by Julianne Malveaux, Jul 14, 1998

While income and education gaps between African Americans and whites are narrowing, the health gap is growing.

The National Institute for Aging recently reported that the average African American remains healthy till the age of 56, as compared to 64 years for a white person. African-American women are three times as likely to die in childbirth as white women are, and infant mortality rates, while dropping, are still twice as high for African Americans as for whites. Black women are diagnosed with breast cancer at younger ages, and are more likely to die from that disease than are white women. African Americans are three times more likely to die from high blood pressure than are whites. The incidence of tuberculosis, diabetes, cancer, heart disease, and stroke are all higher for African Americans than whites. No matter what health indicator is examined, three is a gap between blacks and whites.

Why?

Part of the difference has to do with income. On average, African Americans earn 60 percent of what whites earn. Less money often buys a different set of health services. Indeed, the poorest Americans often have health care delivered through emergency rooms, and have no access to preventive care.

But even when incomes are equal, health gaps remain. Do doctors treat black and white patients differently, regardless of income? Some consumers of health services assert that such differences exist.

Education may also make a difference in the kind of health care people seek out. Again, though, when education levels are held constant, there still remain differences in some health indicators. African Americans may have the ability to seek out the best medical care there is, but may not be able to control the stereotypes that shape the kind of health services they get.

Even when we control for a number of factors, including income, education, obesity, and smoking, the health gap remains.

Does the stress of black life in a racist society contribute to the large number of African-American men diagnosed with prostate cancer? Does it contribute to the fact that many African-American men in their early forties have experienced heart attacks and sometimes died from them? Does it contribute to the alarmingly high levels of high blood pressure among African Americans?

Professor John Hope Franklin, chair of President Clinton's race-relations advisory board, has spoken poignantly of the frequency with which he experiences racial insults. Although Franklin is in his eighties and has made more than 50 years of stellar scholarly contributions, he is subject to the basest of racial slurs. Would a white contemporary of his have the same experience? What health effect comes from the rush of anger, or even disappointment, at assumptions that one is powerless to control? Can this account for some of the difference in the health status of African Americans?

Consider the victims of a car accident, one black, one white. Bloodied and bruised, no one can tell what their status is when they are rushed to the hospital. Those who make assumptions might provide the white patient with expedited service, leaving the African American to wait. If you say it can't happen, consider Crown Heights, NY, in 1991, where ambulances sped by a dying Gavin Cato to attend to the perpetrator of the accident. Later, they said that the ambulances were "private" and no discrimination was involved. Tell that to the Cato family.

To be sure, cultural factors may also play a role in the health gap. It has been more than 30 years since civil rights activist Fannie Lou Hamer declared that she was "sick and tired of being sick and tired," but too many African American women, at all income levels, consider sickness and tiredness par for the course.

How do we close the gap?

There has to be equal access to quality health care, but there also have to be shifts in attitudes. Patients have to be much more aggressive about demanding the care that they need. Doctors have to be much more enlightened abut the assumptions that shape the care they offer.

The health gap is a shameful reminder of the fact that we need much more than a conversation on race to move racial equality.

Typist's note: This person is a syndicated writer?!? My guess is she lives in a tower and has had limited contact with actual poor people (or people who have no health insurance). Maybe if she got out once in awhile, she would see that the poor come in all colors. What about the Appalachian folks who can't even get doctors to practice in their area? From my experience, there is discrimination in the health care system but it is more concerned with the color green than human skin color. Also what about the genetic predisposition for high blood pressure that exists in the African American population? Or doesn't that figure in? And what about cultural attitudes toward health care? I could go on, but alas, I am but a humble typist. -- MJ Willow