it is not location but rather race that is the
determining factor. In metropolitan areas, the mortality rate is an average of
823.8 for Whites and 1115.9 for Blacks (Williams et al. 136). In
nonmetropolitan areas, the mortality rate is an average of 887.45 for Whites
and 1154.05 for Blacks (Williams et al. 136). Both racial ratios lie at about
1.30-1.35 (Williams et al. 136). These statistics show that locations, whether
metropolitan or nonmetropolitan, are still hazardous for African Americans
especially when residential segregation is at play.

Access to healthcare is a complex issue that can be
caused by a variety of factors. A large one is self-assessment of healthcare
need. In a study surveying young African American men, many brought up a lack
of even attempting to receive medical treatment (Watson 1007). Many described receiving
peer pressure from others or a fear of appearing weak as a reason for them to
not seek medical attention (Watson 1007). Others explained that going to a
doctor or hospital was only if you were experiencing serious symptoms or were
near death (Watson 1007). Many described “seeing blood” as the only legitimate
reason to see a physician (Watson 1008). Not one member of the survey talked
about or gave preventative care as a reason to visit a medical facility (Watson

Many members of the study described not having health
insurance or money to pay medical bills as a reason that kept them from going
to a medical facility or kept them from receiving medical treatment if they
went (Watson 1007). African Americans are more likely to work jobs where there
is no “employer-sponsored coverage” for insurance than their White counterparts
(Yearby 83). African Americans are also more likely to be unemployed and/or on
welfare compared to their White counterparts (Yearby 83). These factors prevent
African Americans from having health insurance or an ability to pay
out-of-pocket for medical procedures. The median income in 2004 for a White household
was $47,777, and for a Black household was $29,645 (Williams et al. 141). These
income levels display why it would be difficult for African American families
to access healthcare for economic reasons.

Environment and money are factors that lead to health
disparities between races, but race alone also has major effects. When the life
expectancy is adjusted for income, using the life expectancy of 1980s, men who
made over $25,000 and were White had a life expectancy of 52.9 and those in the
same income level but were Black has a life expectancy 2.7 years lower, 50.2
(Wiliams et al. 141). This trend continues over all income levels with the
lowest income of less than $10,000 a year having a the most extreme difference
of 3.4 years; White men had a life expectancy of 45 and Black men 41.6 (Williams
et al 141). Even at the same income levels, Black men were dying at a younger

A similar trend exists for infant mortality when
comparing the mother’s race and her education levels. When observing the infant
mortality rate for mothers of the same race, it decreases as education level
increases (Anderson 20). Comparing mothers of different races does not follow
this trend. The infant mortality rate of a mother that is white high school
drop-out is at 7.0 deaths per 1,000 live births, but for an African American
mother with over 13 years of education it is 11 deaths per 1,000 live births
(Anderson 20). The difference is even more drastic when comparing college
educated white mothers, which have a 4.6 infant mortality rate, to African
American college educated mothers, who have an infant mortality rate of 11.0 (Anderson
20). A study that can explain this phenomenon compared mothers age and race to
infant mortality rates and found that as African American mothers’ age
increases, so does the infant mortality rate (Anderson 17). This is not the
case for white mothers, whose infant mortality rate decreases after her teenage
years and increases only slightly in her late thirties, never reaching the
extreme seen in her teen years (Anderson 17). African American mothers who are
having children later in life are exposed to their toxic environment for longer
(Anderson 17) and the effects of pollution, exposure to drug and alcohol abuse,
institutional policies, unfair treatment in health care settings, prejudice,
and discrimination can all negatively impact her body and pregnancy (MacArthur foundation
Research Network 33).

When ignoring all other factors but race, it is clear
that systemic racism plays a key role in how the US society and especially the
health care system functions. “Social scientists have amassed a
significant amount of evidence documenting institutional racism” allowing
people, just because they are white, to benefit when selling and purchasing a
home, obtaining a higher education, and/or seeking medical help (Desmond and Emirbayer 345). In a
study examining racial health disparities, several firsthand accounts were
recorded from minority patients and medical professionals. One African American
participant described his/her physician writing a prescription for his/her
diabetes medication and complaining that the patient was lazy and would not
take the medication or change their diet, in turn wasting the physician’s time
(Smedley et al. 393). Several participants described situations where medical
facilities assumed they had no insurance when they first walked in (Smedley et
al. 395). One African American participant described a situation in a hospital
where her nurse calling light was on but the nurse checked in on the white
patient next door, who did not have his/her light on, first before attending to
the African American patient (Smedley et al. 396). One African American
psychiatrist described African American patients often coming to him from white
psychiatrists who had misdiagnosed him/her with schizophrenia (Smedley et al.
397). Another physician described no longer referring minority patients to certain
specialists, as the physician knew they would be mistreated (Smedley et al. 397).
In addition to firsthand accounts, there is mounting evidence that Black
patients’ pain is underestimated and undertreated (Hoffmana et al. 4296). Black patients are less likely
to have pain killers prescribed in comparison to their white counterparts (Hoffmana et al. 4296). These
differences in pain mistreatment is evident in children, too (Hoffmana et al. 4296). There is
evidence of a fundamental belief by physicians that Black bodies are
“biologically different, in many cases, stronger than white bodies” (Hoffmana et al. 4296).

Race is a symbolic category and there is no
scientific evidence to support any biological differences between African
Americans and Caucasians (Desmond and Emirbayer 336). Health disparities caused
by genetic differences between Blacks and Whites cannot be the full cause in
health disparities. In a specific case examining hypertension, it was found to
be the opposite; native-born US Blacks have higher rates of blood pressure than
Blacks born and living in Africa or the Caribbean countries (MacArthur
Foundation Research Network 30). Genetics cannot explain the increasing gap between
African Americans and Whites in life expectancy and infant mortality found in
the US. 

            The future of health
care needs to address the internalized racist practices that are present in the
current system and address the issue at different levels. Medical personnel
must be trained and educated to deal with institutional and internal bias, and the
rights steps for progress are being made. For example, an article in the Journal of Racial and Ethnic Health
Disparities, published in 2016, gives advice and a checklist to help
physicians and other clinicians better treat minorities, women, and other groups
at risk for receiving inadequate care. Patients, especially minority groups,
need to be informed of their rights and abilities to receive preventative and
palliative care. For every one life saved by biomedical advances, eight would
be saved by eradicating health disparities caused by a lack of education (Anderson
25). The US cannot allow its racist history of segregated establishments to
haunt the present lives of African Americans. No infant, child or adult should
die based on the color of his/her skin.




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