Racial disparities in healthcare: a crisis of human dignity
By Conor Kelly (TheLorian)
When dealing with something as complicated and emotionally potent as the Black Lives Matter movement, most people associate the organization’s concerns as only pertaining to the police. And while there are good reasons for many of these assumptions, fighting the lethality of racism is much more than just a fight against the abuse of power by police. Indeed, the lethality of racism comes not just from a rogue set of white men with guns. It comes through the healthcare system where negligence and disregard for black lives reigns.
In the case of Medicaid, the consequences of ineffectual policies are extensive and vast. Medicaid has been around for over forty years, providing coverage to 68 million Americans since August 2019. Of those 68 million Medicaid enrollees, 20 percent, or 13.6 million, are African American. For many African Americans, Medicaid is a lifeline—a lifeline that is consistently neglected. While a majority of states have enacted Medicaid expansions through the Affordable Care Act, many southern states have not. Indeed, the majority of states that have not enacted the expansion are concentrated in the South, where 58 percent of African Americans live.
In states that fail to enact a Medicaid expansion, African Americans are statically more likely to be caught in a coverage gap, according to the Kaiser Family Foundation. Indeed, the South is where the disparities between Black and White Americans are the most extensive. To be clear, I am not suggesting that the South is solely to blame for the conditions of African American health problems. I am, however, suggesting that refusing to expand Medicaid with such a large African American population will inevitably lead to greater harm to the African American community. The burden of such neglect is staggering.
Due to intense poverty and other factors, African Americans have higher healthcare costs, higher uninsured rates, and higher mortality rates for a wide variety of diseases. Between 1999 and 2015, the mortality rate for African Americans declined by 25 percent, an impressive improvement. However, despite those gains, African Americans’ life-expediencies were still lower than that of their White counterparts, with whites living four years longer than African Americans.
The disparities are evident even in young people. African Americans who are in their 20s, 30s and 40s are more likely to die from heart disease, stroke and diabetes than White Americans of the same age groups, according to the Centers for Disease Control. African American infants are also significantly more likely to die than Whites with a mortality rate of 11 deaths per 1000 in 2017. Within that same year, African American mothers were 2.3 percent more likely to receive late or no prenatal care, as reported by The Department of Health and Human Services. It is not merely by coincidence that this neglect is happening, but it is observably connected to implicit and in some cases, explicit bias. In 2015, The National Library of Medicine conducted a systemic review of studies that were published prior to that point. The reviews showed that all but one study found some form of implicit bias against Black and Latino people. Another study conducted by The New England Journal of Medicine showed that implicit bias worsened clinical treatments of chest pains for minorities, specifically Black women.
I wish I could say that this is clearly unacceptable, but if it were so clear, these issues would have been addressed long ago. But because our government, and by extension, some of our people, either do not know or do not care, little is done to undo this perpetual neglect. We can’t claim that there is a right to life, liberty and the pursuit of happiness and then ignore the role healthcare plays in all of those things. We have known about the health disparities since the 1980s, but the efforts we have taken on this front have been inadequate at best. If we are to truly embrace the basic concept that Black lives are valued in this country, then all of these problems have to be addressed now. We can’t selectively care for humanity. We all matter or none of us matter.