Disparities in Health Care

Disparities in Health Care Thanks to medical advances and advanced preventative care, Americans are living longer and healthier than ever. However, these benefits don 't seem to apply to everyone equally because a great disparity exists. Not a disparity based on access or clinical needs, preferences, or appropriateness of intervention, but a racial and ethnic disparity that divides on socioeconomic lines. When all medical care being accessed and administered is considered equal, the poor and racial minorities suffer the most with inadequate insurance coverage, higher incidences of illness, and culturally shaped attitudes that impact and lessen their quality of life. Socioeconomic status is a measure of an individual or family 's relative economic and social ranking (Socioeconomic status,” n.d.). Differences in education, income and occupation affect the socioeconomic status of African Americans. When compared, a lower percentage of African Americans had earned at least a high school diploma than non-Hispanic whites. According to the 2007 Census Bureau report, the average African-American family median income was $33,916 in comparison to $54,920 for non-Hispanic white families. In 2007, the U.S. Census bureau reported that 24.5% of African Americans in comparison to 8.2% of non-Hispanic whites were living at the poverty level. In 2007, the unemployment rate for African Americans was twice that for non-Hispanic whites (U.S. Department of Health and Human Services, 2008) The national healthcare disparities report (NHDR) identifies the differences or gaps where some populations receive poor or worse care than others and to track how these gaps are changing over time. Although the emphasis is on disparities related to race, ethnicity, and socioeconomic status, this report also examines disparities in “priority populations.” These include groups with unique health care needs or issues that require special attention. Among the priority populations addressed in the NHDR are women, children, older adults, residents of rural areas, and individuals with disabilities or special health care needs.
According to the report, health insurance facilitates entry into the health care system. Uninsured people are less likely to receive medical care, are more likely to die early and have a poor health status. The financial burden of no insurance is great; almost 50% of personal bankruptcy is due to medical expenses. Uninsured people report more frequent problems getting care, are diagnosed at later disease stages and get less therapeutic care. They are sicker when hospitalized and more likely to die during their stay. In 2007, 49 percent of African Americans compared to 66 percent of non-Hispanic whites used employer-sponsored health insurance, 23.8 percent of African Americans in comparison to 9 percent of non-Hispanic Whites relied on public health insurance and 19.5 percent of African-Americans in comparison to 10.4 percent of non-Hispanic whites were uninsured. (U.S. Department of Health and Human Services, 2009) Lack of health insurance affects access to care. Also, those without insurance are more likely not to have a primary care provider than those with insurance. Having a primary care provider is associated with a patient’s greater trust in their provider and good patient-provider communication. The primary care provider is able to recognize the patient’s individual health care needs over time and can coordinate care to meet the patient’s needs. Another factor that affects access is the patient’s perception of need for care. Patient perceptions of need include perceived difficulties or delays in obtaining care and problems getting care as soon as it is wanted. Although patients may not always be able to assess their need for care, problems getting care when patients perceive that they are ill or injured reflect significant barriers to care. Although the patient may recognize the need for care they may not have the resources to obtain it. If the patient is uninsured it may be a difficult decision whether to use money for living expenses or medical expenses. A third healthcare disparity affecting African Americans is incidence of illnesses. According to the Centers for Disease Control and Prevention, HIV and AIDS disproportionately affect African Americans in the United States. In 2006, the rate of new AIDS cases for African Americans was 60.3 per 100,000 compared to 6.4 per 100,000 for non-Hispanic Whites. The spread of HIV is related to factors faced by many African Americans, including poverty and high-risk behaviors related to sexually transmitted diseases. Diabetes affects 13.3% of all non-Hispanic blacks aged 20 years or older; while only 8.7% of all non-Hispanic whites aged 20 years or older having diabetes. Non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic Whites. From 2004-2006 the percentage of hospitalizations for lower extremity amputations among diabetes patients is higher for blacks than whites, 5.7 admissions per 1,000 with diagnosed diabetes compared with 2.5 admissions per 1,000 (U.S. DHHS, 2009). Each cultural group has differences in patterns of communication, personal space, social organization, time perception, environmental control, and biological variations. African Americans believe that asking personal questions of someone you have recently met is improper and intrusive and that direct eye contact in conversation is rude. They value personal space believing that touching someone else’s hair is offensive. They usually have close extended family networks and women play a key role in healthcare decisions. Importance is placed on the present time due to the uncertainty of the future. They view nature as dominant and believe that they have little or no control over what happens to them (Stanhope & Lancaster, 2010). African Americans perception of health is harmony of mind, health, body and spirit with nature. When dealing with an illness, including mental illness, they tend to minimize the significance of the disease and try to prevail in the face of adversity through increased striving. Often they will seek guidance from religious figures. Family plays an important role in providing support to individuals with mental health problems. A strong sense of family loyalty means that, despite feelings of stigma and shame, the family is an early and important source of assistance in efforts to cope, and that African American families continue to be involved in the treatment of a mentally ill member (U.S. Department of Health and Human Services, 1999). As we can see the disparities found in racial and depressed socioeconomic backgrounds can severely hinder the benefits being offered by modern medicine. Although many of these factors, like access to adequate coverage, can be addressed through immediate government interaction, there are still factors that must be changed over time. A cultural perception of medical needs is one that needs attention on an educational level. Teach these poor neighborhoods and minorities that they deserve to be treated and they will slowly start to view health care providers in a more trusting fashion. Ensuring that everyone has a chance to live a healthy life also requires efforts of collaboration among multiple sectors that include housing, labor, and even the justice system. We can close the disparity gap in our lifetime. We just have to acknowledge it and not just pretend it doesn 't exist.

Works Cited
Office of Minority Health, Office of the Director, CDC.(2005). Health Disparities Experienced by Black or African Americans --- United States. Morbidity and Mortality Weekly Report, 54(1),1-3. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a1.htm
Socioeconomic status. (n.d.). In National Center for Educational Statistics glossary. Retrieved February 28, 2010, from http://nces.ed.gov/programs/coe/glossary/s.asp
Stanhope, M., Lancaster, J. (2010). Foundations of Nursing in the Community: Community- Oriented Practice. St. Louis, Missouri: Mosby Elsevier.
U.S. Department of Health and Human Services (1999). A Report of the Surgeon General
 Executive Summary. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec8.html
U.S. Department of Health and Human Services. (July 2008) African American Profile. Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=51
U.S. Department of Health and Human Services (March 2009). National Healthcare Disparities Report 2008. Retrieved from http://www.ahrq.gov/qual/qrdr08.htm
U.S. Department of Health and Human Services. (January 2010) A Statistical Profile of Black Older Americans Aged 65+. Retrieved from http://www.aoa.gov/AoARoot/Aging_Statistics/Minority_Aging/index.aspx

Cited: Office of Minority Health, Office of the Director, CDC.(2005). Health Disparities Experienced by Black or African Americans --- United States. Morbidity and Mortality Weekly Report, 54(1),1-3. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a1.htm Socioeconomic status. (n.d.). In National Center for Educational Statistics glossary. Retrieved February 28, 2010, from http://nces.ed.gov/programs/coe/glossary/s.asp Stanhope, M., Lancaster, J. (2010). Foundations of Nursing in the Community: Community- Oriented Practice. St. Louis, Missouri: Mosby Elsevier. U.S. Department of Health and Human Services (1999). A Report of the Surgeon General Executive Summary. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec8.html U.S. Department of Health and Human Services. (July 2008) African American Profile. Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=51 U.S. Department of Health and Human Services (March 2009). National Healthcare Disparities Report 2008. Retrieved from http://www.ahrq.gov/qual/qrdr08.htm U.S. Department of Health and Human Services. (January 2010) A Statistical Profile of Black Older Americans Aged 65+. Retrieved from http://www.aoa.gov/AoARoot/Aging_Statistics/Minority_Aging/index.aspx