Demographics can mean health care disparities
■ A message to all physicians from the chair of the AMA Board of Trustees, J. James Rohack, MD.
"Facts do not cease to exist because they are ignored," noted the famous English author Aldous Huxley. The demographic changes that the United States and my own home state of Texas will undergo over the next 40 years offer sobering facts to those of us who provide medical care -- facts that we can't risk ignoring.
Most of us can envision the coming impact of our aging population, such as the need for certain specialties to treat the growing disease burden. But if we focus only on the aging of our population, we risk overlooking another, powerful demographic shift: By 2050, almost half of our population will consist of African-Americans, Asian-Americans, Hispanic-Americans and American Indians. Thus, another question we need to ask is this: With increasing numbers of minority patients, are we prepared to deliver culturally responsive, equitable care?
Unfortunately, as of today, the answer appears to be "no." Consider the facts. Research has shown that minority groups experience disparities in health care, health status and health outcomes. The Institute of Medicine report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" (2002), defines disparities in health care as "racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of interventions." Documentation shows that health care disparities exist for Hispanic-Americans, American Indians, Asian-Americans and African-Americans.
Fact: Among Medicare recipients in managed care plans, African-Americans were less likely than whites to receive breast cancer screenings (63% vs. 71%), diabetic eye exams (44% vs. 51%), beta-blocker after myocardial infarction (64% vs. 74%), follow-up after hospitalization for mental illness (33% vs. 54%), and influenza vaccinations (46% vs. 68%). These differences cannot be explained by insurance status.
Fact: Of patients who are approved for renal transplantation, 52% of whites received a kidney, compared with 17% of African-Americans. Sixty-five percent of minority patients who reported having cancer pain did not receive the recommended prescriptions, compared with 50% of whites. White patients are 78% more likely than African-Americans to receive revascularization procedures after angiography.
Fact: When the Kaiser Foundation surveyed physicians in 2002, it asked if the American health system treats people unfairly based on their racial or ethnic background "very" or "somewhat often." Physicians responded "yes" in the following percentages, based on ethnicity: white, 25%; Asian, 33%; Latino, 52%; and African-American, 77%.
Faced with the facts, our American Medical Association, with the help of our Minority Affairs Consortium and its Governing Council Chair, Kevin McKinney, MD, in April 2004 helped to create the Commission to End Health Care Disparities. The Commission will work proactively to increase awareness among physicians and health professionals, using evidence-based and other strategies to inspire change. Members also will advocate for action, including action in government, to eliminate disparities in health care and to strengthen the health care system.
What can you do as a physician? For the individual patient, building trust is key. Expressing that you care, communicating clearly and completely, demonstrating honesty and respect, and understanding individual patient's experiences are important first steps. You can educate yourself and others, using resources available through our AMA Web site, including a health disparities awareness video (link).
While Texas is at the point of the spear of America's ethnic and demographic changes, the whole nation will feel the impact. I hope that the vision of the Commission to End Health Care Disparities soon will become a reality, as it helps member organizations, physicians, health professionals and health systems to provide quality care to all people.
You, too, can make a difference by recognizing the facts and making changes. If all physicians do their parts, and if we all work together to transform health care for minority patients, we will find ourselves ready for the demographic changes that lie in wait.
Together, we can make a difference. Together, we are stronger.