The picture of health, in color

By Michelle Chen Feb 13, 2009

Two new studies examine how race colors the health care system, revealing new angles on environmental and social influences on the health of Blacks and Latinos. A study by National Cancer Institute researchers found that crippling health care costs are driving cancer survivors to forgo critical services and treatment—and that even with insurance coverage, financial burdens continue to plague post-survival health care. Race deepens these disparities in care, but the study also points to comprehensive public health coverage as a remedy for the gap. Healthday reports:

“Hispanic cancer survivors, for instance, were twice as likely as their white peers to forgo prescription drugs because of cost. African-Americans were 87 percent more likely than whites to do that. “Costs drove dental care to the wayside 2.3 times more often among Hispanic cancer patients than among white patients and 57 percent more often among African-American patients. “Such racial disparities were not exclusive to cancer patients, the researchers noted, although health-care patterns were not always the same for the general population as among cancer patients. “In addition, race did not appear to play a role among cancer patients older than 65 — perhaps because access to Medicare leveled the playing field.”

Another study looks at race and structural obstacles to care. Researchers concluded that “Clinics serving higher proportions of minority patients have more challenging workplace and organizational characteristics.” Patients and care providers face a combination of high needs and low resources. For clinics where at least 30 percent of patients were people of color (compared to clinics serving less than 30 percent people of color), there was less access to medical supplies, less access to referral specialists, and fewer examination rooms per physician. Compounding those resource shortages, patients exhibited higher rates of depression, greater dependency on Medicaid, and “lower health literacy.” Physicians from high-minority clinics are also more likely to report patients as “frequently speaking little or no English,” having more problems with chronic pain and substance abuse, and generally “being more medically complex… and psychosocially complex.” The researchers noted:

"These adverse work environments may contribute to healthcare disparities by increasing the risk of provider biases and by stereotyping of minority patients, especially in settings where medical complexity and clinical uncertainty compete with time pressure,"

A grim prognosis for equitable care in a time of increasing scarcity. Photo: Jose Luis Villegas/UC Davis Health System