Sometimes life is just not fair. People are not treated equally. You might not know it, but who you are can impact your health and your healthcare. Your gender or race can impact your healthcare. So can your income or sexuality. What’s the story?
This is the first of a 2-part series on this topic. Next week’s post covers what leads to healthcare disparities and tips for people to get the best care possible.
Race matters, unfortunately.
The racial health gap in the US is well-documented. And it starts from day one. Blacks have a higher infant mortality rate (11.3 blacks vs. 5.1 whites per 1,000); American Indian and Alaska Natives have an infant mortality rate of 8.1/1,000.
Latinos and blacks experience 30-40% poorer health outcomes than white Americans, causing increased illness rates and shortened lifespans. Although the life expectancy gap between black and white Americans has narrowed, disparities still persist. Improvements in the healthcare system have increased life expectancy for most Americans, but white Americans have gained the most. This larger health gain for whites widens the racial gap in health. Other ethnic groups suffer from healthcare disparities as well.
How wide is the gap?
According to a US government report, 33-42% of blacks, American Indians, Alaskan Natives and Hispanics received worse care than whites on 33-40% of quality healthcare measures.**
Examples of how healthcare disparities impact minorities:
- The death rate from breast cancer for black women is 50% higher than for white women. Racial and economic inequities in screening and treatment options contribute to this difference in survival rates.
- Blacks have higher rates of heart failure and strokes than whites. Although 25% of black Americans have high blood pressure (compared to 10% of white Americans), black patients are 10% less likely to be screened for high cholesterol than white patients.
Gender plays a role.
Doctors and nurses treat women differently from men, which can delay treatment and cause harm. Additionally, medical research has long been focused on men, leading to guidelines for diagnosis and treatments based on a man’s biology. This male focus has caused misdiagnosis and harm for women, because tests, dosages, symptoms and treatments for major diseases have long been based on the “typical” 154-pound white male patient. Fortunately, times are changing, and research is starting to focus on men and women.
Women’s health and healthcare is negatively impacted in many ways just because they are women. A few examples:
Doctors often overlook or minimize women’s pain.
Women are more likely to suffer from pain than men; and both male and female doctors are more likely to dismiss women’s pain. One survey found that over 90% of women with chronic pain feel the healthcare system discriminates against female patients. Although women report more frequent, more severe and longer lasting pain than men, research shows doctors less aggressively treat women for pain compared to men. One emergency room study found that women waited 16 minutes longer than men to receive pain medication, and were less likely to receive opioids.
Women with heart disease are often not treated appropriately.
Heart disease in women is underdiagnosed and undertreated:
- One study of women (30-55 years old) hospitalized for heart attacks found that the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis.
- Women are nearly twice as likely as men to die within a year after a heart attack, partly because “cardiovascular care has been slow to acknowledge the gender differences in heart disease”.
- Results from the traditional treadmill tests to detect heart problems are more likely to be inaccurate for women because the scoring system is based on results from middle-aged men.
Things are worse for women with diabetes.
- Women with diabetes have significantly poorer outcomes than men.
- Diabetic women are more prone to heart disease and more likely to suffer a fatal heart attack, but research shows they often receive less aggressive treatment for cardiovascular risk factors.
Your financial well-being can directly impact your health. There is a well established connection between poverty and poor health. People with low income and low educational levels are more likely to be sick, and are more likely to have worse outcomes, including death. Heart disease, diabetes, obesity and low birth weight are more common among those with low income and low educational levels.
According to a US government report:
- 56% of those from poor and low-income households have worse care for almost 60% of quality measures** as compared to high-income households.
- 42% of patients from middle-income households received worse care for >40% of quality measures** compared to high-income households.
As expected, having a good insurance plan makes a difference. Uninsured people had worse care than privately insured people for almost 2/3 of healthcare quality measures.**
Examples of how income levels can impact health:
- In the US, 60% of low-income women are screened for breast cancer vs. 80% of high-income women.
- In low-income neighborhoods, diabetic patients are 10 times more likely to have a limb amputated than those from affluent areas.
Sexuality impacts care.
LGBT patients, including youths, may receive poor quality of care due to stigma, lack of awareness by healthcare providers, discrimination, and insensitivity to the unique needs of this community. Research shows that LGBT patients can experience denial of care, inadequate care, verbal abuse, disrespectful behavior and other barriers to high quality care. Unfortunately, the education and training for healthcare professionals regarding the unique needs and treatment of LGBT patients is lacking.
**Quality measures include death rates for specific diseases, hospital admission rates, and post-surgical complication rates. See the complete list of quality measures here.