Race, Health & MedicineThe View from

the Black Diaspora

Sheila L. ThornePresident & CEO

Multicultural Healthcare Marketing Group

The Global Village

2

82 out of 100Persons of Color

61of the 82Asians

9 out of 100 Speak English

www.TheDiversitySpeaker.com If the World Were 100 Updated 201000 People updated 2010

A Microcosm of the Global Village

3

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

4

“Slave Health Deficit”

An American Health Dilemma

Race, Health & Medicine in the United States

Slavery to 2000

W. Michael Byrd, MD, MPHLinda A. Clayton, MD, MPHHarvard School of Medicine

Harvard School of Public Health

6

Blacks/African Americans45,003,665 = 14% of U.S. Population

New York: 32%

Philadelphia: 45%

Memphis: 64%

New Orleans:61.9%

Miami: 27%

Atlanta: 67%

Baltimore: 65%

Washington, DC: 72%

Chicago:39% Detroit:

85%

Houston:28%

Dallas:48%

Los Angeles:14%

Oakland:44%

Gary84%

Black/African-American Population

7

Miami Gardens: 77%

St. Louis:51%

Cleveland: 53%

Tend to be poorer in health Lower level of symptom and disease awareness Use fewer health services Suffer disproportionately from premature death,

disease and disabilities Do not receive preventative health tests and the

likelihood of undergoing those screenings declines with age

Higher mortality rates Co-morbid conditions; multiple meds First entry in healthcare system – advanced disease CHRONIC STRESS!

8

Health Profile of Blacks/African Americans

Leading Health Disparities

• Cardiovascular Disease

• Cancer• Diabetes• HIV/AIDS• Infant Mortality• Asthma• Mental Health

Disorders

National Institute of Medicine – Institute of MedicineUnequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Adverse Environmental conditions

Social policy

Poverty

Racism

Limited Access to Care

PoorEducation Poor Family Support

Lack of access to good Nutrition

Low Literacy

StressSmoking

Poor Working Conditions

Poor Housing

Bad NeighborhoodsUnemployment

Hopelessness

Why Health Disparities?No health insurance

Adapted from A. R. James

1985 Heckler-Malone Report

•The Report stated: " Despite the unprecedented explosion in scientific knowledge and the phenomenal capacity of medicine to diagnose, treat and cure disease, Blacks, Hispanics, Native Americans and those of Asian/Pacific Islander heritage have not benefited fully or equitably from the fruits of science or from those systems responsible for translating and using health sciences technology."

+

The Beginning Of The Cultural Competency Movement

“Our findings indicate that the race and sex of patients independently influence physicians’ recommendations for the management of chest pain. They suggest

that decision making by physicians may be an important factor in explaining differences in the treatment of cardiovascular disease with respect to race

and sex.”

SOURCE: Schulman KA, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999; 340:618-26

12

Racial and Ethnic Health Disparities: Documented Data!

Kevin Schulman, MD, The Effect of Race and Sex on Physicians' Kevin Schulman, MD, The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catherization, NEJM 1999Recommendations for Cardiac Catherization, NEJM 1999

““Our findings suggest that Our findings suggest that racerace and and sexsex independently influence how independently influence how physicians manage chest pain.”physicians manage chest pain.”

 

REFERENCE: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002.

2002 Institute Of Medicine Report“Unequal Treatment”

14

Health disparities remain even after adjusting for health insurance coverage, income, education and health care system characteristics that influence access to and quality of health care.

Racial and ethnic minorities receive less than quality care in America.

15

CulturalCompetenceInitiative

“Unconscious bias”

American Medical AssociationPhysicians dedicated to the health of America

16

American Medical Association

Apologizes for Racism

July 30, 2008

“On behalf of the American Medical Association, I unequivocally apologize for our past behavior,” said AMA President Dr. John C. Nelson, “including barring Black physicians from our ranks for decades.”

“We pledge to do everything in our power to right the wrongs that were done by our organization for decades to African-American physicians and their families and their patients.”

Cultural Sensitivity Cultural CompetencyNational Movement

Cultural Sensitivity – a recognition and awareness that there are differences between cultures

Cultural Competency – a set of behaviors, attitudes and policies that enables effective work in cross-cultural situations; the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors and needs presented by individuals and communities.

18

Professionally Active MDs - Clinicians

Source: American Medical Association Physician Characteristics

Male 85.9%

Female 14.1%

Native American 0.1%

Asian 12.6%

Black/African American

3.6%

Hispanic/Latino 4.9%

White/Caucasian 75.4%

PROFESSIONAL MEDICAL SOCIETIES: published guidelines/policies related to the care of culturally diverse populations and the

elimination of health disparities

• Society of Teachers of Family Medicine• American Academy of Family Physicians• American Osteopathic Association• American Academy of Pediatrics• American College of Physicians• Society of General Internal Medicine• American College of Cardiology• American Heart Association• American Psychiatric Association• American College of Obstetrics & Gynecology• American College of Emergency Physicians• American Academy of Orthopaedic Surgeons

19

Psycho social impact of racism…on healthcare!

“Discrimination is the hellhound that gnaws at Negroes in every waking moment of their lives declaring that the lie of their inferiority is accepted as the truth in the society dominating them.”

U.S. History of Bias and Discrimination

Imposed by legislationSupported by businessEnshrined in government policyEnforced by flawed U.S. judicial systemLegitimized by bigots

0.0%

5.0%

10.0%

15.0%

20.0%

Total White AfricanAmerican

AsianAmerican

Hispanic

Source: The Commonwealth Fund 2001 Health Care Quality Survey

5%

1%

15% 13%

11%

African Americans Believe They Would Receive Better Health Care If They Were of a Different Race

22

African Americans More Likely to Feel Treated with Disrespect

11%9%

16%18%

13%

0.0%

5.0%

10.0%

15.0%

20.0%

Total White AfricanAmerican

AsianAmerican

Hispanic

Source: The Commonwealth Fund 2001 Health Care Quality Survey

* Felt disrespected because of ability to pay, to speak English, or their race/ethnicity

Percent of adults who felt they

were treated with disrespect*

African Americans HaveLess Confidence in Their Doctors

69% 72% 69%

57% 54%

0%

40%

80%

Total White AfricanAmerican

Hispanic AsianAmerican

Source: The Commonwealth Fund Health Care Quality Survey.

Percent of adults reporting great deal of confidence in doctor

Chart 16

Widespread, deep-rooted mistrust/distrust of clinical research, healthcare providers, Western medicine, U.S. healthcare system

Trust & African Americans

25

The Tuskegee Syphilis Experiment1932 – 1972

Initially involved 600 Black men – 399 with syphilis, 201 without; conducted without patients' informed consent  

Men did not receive the proper treatment; penicillin became treatment drug of choice for syphilis in 1947--not offered to these men!

Originally projected to last 6 months, the study lasted 40 years

In 1932, Public Health Service began Tuskegee Study of Untreated Syphilis in the Negro Male – to record the natural history of syphilis in hopes of justifying treatment programs for Blacks

SOURCE: Centers for Disease Control and Prevention: US Public Health Service syphilis study at Tuskegee. (http://www.cdc.gov/tuskegee/timeline.htm)

26

Henrietta Lacks – HeLa Cells

1. In 1951, Henrietta Lacks, African American mother of five, native of rural southern Virginia, went to Johns Hopkins Hospital and she was quickly diagnosed with cervical cancer. Eight months later, she died at age 31.

2. Researchers took a fragment of Lacks' tumor and sliced it into little cubes. The cells, dubbed "HeLa“, multiplied as no other cells outside the human body had done before.

3. Their growth spawned a breakthrough in cell research. The cells were put into mass production and traveled around the globe--even into space.

J. Marion Sims, MD, PhDFather of Gynecology

• In the 1840s, J. Marion Sims, MD, a native of South Carolina, touted to be the Father of Gynecology, owned slaves in Alabama, and in fact, actually purchased slave women and conducted experiments on them for several years in his backyard hospital.

• Sims honed his surgical skills by performing scores of painful operations on the genitals of black female slaves. His early attempts so often failed that he operated on one young black woman 34 times without anesthesia.

• Dr. Sims became the world’s leading authority on female reproductive health and by the late nineteenth century, he was internationally praised and rewarded for his surgical discoveries.

Communities of ColorParticipation in Clinical Research

• Blacks/African Americans comprise 14% of U.S. population but just 5% of clinical trial participants

• African-Americans on average are twice as likely and Hispanic Americans are 1.7 times more likely to develop type II diabetes yet underrepresented in clinical trials of new medications.

• Hispanics/Latinos comprise 16% of U.S. population but less than 1% in clinical trials

• Cancer is leading cause of death for Asian Americans yet less than 3% of trial participants.

29

Sources: http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm; clinicaltrials.gov; www.cdc.gov/nchs/data/factsheets/factsheet_disparities.pdf

Factors Contributing to Variability in Drug Response

ENVIRONMENTAL FACTORS

Climate SmokingParasites AlcoholPollutants Drugs

Adapted from Poolsup et al. (2000)

BIOLOGICAL FACTORSAge

GenderGeneticsDisease

CULTURAL FACTORSAttitudeBeliefs

Family influence

VARIABILITY IN:Drug metabolismDrug receptors

Drug response proteinsDisease progression

proteins

Perceived and Real Barriers

31

• Widespread, deep-rooted mistrust / distrust of scientists, White researchers, medical establishment

• Based upon historic abuses (Tuskegee Syphilis Experiment), personal negative experiences, documented institutional racism in healthcare delivery

• Pressure from family members with negative attitudes about clinical research

• Time, travel and economic barriers• Personal obstacles: work / family-related (e.g. childcare,

eldercare)• Communication / language / literacy issues• No insurance or Under-insured• Lack of access to healthcare and healthcare information

Loretta Mary Aiken

32Jackie ‘Moms’ Mabley

“If you always do what you always did, you will always get what you always got.”

33Jackie ‘Moms’ Mabley

34

Crayola – Skin Tones!

Quality, Affordable, Accessible, Culturally Respectful , Evidenced-

Based, Healthcare is not a privilege.

It’s a civil right!

36