Nearly half a century has passed since Rev. Martin Luther King Jr. famously said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Yet decades later, only modest progress has been made to reduce the pervasive racial and ethnic health disparities that exist in this country — and we don't have to look far to see the effects.
According to the Maryland Department of Health and Mental Hygiene, in 2010, African Americans represented 62 percent of adults and adolescents living in Baltimore City, yet they accounted for 85 percent of HIV cases. And across the state, African Americans were 10.9 times more likely than whites to die from HIV/AIDS. Between 2006 and 2010, the rate of diabetes among African Americans aged 65 years and older in Maryland was 32.2 percent — compared to only 17.3 percent for their white counterparts. During the same time period, African Americans also had higher rates of diagnosed hypertension, obesity and kidney disease than non-Hispanic whites.
Maryland's Hispanic population also bears the heavy burden of inequalities in health care. In 2010, the HIV rate for Hispanics, while significantly lower than for African Americans, was still 3.6 times higher than for non-Hispanic whites. And at 29.1 percent, the rate of diabetes among Hispanics was only marginally lower than for African Americans.
Meanwhile, between 2006 and 2010, African Americans were nearly two times more likely than whites to be unable to afford to see a doctor and more than twice as likely to be without health insurance. And compared to whites, Hispanics were more than three times as likely to be unable to afford to see a doctor and more than five times as likely to be without health insurance. These steep health disparities among African Americans and Hispanics in Maryland provide a grim snapshot of a widespread problem with devastating implications for the growing minority populations in this country.
April marks National Minority Health Month — a critical opportunity to highlight the persistent health inequities that lurk under the radar of the majority in this country while furtively working to hinder social justice. But the work to eliminate health disparities in this country must remain a national priority year-round, not just during April. The cost of inaction — both moral and economic — is truly staggering.
A recent study from the Program for Research on Men's Health in the Johns Hopkins Center for Health Disparities Solutions offers a big-picture view of this issue. The study looked at the economic impact of health disparities among U.S. men and estimated that these disparities cost the economy more than $450 billion between 2006 and 2009.
According to the study, African American men incurred the vast majority of these costs — a total of $341.8 billion in excess medical costs due to health inequalities. That mind-boggling number is the sum of the direct medical expenditures attributable to health disparities over the four-year period ($24.2 billion) and the indirect costs associated with lower worker productivity due to illness and premature death ($317.6 billion over the four-year period). The study calculated these costs for African American, Asian, Hispanic and white men, and found that African American men incurred 100 percent of the direct medical costs due to health disparities and 72 percent of the indirect costs over the four-year period. According to the study, Hispanic men incurred an additional $115 billion in indirect costs due to health disparities, and Asian men incurred another $3.6 billion in indirect costs due to health disparities over the four-year period.
King's oft-quoted words, first spoken nearly 50 years ago, stand as a stark reminder of how far we still have to go to eliminate the vast health inequities in this country. Certainly, some progress has been made — for example, the landmark Affordable Care Act, while still in the nascent stages of implementation, contains important provisions to reduce racial and ethnic health disparities. But relief can't come soon enough for the individuals and families who shoulder the burden of these inequities.
Dr. Roland J. Thorpe Jr. is an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and Director of the Program for Research on Men's Health at the Johns Hopkins Center for Health Disparities Solutions. This article is written in a personal capacity and is independent of his affiliation with Johns Hopkins University. His email is firstname.lastname@example.org.
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