By Charlene Muhammad CHARLENEM
LOS ANGELES–Blacks still struggle to get proper medical care and are paying a heavy price, sometimes financially and other times with their lives.
The problem has surfaced even with artificial intelligence alongside a consistent lack of culturally competent doctors and other health professionals, access to treatment, and some say, a lack of self-care.
“Studies have shown that when you factor out variables such as income, employment status or level of education, Blacks still have the worse health outcomes. This demonstrates that the issue in this country is race and racism,” said Dr. Oliver Brooks, president of the National Medical Association, which represents Black physicians and their patients in the United States.
“For example, studies have demonstrated that Black women are three to four times more likely to die within one year of giving birth, known as maternal mortality, regardless of these other factors. Racism still exists in America; and it has a direct effect on Black lives,” Dr. Brooks, chief medical officer of Watts HealthCare Corporation in Los Angeles, told The Final Call.
In addition, Blacks tend to live in areas where environmental toxins such as lead and air pollution are at higher levels, stated Dr. Brooks.
“Some of this can be traced back to redlining policies that have had us living in specified neighborhoods. Higher levels of these environmental toxins have led to respiratory illnesses such as asthma, and lead exposure leads to delayed development in our children. Racism or a lack of cultural sensitivity also leads to Blacks not being offered life saving treatments such as heart surgery or other procedures related to vascular disease, or as stated more advanced cancer treatments,” continued Dr. Brooks.
According to the Centers for Disease Control and Prevention, racism has been linked to low birth weight, high blood pressure, and poor health status. Further, Blacks received worse care than Whites for about 40 percent of quality measures such as person-centered care, patient safety, healthy living, effective treatment, care coordination and affordability, according to the 2018 U.S. Department of Health and Human Services’ National Healthcare Quality and Disparities Report.
The death rate for Blacks is generally higher than Whites for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS, according to the Office of Minority Health.
Railroad to death?
Race and its impact can even surface in seemingly unlikely places, such as data driven programs. New York state is investigating UnitedHealth Group, Inc., for using a data analytics program that significantly underestimated health needs of Black patients.
Between 2013 and 2015 flawed algorithms, or calculations, used by the program Impact Pro “ranked healthier white patients as equally at risk for future health problems–and therefore in need of more intensive healthcare intervention–as black patients who suffered from far more chronic illnesses,” said state officials late last month. They cited a study of the system published Oct. 25 in the journal Science.
Based on the algorithms, which were marketed to health insurers and healthcare providers, Black patients’ health concerns were deemed less significant than White patients, the officials told UnitedHealth in a letter.
Linda Lacewell of the New York State Department of Financial Services and Dr. Howard Zucker, a commissioner with the New York State Department of Health, chided UnitedHealth. Discriminatory results, whether intentional or not, are unacceptable and unlawful in the state, they said.
Citing America’s long, troubled history of racism in healthcare, the officials called on the company to immediately investigate and show the algorithm is not racially discriminatory or stop using Impact Pro or any other data analytics program if UnitedHealth could not prove it doesn’t rely on racial biases or perpetuate racially disparate impacts.
It’s well documented that Blacks endure longer wait times than Whites when seeking treatment, and Black claims of pain are taken less seriously than Whites, so Black medical histories are less likely to reflect their true medical needs than Whites who have historically been given greater medical attention, observed Ms. Lacewell and Dr. Zucker.
“New York will not allow racial bias, especially where it results in discriminatory effects that could mean the difference between life and death for an individual patient and the overall health of an already-underserved community,” they said.
Ill, ignored and misunderstood?
Another recent study from Dana-Farber Cancer Institute and the University of Texas Southwestern found racial disparities in culturally competent cancer care.
Non-White cancer survivors are less likely than Whites to be seen by cancer specialists who share or understand their culture, and the disparity is likely due in part to a low representation of minority physicians in cancer subspecialties, said the study’s authors.
One of the first nationally representative studies to examine patient-reported preference for, access to, and quality of provider cultural competency among cancer survivors, the study published Oct. 31 in JAMA Oncology.
Almost half of non-Whites–49.6 percent–said it was somewhat or very important to be treated by doctors who understand their culture. Non-White patients were also less likely than Whites to receive treatment from health providers who understood their culture, by a difference of 65.3 percent to 79.9 percent.
And 12.6 percent of minority patients said they were never able to see physicians who shared or understood their culture–compared with four percent of Whites, according to the study.
“To us, it was definitely a little shocking. The numbers are pretty clear. The numbers almost flipped between disparities between how important it is to minority cancer survivors to have this care and their inability to,” said report author Santino Butler of Dana-Farber/Brigham and Women’s Cancer Center.
“The most shocking thing was also that when these people were asked how are their providers doing on a specific basis–such as how often do they get respect, easily understandable information, asked about their opinions–all those didn’t show any disparities between racial minorities and non-Hispanic White cancer survivors, so that was also pretty surprising, because that’s the discrepancy,” said Mr. Butler.
“You’d think that if minority cancer survivors are 15 percent less likely to see these providers, that maybe these providers are less likely to provide certain types of care, but that wasn’t the case. That’s not what we saw,” he said.
Mr. Butler told The Final Call one explanation might be that those three factors aren’t all-encompassing or capturing all that it takes to be a “culturally competent” provider.
“There’s probably a lot more that goes into that and just because a provider checks off those three check boxes or a couple of check boxes, doesn’t mean that they’re providing the patient-centered care and getting the trust and the other factors that go into their patients considering them doing a good job in terms of being culturally competent,” Mr. Butler explained.
Dr. Brooks offered a once long-held, but difficult to achieve solution: Increase the number of Black doctors and other health professionals.
“A study out of Oakland, Calif., found that when Black men were treated by Black doctors for heart disease, their outcomes were better than when they were treated by others. At present about 1 in 8 Americans are Blacks but only about 1 in 15 doctors are Black,” said Dr. Brooks.
“The second solution is not simple or easy: reduce the systemic racism that is at endemic proportions in America. This can be done by elevating the level of cultural awareness of the majority population and along with implicit bias training. That is a steep climb, but we’ve seen over the mountaintop, and there is always hope ahead, however hope without a plan is folly,” Dr. Brooks added.
Educate and advocate
For Charles Mattocks, award-winning filmmaker, celebrity chef, author and health advocate, the key is to educate and inform. As he went about doing that through a 2013 national RV tour, providing free diabetes testing at major sporting events, shopping malls, churches, and state fairs, he realized people knew nothing about diagnoses they were receiving, especially Black men and women.
“They would just get a prescription, and that was it. They didn’t have any other information. They didn’t have any, per se, real follow up or other experts to go see. They just got a prescription, and was sent home,” Mr. Mattocks told The Final Call.
From Black churches to other Black institutions, education and information about Black health care from prevention to treatment simply was lacking, said Mr. Mattocks, who suffered himself with Type 2 diabetes.
“We seem to be undereducated and under informed, and we also don’t seem to ask many of the questions that we need to ask. We know that White males live approximately seven years longer than African American males, and White women live more than five years longer than Black women,” Mr. Mattocks told The Final Call.
That is due to not just disease prevalence, but also the severity of diseases plaguing Blacks, and some are preventable, experts noted.
Part of the problem is also cultural, Mr. Mattocks observed. His father died from cancer.
“This is a man who had an amazing career as a union welder, so he had all the access to doctors, tests, whatever you want, and he literally died overnight, per se,” said Mr. Mattocks.
According to Mr. Mattocks, his father didn’t go to the doctor, and didn’t get recommended exams for Black men at age 50, such as a prostrate exam or colonoscopy, which tests for abnormalities in the large intestine and rectum.
“He didn’t know he had cancer until literally he got it and then no more than a few weeks later–dead,” said Mr. Mattocks. He urged Blacks to get early and proper testing and an understanding of drugs and healthcare.
“We just seem to be a community that once the doctor gives us some medication, we take it without question and we’re on 4, 5, 6 different medications from blood pressure to cholesterol, diabetes. And we also fail to at times, let’s face it, we fail to take into consideration our diet and our health,” said Mr. Mattocks.
His father’s ordeal and desire to help people have led him to, create a cancer TV reality show “Eight Days with Charles Mattocks.” It takes viewers inside individual cancer patients’ journeys through their treatments and their compelling stories. His aim is to inspire and educate people in their living rooms.
Matthew Knowles, father of singer BeyoncÃ©, is executive producer of the show, which is scheduled to air January 4, 2020 on A&E’s FYI channel.
“He’s dealing with breast cancer, which almost no minority male understands that a Black man or minority can get breast cancer. We really need to check ourselves, to speak up for ourselves,” said Mr. Mattocks.
Sheila Muhammad and her husband Elroy Williams of Houston spoke up when they felt doctors were trying to have him undergo unnecessary chemotherapy treatment for prostate cancer.
According to Ms. Muhammad, who retired three years ago as a medical assistant professor at Houston Community College, despite a successful surgery, being in remission for five years and positive results after extensive and expensive tests, doctors insisted on radiation treatment.
“I just think it’s a money thing, because he has insurance, and he is doing fine. The doctor that recommended the test didn’t stay in the room with my husband no more than five minutes. They already had set up his payment plan and everything for chemo, although he told them, ‘I can’t afford this.’ But they had set it all up before he had even agreed,” Ms. Muhammad stated.