The ‘60s brought the Watts riots. During a period in United States history when race relations were tense, the riots signaled more than just turbulent times. The raucous signified an entrenched sense of racial otherness, even after a century of so-called “emancipation.” Jim Crow laws precluded blacks from sitting in the same classrooms and bathrooms as whites; this led to the rise of great leaders who upended the status quo. From Martin Luther King Jr. to Malcolm X, there was no shortage of trailblazers who challenged social norms and risked their lives for equal treatment of the races.
The ‘70s arguably set the stage for today’s Tea Party – though blacks were given the same rights legally as their white counterparts, they practically were still discriminated against. White Southerners had been told their entire lives that they were “better” than blacks, that they deserved more and were entitled to their place in society. In the aftermath of the Civil Rights Act of 1964, white Southerners suddenly had to adjust to new standards. Many were angry, felt cheated and rebelled through violence against members of the black community. In 1969, Republican strategist Kevin Phillips identified angry white Southerners as the future of the Republican Party. Though of course, there are plenty of blacks who vote Republican, his sentiment was widely adopted. Today, 55% of voting White Southerners identify as Republican. In contrast, about 11% of voting blacks identify as members of the GOP.
Race relations are ingrained in our nation’s history, but in the public eye these important relationships and the disparities that have resulted are less often discussed in the context of healthcare. This is curious, of course, because annual US healthcare spending hit $3.8 trillion (yes, trillion) last year. In public health settings, we often discuss the causes of these exorbitant numbers and what the origins may be. To outsiders looking in, it appears as though we have come a long way in terms of race relations in the United States. Barack Obama is the 44th President of the United States, Paulette Brown is the first black American Bar Association President, Wendell Scott was inducted into the NASCAR Hall of Fame – so, of course, bigotry is a non-issue, right?
Not exactly. Though there have been tremendous advances in medicine, it is still clear that racial and ethnic minorities receive lower quality of care than their white counterparts. Minorities experience greater morbidity and mortality than non-minorities, and this disparity has nothing to do with access, clinical needs, preferences or the appropriateness of the intervention.
Quite simply, healthcare is not as available to blacks as it is to non-minorities. Though the Affordable Care Act has tempered the blow of deficient health coverage, inadequacies remain. In 2010, the Center of American Progress issued a report stating that as a nation, the cost of racial and ethnic disparities amounts to $415 billion. Disparities in health status attributed to race and ethnicity are often difficult to measure; there are confounding factors such as socioeconomic status, education and work status. But, a few things are quite clear. Thirteen percent of blacks across all age groups report that they are in fair or poor health. Thirty-seven percent of black men and almost fifty percent of black women are obese. These numbers are higher than whites in almost every state. Blacks also have higher rates of hypertension, diabetes, and heart disease than other groups. Rates of diabetes in blacks are double than rates in whites. The infant mortality rate in this population is more than double than the infant mortality rate in non-Hispanic whites.
These statistics are not merely numbers, but instead, they cry for the attention of whomever the future incumbent of the West Wing may be. Donald Trump is likely to be the Republican candidate for President; pomp and circumstance surrounding debates, interviews and appearances by politicians vying for power often cast shadows over some of the more troubling realities we’ll face once the hoopla has subsided. Why is the presidential race relevant? Well, for one, Trump has called for the repeal – yes, repeal – of the Affordable Care Act. He has cited that people’s premiums have increased by 35% to 55%. Trump has also mentioned that deductibles are so high under Obamacare that no one will purchase health insurance. Years ago, it may have been unimaginable to consider Trump as a serious contender in the presidential election. Yet today, he is the Republican frontrunner. Polls currently predict that whether it’s Clinton or Sanders, our next Democratic candidate will become POTUS and beat Trump. However, these are just polls. The political climate is volatile. Additionally, polls are not reliable. In 1995, Senator Bob Dole led Bill Clinton in polls by six percentage points. Clinton ended up winning by eight percentage points. The fact is that Trump, Cruz, Rubio or whoever the Republican nominee may end up being could sweep away this election and work hard to repeal the PPACA.
Here’s why this would be bad: healthcare in America pre-Affordable Care Act facilitated disparities between blacks and whites. Disparities occur in the quality of care received even when income, health insurance, and access to care are taken into account. Blacks and other racial minorities are far worse off than their white counterparts when it comes to life expectancy, infant mortality, prevalence of chronic diseases and insurance coverage. Obamacare is the first paradigm that addresses racial and ethnic disparities in healthcare. Under the 2010 PPACA, all federally funded health programs are required to collect and report race, ethnicity and language preferences and other pertinent demographics. Tracking these data helps identify and eliminate disparities; tracking also improves the quality of care. Not only does the PPACA boost tracking, but it also elevates the National Center for Minority Health and Health Disparities (NCMHD) to “full institute” status within the National Institutes of
Health (NIH). This allows for focus on minority health issues at the NIH and other key HHS agencies like the FDA, AHRQ and CDC.
Americans generally agree that the United States has come far in terms of race relations. The turmoil in a post-war/pre-Civil Rights era has led to substantial progress and legal equality between whites and minorities. However, we pry under the covers and discover that discrimination and disparities exist subtly – namely, when it comes to healthcare. Obamacare was a good start, but that’s all it was. The incumbent in 2017 could potentially scorch the ground we’ve gained or he/she could carry the torch in the way of further progress. In 2007, Barack Obama asked the American people to “vote for change.” With his stake in the ground and a foundation for the future of healthcare in America, I’d now ask that we “vote for more of the same.”