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December 26, 2002

Why Black People Die Early

In a few recent posts (here and here), I've noted problems with the conservative argument that blacks lose out under social security because they die earlier and collect fewer years of benefits. Aside from the actuarial inaccuracies in this conservative propaganda, the real perversity is the "outrage" at social security without real outrage at the core issue -- blacks die earlier than whites. And the same applies to latinos as well.

What could be a more real and course version of racism in America than this ongoing reality?

Well, with the ousting of Trent Lott and a supposed new commitment to atone for past racism, maybe the GOP can address this form of racism in society, especially with our Dr. Frist heading the Senate?

Let's start with a few basics:

Reading Material: Most of the following will come from these major publications.

  • Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. National Academy of Sciences.
  • Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality, A Report of the United States, Commission on Civil Rights (September 1999).
  • Changing America: Indicators of Social and Economic Well-Being by Race and Hispanic Origin. US Department of Health and Human Services.
  • Fact Sheet: Addressing Racial and Ethnic Disparities in Health Care. Agency for Health Care Policy and Research. Dept. of Health and Human Services.

    Who Dies and When:

  • Whites live 5.6 years longer than blacks on average.
  • Infant mortality rates are 2˝ times higher for blacks than for whites.
  • Black men under age 65 have prostate cancer at nearly twice the rate of white men under age 65.
  • The death rate for heart disease for blacks is higher than for whites (147 deaths per 100,000, compared with 105 deaths per 100,000).
  • Individuals from racial and ethnic groups account for more than 50 percent of all AIDS cases, although they account for only about 25 percent of the U.S. population.
  • Diabetes rates are 70 percent higher for blacks than for whites, and the rate among Hispanics is twice that of whites.
  • Black children are three times more likely than white children to be hospitalized for asthma.

    Lack of health insurance: Nothing is more glaring in our society than its unequal health care, driven by our unique status as the only major developed nation without guaranteed national health coverage. Given our employer-base health coverage system, discrimination in job opportunities leads to discrimination in access to health care. "Sixty-nine percent of whites are insured through their employers, compared with only 52 percent of blacks and 44 percent of Hispanics." Even among full-time workers, there are still disparities between whites and minority workers in health coverage.

    And the closures of community hospitals just adds to the health coverage crisis, since those without health insurance are the most likely to turn to such institutions. But with for-profit corporations like the Frist Family HCA Corporations buying up non-profit hospital systems and often shutting down low-profit branches in poor, heavily minority communites, the problem just gets worse.

  • African Americans and Hispanic Americans are far more likely to rely on hospitals or clinics for their usual source of care than are white Americans (16 and 13 percent, respectively, v. 8 percent).
  • Hispanic children are nearly three times as likely as non-Hispanic white children to have no usual source of health care.
  • The higher the percentage of blacks in a community, the more likely the hospital is to close. Of the more than 200 hospitals in black communities in the 1930s, only 12 were still operating in 1991.
  • 27 percent of families in which all family members are uninsured report that they had delayed or not received needed health care, compared to only 8 percent of those with all family members insured.

    Discrimination in Rates for Health Insurance
    One factor that undermines health care for minority groups is discrimination by insurance companies that charges them higher rates for the same insurance received by whites. See here . In one Florida investigation, hundreds of thousands of blacks who bought health care policies from the 1940s through the 1960s in the South are still paying higher rates, in some instances more than a third higher than whites.

    Employer-provided health care is subsidized through the tax code. Because many blacks and other minorities don't have access to jobs providing health care, they automatically face higher costs in finding private insurance.

    Discrimination in Health Care
    The following is only a sample of widespread studies documenting the discrimination against blacks and other minorities in health treatment. Even when controlling for access to health insurance, discrimination persists in our health care system:

  • Transplants and surgery: Whites are two to three times more likely to receive a kidney transplant than non-whites, and three times more likely to undergo bypass surgery.
  • b>Asthma. Among preschool children hospitalized for asthma, only 7 percent of black and 2 percent of Hispanic children, compared with 21 percent of white children, are prescribed routine medications to prevent future asthma-related hospitalizations.
  • Breast cancer. The length of time between an abnormal screening mammogram and the followup diagnostic test to determine whether a woman has breast cancer is more than twice as long in Asian American, black, and Hispanic women as in white women.
  • Nursing home care. Asian American, Hispanic, and African American residents of nursing homes are all far less likely than white residents to have sensory and communication aids, such as glasses and hearing aids.
  • Elder Care: Blacks enrolled in Medicare managed-care plans are 21 percent less likely than Whites to receive follow-up help after hospitalizations for mental illnesses.

    While it won't solve all these problems, given persistent racism even against blacks and latinos with health insurance, establishing a national and comprehensive health insurance system is the first step in ending this murderous level of institutional racism in American society. Increased affirmative action and loan repayment systems for black and latino doctors would be another step to getting health care providers into the system who might treat minority illness with the same dedication as illness suffered by whites.

    Posted by Nathan at December 26, 2002 04:00 AM

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    Comments

    Ok so far so good. Now how about an article called "Why Male People Die Early". I think the figures comparing men with women are a little worse in some areas. For example the title area -- men live about 6 years less than women.

    Posted by: DavidByron at December 26, 2002 05:55 PM

    Assuming David's analogy is intended to be serious... and I'm not at all sure he isn't spoofing... many of the reasons women live longer than men are biological, while most of the reasons whites live longer than blacks are demonstrably societal. Of course there are exceptions in both comparisons, but as Nathan ably documents, the black/white disparity in longevity can in fact be addressed by changes to public policy and corporate behavior, even in those few cases in which the differences are genetic in origin.

    Implicit in David's interpretation is the notion that somehow men are discriminated against. But of course that's garbage. Both government and corporations do a pretty good job of discriminating against women. Who knows how much greater still the average longevity of women would be if government-funded medical research had paid equal attention over the years to women's medical problems. But the fundamental difference is biological, and the discrimination in research dollars has historically been against the group that already lives longer. This problem is very real and must be addressed, but it is not analogous to that of longevity differences among races.

    Posted by: Steve Bates at December 28, 2002 12:06 AM

    That reply was a good example of the prejudice men face. There's no reason to assume men live less than women "naturally" any more than saying blacks naturally live less than whites. In any case it would be irrelevent. A lot of things happen naturally which are not good. If women suffer more from breast cancer we don't shrug and say "that's nature" we do something about it (we don't do anything about prostate cancer that kills just as many men of course....)

    I would say most of the reasons men live shorter lives are "demonstrably societal". And Steve you just show your ignorance when you claim men are treated better. Health expenditures on women is a lot more than men. For sex specific expenditure it is something like triple for both medical and research. Hey Steve what's the male equivalent of the word "gynacologist"?

    Posted by: DavidByron at January 15, 2003 12:56 AM

    David, I know you roam Internet boards trashing feminism, but this stuff about medical research is just kind of silly. The most obvious reason for longer female longevity, aside from whatever biological issues may be at stake, is the fact that women smoke in lower numbers than men. The converging of smoking rates is narrowing the longevity gap. See here.

    Posted by: Nathan Newman at January 15, 2003 01:14 AM

    If men are dying because men smoke more then wouldn't a progressive and populist conclusion be that men need an education campaign specifically targeting them so that they stop killing themselves so much?

    However call me suspicious but I think when women get about triple spent on them (for sex specific research for example) that might possibly be contributing to the 6-7 years longer women live for. Otherwise why do we bother spending anything on medical research?

    Men, like blacks, tend to live lives that are more likely to subject their bodies to ill health. For example what is it? 95% of on the job deaths are men? The top 19 most dangerous jobs are overwhelmingly male jobs? Men have lives that are more stressful than women's and more dangerous both at work and off work. Why is that do you think? Why are men so careless with their lives? Do you think it is genetic or socially taught? And does it really matter?

    The solution in either case is to target men, and the things that make men's lives more destructive and bring down that hideous seven year gap in life span. That is just as important as the seven year gap between the races.

    Posted by: DavidByron at January 15, 2003 11:05 PM

    when you talk about life expectancy - are all deaths included or just death by natural cause - asking because if a young person dies that would bring the average way down?

    Posted by: kurtiscooper at May 22, 2003 04:08 PM

    I think it is a pretty job of discriminating against humanity, First of all men’s lives more destructive and bring down that hideous seven year gap in life span. Men have lives that are more stressful than women's and more dangerous both at work and off work.

    Posted by: Susan R at January 27, 2006 11:31 PM

    Nowadays life expectancy difference between man and women are narrower, as more women are fulfilling the role of the man

    Posted by: Robert at March 28, 2006 12:17 AM

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