By Kimberly N. Alleyne
WASHINGTON—Health disparities are creating economic burdens for families, communities and the nation’s health care system. Across the country, infant mortality and chronic diseases continue to affect people of color at rates far higher than those for whites.
In recent years, the focus has increased on the impact of disparities on minority communities, with public officials, community activists, civic leaders and health care experts proposing ways to improve access to medical care and raise awareness of positive benefits of preventive care. But health experts say the economic toll of health disparities and substantial costs associated with lost productivity are being overlooked.
“Racial and ethnic groups have higher incidences of diabetes, high blood pressure and cancer, et cetera,” says Brian D. Smedley, vice president and director of the Health Policy Institute at the Joint Center for Political and Economic Studies in Washington, D.C. “That prevalence [of chronic diseases] comes with a price tag in terms of excess direct medical costs, nearly $230 billion over a four-year period that we studied.”
The study found that between 2003 and 2006, 30.6 percent of direct medical care expenditures for African-Americans, Asians and Hispanics were excess costs due to health inequalities. The study estimated that eliminating health disparities for minorities would have reduced direct medical expenditures by $229.4 billion and slashed indirect costs associated with illness and premature death by more than $1 trillion for those years.
The 2010 National Healthcare Disparities Report documented that racial and ethnic minorities often receive poorer care than whites while facing more barriers in seeking preventive care, acute treatment or chronic disease management. The report is produced by the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services (HHS).
According to the report, minorities also experience rates of preventable hospitalization that, in some cases, are almost double that of whites; African-Americans have higher hospitalization rates from influenza; and black children are twice as likely to be hospitalized and more than four times as likely to die from asthma as white children.
Thomas A. LaVeist, director of the Hopkins Center for Health Disparities at the Johns Hopkins Bloomberg School of Public Health in Baltimore, says increased health risks for minorities are directly related to where they live and work.
“The fact is that we have an inequitable distribution of opportunity,” he says. “Where you live determines what schools your children get to attend. It determines if your house will appreciate or de-appreciate and whether you can create wealth. It also determines whether you are exposed to environmental inequalities and the type of health care facility that is available to you. Where you live, work, play and pray affects quality of health care.”
Jennifer Ng’andu, deputy director of the Health Policy Project at the National Council of La Raza in Washington, speaks even more pointedly: “If we look at communities of color, we see that many racial and ethnic groups live in unsafe environments, there is poor housing and there is loss of productivity because of illness.
“Essentially, every time a person of color goes to the doctor, 30 percent of their bill is due to health disparities so they end up paying more in the doctor’s office because over time they receive health care that is not appropriate or effective,” she says. “They become needlessly sicker and are more likely to die prematurely, so they end up paying more medical expenses.”
Health experts and civic leaders say financial strains are adversely manifested in varying ways in communities and have a huge impact on children, often involving academic performance.
“There are direct biological consequences in that a child who does not have good access to health services will experience developmental setbacks because they are sick or their parents are sick,” Ng’andu says. “It makes it harder for them to achieve in school and can have serious consequences on their future. We have to invest in children early, their health early, their education, making sure they have healthy communities to grow in.”
According to the Centers for Disease Control and Prevention in Atlanta, the percentage of children and adolescents with a chronic disease swelled from 1.8 percent in the 1960s to 7 percent in 2004. The increase has an adverse impact on childhood education. For example, a report by the American Lung Association says asthma is a leading cause nationwide of youngsters missing school. Asthma affects Puerto Rican and African-American children more often, perhaps because they often live in communities with poor air quality.
“Studies show a spread of diabetes among children, but particularly among black and Latino children,” says Sinsi Hernandez-Cancio, director of health equity at Families USA in Washington.
“There are long-term effects. You are more likely to lose a limb, have a heart attack or lose a kidney, and the longer you have the disease, the greater the toll on life quality. We can expect to see this as these children grow older. There is also an impact on children when other family members have a disease because they sometime miss school to care for an ill family member.”
Because racial and ethnic health care disparities can hinder a breadwinner’s earning capacity, the entire family is often affected adversely.
“Kids are forced to be translators at the doctor’s office,” Hernandez-Cancio says. “That has an enormous toll, so they see firsthand all this information on how mommy or daddy is not doing well. We have had stories of children staying home to take care of their parent or another sibling. Stresses such as these affect their ability to develop into an independent, productive individual in the future.”
Ng’andu agrees. “When kids are hungry, when they are exposed to serious nerve stress and environmental stresses,” she says, “it affects them and their ability to learn and perform well academically. Investment in their health is very important to their future success and achievement and also their ability to work and contribute to their communities.”
Hernandez-Cancio says disparities in infant mortality rates also take a toll on minority families. While the 2010 rate for whites was 5.63 per 1,000 live births, it was 13.31 per 1,000 live births for African-Americans, 9.22 for American Indians or Alaska Natives and 7.71 for Puerto Ricans, according to the CDC.
“The infant mortality rate is considered a very basic measure of how a country’s health care system is working, and it is an indication of other symptoms,” she says. “We rank 41st globally. As an advanced, wealthy nation, we are not doing well.”
Hernandez-Cancio says that disparities in chronic diseases is also a major problem, that millions of dollars are spent battling such diseases that have been treated improperly or, in some cases, could have been prevented.
Each year, she says, health care inequities result in 100,000 premature deaths in the United States, and many are attributed to chronic diseases. “The health care system is so expensive. If you look at the numbers, a huge portion of health care costs is improving chronic diseases. When these diseases spiral out of control, it raises costs. We have to get a handle on these diseases to bend the cost curve.”
Data indicate extreme disparities in chronic diseases, including heart disease, certain cancers, strokes, diabetes and arthritis. According to the CDC, these diseases cause seven of 10 deaths annually in America and more than 75 percent of health care costs.
Smedley says African-Americans experience higher incidences of diabetes, high blood pressure, cancer and other chronic diseases. According to the Joint Center study, chronic diseases cost the U.S. health care system nearly $232 billion from 2003 to 2006.
Early detection, quality of care and improving prevention management are important as it becomes clear that doing so in communities of color is crucial to curbing costs. “If we don’t get a handle on these diseases, it is going to be harder to manage the system,” Hernandez-Cancio says, adding that prevention can alleviate many costs.
The health care reform law includes provisions that improve financing and delivery while also improving access for vulnerable populations and investing in prevention.
“Investments in prevention go a long way in preventing racial and ethnic health inequality in the first place,” Smedley says. “About five cents of every federal health dollar is spent on prevention. Prevention works. It works to keep our population healthy and reduces health care costs.
“We pay now or pay later. We’re going to be paying the price in higher health care costs, but also a population that is less healthy and unable to participate in the nation’s economic recovery.”
Racial and ethnic minorities are much less likely than the rest of the population to have health insurance, according to the National Center on Minority Health and Health Disparities, part of the National Institutes of Health, a component of HHS. These minorities constitute about one-third of the U.S. population but are more than half of the 50 million uninsured.
They are also overrepresented among the 56 million people in America with inadequate access to a primary care physician. The Joint Center study found that “the combined costs of health inequalities and premature death in the United States were $1.24 trillion” between 2003 and 2006.
The cost is expected to increase. By 2042, people of color are expected to be 50 percent of the U.S. population, signaling significant economic implications for minority communities.
“About 47 percent of American children under 18 are children of color,” Hernandez-Cancio says. “That really indicates this is the future of this country. The fact that they don’t have the mentorship who can provide structure for them, either because of financial pressures, chronic disease or premature deaths, can be highly detrimental to their future.
“Whether or not you are directly connected to these communities, you have a vested interested in their development and future.
“We cannot afford not to address financial burdens and health care disparities that contribute directly to instability of our health care system. We have to tackle this problem now.”