Report Says Minorities Get Lower-Quality Health Care
Moral Implications of Widespread Pattern Noted

By Ceci Connolly
Washington Post Staff Writer
Thursday, March 21, 2002; Page A02

Minorities in America -- even those with private health insurance -- receive lower-quality care than that given to whites, a pattern so widespread and severe that it contributes to higher death rates and shorter lifespans, a major report released yesterday says.

Although it was not possible to quantify the inequities, researchers identified language barriers, inadequate insurance coverage, bias among doctors and nurses, and a woeful lack of minority physicians as reasons why nonwhite patients received fewer tests and inferior treatment.

"This is a pervasive problem with moral and ethical implications for our society," said Martha Hill, a professor at Johns Hopkins University School of Nursing and vice chairman of the Institute of Medicine committee that prepared the report.

The problem of access to medical care among minorities is well documented, but the 562-page report is the most exhaustive analysis of the disparities in treatment and health outcomes. The report, requested by Congress, shines a harsh light on the effects of patient stereotyping and of an expensive health system that often forces patients to ration their own care.

"We have a health care system that is the pride of the world, but this report documents that the playing field is not even," said David Williams, a sociology professor at the University of Michigan who described the study as "a wake-up call for every health care professional."

A nonwhite patient in the United States today is far more likely to be treated by a white doctor who earns less, received less training and does not have a clear understanding of the patient's native language or cultural heritage, according to the report. Most remarkably, over the past three decades, the share of black physicians in the country rose from 3.5 percent to 3.9 percent.

The biggest discrepancies -- and the most devastating health consequences -- came in the areas of cardiovascular disease, HIV/AIDS, cancer and diabetes. African Americans, Asian Americans, Hispanics and Native Americans were less likely to receive sophisticated treatments such as angioplasty, bypass surgery, kidney transplantation or a combination drug therapy known as the "AIDS cocktail."

One study of 13,000 New Jersey heart patients found that far fewer African American patients received catheterization to clear the arteries, despite exhibiting the same symptoms. Another study involving 13,600 nursing home residents found that blacks "had a 63 percent greater probability of being untreated for pain relative to whites."

"Significantly, these differences are associated with greater mortality among African-American patients," the researchers note. "By contrast [minorities] are more likely to receive certain less-desirable procedures, such as lower limb amputations for diabetes."

Bias in medicine appears to parallel other societal stereotypes, said Alan Nelson, chairman of the committee. Medical schools often teach that some minorities complain more about pain or do not follow drug regimens; many doctors and nurses are unaware of cultural beliefs that can affect health, researchers said.

"Physicians and other health care providers are more comfortable interacting with people like themselves -- highly educated, articulate individuals," said committee member Risa Lavizzo-Mourey, senior vice president of the Robert Wood Johnson Foundation. "Providers go into health care professions with good intentions, yet the evidence does suggest there is unequal treatment."

A small number of minority patients refused tests or treatment, but those attitudes were "unlikely to be major sources of health care disparities," the report says. It was much more likely that doctors did not present the treatment options clearly to nonwhites or that minorities had to make medical choices based on cost.

The panel of experts offers a battery of recommendations, though many are nonspecific. The report calls for increased awareness, more interpreters, more minority physicians, better data and more money for the Office of Civil Rights, which enforces equity laws.

Black physicians and lawmakers hailed the report as long overdue, though some criticized the Bush administration for failing to put enough money into minority health programs. "This isn't only about health disparities," said Ivan Walks, director of the D.C. Department of Health. "It's a story about a missed opportunity to really spend resources differently."

Del. Donna M. Christian-Christensen (D-U.S. Virgin Islands), chairman of the Congressional Black Caucus, said the government's minority HIV/AIDS initiative and medical education programs that would help draw more minorities into the profession are underfunded in the proposed fiscal 2003 budget.

Today, Pfizer Health Solutions and the Washington Business Group of Health will announce a two-year project aimed at improving minority health through better information and screening, said Judith Campbell who is overseeing the effort for Pfizer. Offices are a logical place to reach minorities, she said, noting that, "by 2008, 41 percent of our workforce will be nonwhite."