More on the debate around the HHS Disparities report...
Jackie
========================================
Washingtonpost.com
Why Is HHS Obscuring a Health Care Gap?
By H. Jack Geiger
Over the past four years my colleagues and I have read and reviewed more
than a thousand careful, peer-reviewed studies documenting systematic
deficiencies and inequities in the health care provided for African
Americans, Hispanics, Native Americans and members of some Asian subgroups.
The evidence is overwhelming. Unfortunately, the Department of Health and
Human Services seems intent on papering it over.
This is the only conclusion that can be drawn from HHS's recent treatment
of the first national report card on disparities in the diagnosis and
treatment for this country's most vulnerable populations. The department
edited and rewrote the report's summary until it reflected nothing close to
reality.
The reality is this: If you are an African American man with one form of
lung cancer, you are far less likely than a similarly ill white patient to
receive a surgical procedure that would cut your chances of early death
nearly in half, from 95 percent to 50 percent -- even if you have the same
health insurance coverage and are in the same hospital. If you are a
Hispanic trauma victim with multiple bone fractures, you are less likely to
be given adequate pain medication -- or any at all. If you are a low-income
or minority child with severe asthma, your chances of getting the most
effective drug combinations are slimmer, and you endure repeated attacks of
the disease and hospitalizations. Native Americans with diabetes, or
Asian/Pacific Islanders with HIV-AIDS, all too often experience such
disparities in care. The pattern extends over the full range of medical
conditions.
The reasons are complex. Patients often mistrust the medical system
because of perceived past discrimination. On the physicians' side, poor
communication, lack of cultural understanding, and subconscious negative
racial and ethnic stereotyping can be involved. Much needs to be learned.
But even though there are at least eight major reviews of all this evidence,
including the Institute of Medicine's landmark 2001 study, "Unequal
Treatment," there has been no overall national assessment of the scope of
the problem. So it was a welcome development when Congress mandated HHS's
Agency for Healthcare Research and Quality (AHRQ), a body with an impeccable
track record of expertise and honesty, to produce the first annual national
report card on disparities.
The AHRQ did its job well. Its draft report was a clear and massive
presentation of the data on disparities in care associated with race,
ethnicity and socioeconomic status. Its summary was blunt, noting that such
disparities are "national problems that affect health care at all points in
the process, at all sites of care, and for all medical conditions,"
affecting health outcomes and entailing "a personal and societal price."
After "review" by HHS, those truthful words are gone, as are most
references to race and ethnicity, now described as problems that existed "in
the past." Prejudice is "not implied in any way." Disparities are simply
called "differences," and -- incredibly -- "there is no implication that
these differences result in adverse health outcomes."
What of the thousand or more studies to the contrary? The new summary
says: "Some studies and commentators have suggested that a gap exists
between ideal health care and the actual health care that Americans
sometimes receive." Worse, the new summary begins with a short list of
relatively minor health areas in which minority and poor populations do
slightly better than the majority (because, an AHRQ spokesman said,
"Secretary [Tommy] Thompson likes to focus on the positive.")
There is a pattern here. A few weeks ago, all of the different institutes
that make up the National Institutes of Health released their draft
"strategic plans" to overcome racial and ethnic disparities in health status
-- the burdens of greater illness and shorter life expectancies of America's
minority populations. Disparities in health care obviously contribute to
those burdens. But only three of the NIH's 14 institutes even mentioned
them.
A recent report by a panel of experts convened by Physicians for Human
Rights recommended corrective steps to be taken by government at every
level, as well as by the medical profession, hospitals, HMOs, community
groups and civil rights organizations. But the federal government has an
especially critical role to play in collecting and honestly analyzing data,
supporting a more diverse health workforce, and ensuring enforcement of
civil rights in the health care system. To avoid the truth, or cloak it in
more comfortable words, is to abandon that responsibility.
The Rev. Martin Luther King Jr. understood what is at issue here. "Of all
the forms of injustice," he said, "discrimination in health care is the most
cruel."
The writer is Arthur C. Logan professor emeritus of community medicine at
the City University of New York Medical School and a past president of
Physicians for Human Rights. He will discuss this article online today at
noon on washingtonpost.com.
Would you like to send this article to a friend? Go to
http://www.washingtonpost.com/ac2/wp-dyn/admin/emailfriend?contentId=A50837-
2004Jan26&sent=no&referrer=emailarticle
C 2004 The Washington Post Company
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