|
Our
health care system, for all its technological advances,
is grossly inadequate at recognizing the special needs of
some individuals. Certain segments of the population are
underserved or misrepresented by our health care system.
As a result, such people may forego treatment altogether,
or be denied access to certain treatment options.
We
need to recognize these faults in order to promote social
equality. Changing social attitudes begins and ends with
changing medical practices that affect these individuals.
Often
medical decisions are unduly influenced by the patient's
sex, age, race, or sexual orientation. Below are some
articles dealing with racial bias and discrimination in
health care. We will identify some of the barriers that
prevent these groups from receiving adequate health care.
|
Background on Asian and
Pacific Islander
Communities and the HIV Epidemic
As is true with other
underserved racial and ethnic groups, Asians and Pacific
Islanders strongly feel the need for effective and
accessible care. Poor people of color are less
likely to seek early treatment for HIV infection, are
likely to have been less healthy when they contracted the
virus, and are likely to have more advanced symptoms when
they present themselves for treatment.
Public health
officials should work with researchers, health
professionals, and community-based service providers to
gain a better understanding of the role of cultural and
socioeconomic factors in the transmission of HIV, the
disease process, and access to care...
|
Black Health in the United
States
Perhaps
you have heard the claim that white people are being
denied access to resources because of the demands of
Black people, because of "reverse
discrimination." Statistics suggests that the
medical problems for Blacks are different from those of
Whites. However, our health care system is not designed
to deal effectively with these special problems. One
cause is racial bias, in which Blacks are not only denied
access to adequate health care, but are blamed for
excaberating the "crisis" in health care in
general. Consider these figures which show the disparity
in Black/White medical issues.
Racial
Differentials in Death
In 1992 the infant mortality rate in the U.S. was 8.5
infant deaths per 1000 live births. The rate for White
infants was 6.8 while the rate for Black infants was
16.7. Historically the Black rate has been twice the
white rate. However, now it is 2.7 times as high and the
Centers for Disease Control (CDC) estimates that it will
be 3 times as high by the turn of the century. The Black
infant mortality rate is higher than the rate of every
industrialized country and even some Third World
countries. Maternal mortality, a related measure, reveals
an even worse differential: Black women die during
childbirth four times more often than white women. In
1992, the life expectancy of a person born in the U.S.
was 76 years. It was 74 for Black women, 65 for Black
men, 80 for white women, and 73 for white men. Thus,
white people will live, on the average, 7 years longer
than Black people.
Today's
Epidemics
The major epidemics of the day are tuberculosis and AIDS
and Black people are disproportionately attacked by both.
The AIDS case rate is six times higher for Black people
than white people while the TB case rate is eight times
higher.
Access
to Care
Under recent cutbacks many inner city hospitals have been
closed. Even when hospitals are able to remain open,
access to care is denied. A couple of years ago,
researchers revealed the common practice of "patient
dumping," whereby private hospitals transferred
large numbers of patients, overwhelmingly Black and
Latin, to other hospitals because they had no insurance.
The researchers determined that 24% of these were
transferred while medically unstable, and thus at risk
for their lives. Managed care, the new
cost cutting wonder, will only further worsen access to
care for people of color as health "care"
empires search for ways of increasing profits still
further.
(See Patient Dumping, Managed Care, and Equal Access)
Drugs
While the media focus on the devastating impact that
illegal drugs are having on the Black community, little
is said about the impact of alcohol and cigarettes.
Conclusion
The impact of racism on health care is be seen
everywhere. While "oppressed white men" are
feeling bad about how little they have and how much Black
people have taken from them, virtually every measure of
Black health reveals tremendous devastation.
|
CASE: Invisible
Women - Building a Lesbian Health Agenda
Lesbians are a unique
population of women whose specific health care concerns
are not often consistently met by the current health care
system. Various analyses state that at least 2-12% of the
U.S. population is lesbian. Lesbians have seemed
invisible within the health care system because they
don't necessarily differ from heterosexual women in any
obvious ways, and b ecause they may choose not to "come
out" and disclose their sexual orientation for any
number of reasons. Although studies in lesbian
populations are limited, there are indications that
depression, substance abuse, suicide, and social
isolation may occur more frequently in lesbian women than
heterosexual women. Additionally, lesbians may have
higher prevalence rates of certain cancers that differ
from those of heterosexual women, as well as lower rates
of some sexually transmitted diseases...
Among
the issues brought up in this article is the need to
foster trust
through a non-biased health care setting. Medical
questions should be
phrased so that they do not assume heterosexuality and do
not
threaten people who live alternative lifestyles.
|
Identified
Barriers to Care
Three categories relating to culture,
service provision, and policy and funding at Federal,
State and local levels. The following barriers reflect
those confronted by many people seeking adequate health
care.
Cultural Barriers
Diversity
Lack of ethnic-specific and
language appropriate prevention, care services,
treatment (including access to experimental
drugs) and information materials.
"One-size-fits-all"
approach to Health Programs
Alienation and dissatisfaction,
which may lead to discontinuation of treatment
Patterns in utilization of health
care services differ among various groups, yet
this is not taken into consideration in designing
programs and services for these populations
Other Barriers to Services
Lack of Services for Women
Inadequate Youth Services
Inefficient Systems Within
Agencies
Lack of Access to Alternative
Treatment
Insensitivity Among Providers
Structural
Barriers: Policy and Funding
|