AAFP Past President Calls for End to Health Care Disparities

The nation's health care system continues to perpetuate health care disparities by providing different levels of care for minority and nonminority patients, thus creating a two-tiered health care system that makes it difficult for minorities to access a high level of care. That's according to former AAFP President Warren A. Jones, M.D., of Ridgeland, Miss., who delivered the keynote address during the 2008 National Conference of Special Constituencies here on May 1.

Jones told audience members that "measurable differences" exist between the clinical appropriateness of care and the health care system's ability to deal with minority and nonminority populations. In many cases, he said, "there is a preponderance of evidence to suggest discrimination and bias in how care is delivered" to minority populations.

According to Jones, who also is executive director of the Mississippi Institute for Improvement of Geographic Minority Health, several diseases disproportionately affect minority populations, including asthma, cancer, cardiovascular disease, diabetes, HIV/AIDS and obesity. These diseases, in and of themselves, however, do not constitute health care disparities, said Jones, explaining that the system's inability to respond to these conditions in an appropriate way is what leads to disparities.

Jones referred to various studies showing wide disparities in care between minorities and nonminorities. For example, according to a 2002 Institute of Medicine study, minority patients with cardiovascular disease are less likely to receive appropriate cardiovascular medications or to undergo cardiac catheterization or bypass surgery than their white counterparts.

Black Americans suffer strokes as much as 35 percent more often than their white counterparts, according to the IOM study, but they are less likely to receive major diagnostic and therapeutic interventions. Moreover, blacks with kidney disease are less likely to be on waiting lists for transplants or to receive dialysis, and those with asthma are not as likely to receive appropriate medications to manage chronic symptoms.

Jones also referred to the 1999 Schulman experiment, which looked at key cardiac interventions recommended for white and black, male and female "virtual" patients seeking care for symptoms commonly associated with heart disease. The study found that white males were the most likely to receive state-of-the-art assessment, evaluation and intervention for cardiac disease, followed by white females, black females and black males.

Health care disparities are not caused by racial or ethnic factors alone, said Jones; socioeconomic and geographic conditions also contribute. Ending disparities presents a daunting challenge, he added, noting that blacks comprise 12 percent of the U.S. population and Latinos make up 15 percent. However, only 3 percent of nonfederal physicians in the United States are black, and only 3 percent are Hispanic, creating a cultural divide between patients and their physicians in many cases.

"By 2050, 50 percent of the U.S. population will be nonwhite," said Jones. "Yet, the physician population of our country continues to be predominately white and male."

Jones readily acknowledges the role research plays in curing diseases and ameliorating many health conditions, but he notes that much of the medical research conducted in this country is geared toward the white majority, not people of color, who tend to have a higher incidence of disease. In addition, minorities -- especially blacks -- often have an inherent mistrust of the system, making them reluctant to enroll in clinical trials, said Jones.

"We talk a lot about health disparities, but the question is, who is responsible?" he said. "Is it the government, providers, patients, payers?" In reality, it is a never-ending circle that will not stop until people step up and take responsibility for the problem, he told audience members, adding "There are challenges out there that deal with health disparities, but the solutions to those challenges start with you."