By Michael Maizel
Since the liberation of the thirteen colonies from foreign control, healthcare inequities have been a major source of tension among Americans. Although the Declaration of Independence claims that all men are created equal, African Americans have typically been excluded from this ideal. Until the end of the Civil War, many of them were held captive by slaveowners that showed little concern for their overall health. This inhumane treatment of slaves is what started the unequal distribution of healthcare in America, and healthcare policies have failed to successfully alleviate this dilemma. By providing a brief history of health care in America and an overview of current American health insurance policies, I will explain how the unequal distribution of healthcare leads many African Americans to have a negative perception
Before discussing current health insurance policies in America, it is essential to provide background knowledge on health care and how African Americans were historically prevented from having access to it. From 1776 to 1965, minimal efforts were made to include African Americans in medicine. According to Michael Byrd and Linda Clayton, “doctors categorized blacks as subhuman ‘things’ – separate from white.”[1] In fact, during the eighteenth century, medical researchers even began utilizing African Americans for training purposes and as test subjects. These disturbing trends continued through the twentieth century, but stalled after the culmination of World War Two. Congress was afraid that African Americans returning from war wouldn’t tolerate the racism ingrained in the healthcare system, and many activist groups were formed during this time period. However, this push for equality resulted in little action, as African Americans still struggled to receive proper care and “nearly 90% of whites had access to decent, mainstream, health care.”[2] They were also relegated to segregated health facilities and kept out of mainstream medical systems. Clearly, the slave health deficit has yet to be made up in America.
Even though the passing of the Affordable Care Act in 2010 was a massive step towards reforming the healthcare system, health insurance policies in America still create an unequal gap in coverage. Currently, there are two ways to receive health insurance: a private option and a public option. Private options allow workers to automatically have their medical expenses covered through their employers, and public options (Medicare and Medicaid) provide health insurance to older and poorer citizens. Although these policies may seem fair and logical, their implementation into society presents many challenges. Statistically, rates of unemployment are higher among African American men and women, which means that the number of African Americans with employer-based insurance is less than that of their non-Hispanic white counterparts. Specifically, African Americans have a 23% chance of losing health insurance within a year, and “non-Hispanic whites have a probability of 0.12 of losing health insurance within one year.”[3] This is due to the fact that a citizen’s health insurance status is not permanent, but rather fluctuates with poverty and unemployment. Rates of uninsured Americans tend to rise during economic recessions, and these hardships disproportionately affect African Americans. Additionally, Medicaid is only available to people who earn less than 138% of the federal poverty line ($16,395 a year), and this prevents many people who earn slightly more than that from having access to it. While African Americans are expected to live over 12 years without insurance, whites are only “expected to live on average a little less than eight years without it.”[4] With these unbalanced timeframes of being uninsured, it is no surprise that white individuals are expected to live approximately 4 years longer than African Americans. Therefore, these policies maintain the unequal gap in healthcare coverage that has been present since the origin of this country.
This unequal distribution of healthcare in the United States leads many African Americans to have a negative perception of medicine. According to a recent study out of the University of Connecticut, researchers found that “mistrust of health care providers, fueled by painful experiences with racism, makes African American men more likely to delay routine screenings and doctor’s appointments.”[5] Even though postponing medical screenings can be detrimental to anyone, it places African Americans in especially precarious situations. Since obesity and diabetes historically afflicts African Americans at a higher rate than any other demographic, it is pivotal for them to receive proper blood pressure/cholesterol screenings. While these findings tend to be viewed with a certain degree of detachment, they represent the lives of real people. For example, Albrea Crowder, a health administrator in North Carolina, explains that one of her customers has “been doing home health for probably about fifteen years now.”[6] Although she has low income, she doesn’t qualify for insurance, and this dilemma is what led her to resort to home remedies. However, even when citizens have access to Medicaid, its services are often limited. Lyman Henderson, a dentist practicing in North Carolina, points out that many of his patients can’t afford to get the proper treatment they need due to health insurance gaps. He concedes that it’s too expensive to perform root canals or replace missing teeth with bridges because “you have to do it the cheapest.”[7] Other times, the physician is the source of the problem. In an article titled “Conflicting Explanatory Models in the Care of the Chronically Ill,” Arthur Kleinman summarizes the story of Mrs. Flowers, an African American woman with hypertension. Instead of showing sympathy towards her situation, the physician ridicules her for continuing to incorporate salt into her diet. He fails to realize, though, that she is trying to care for numerous family members and struggles to find time to cook nutritious meals.[8] All of these negative experiences with healthcare lead many African Americans to either turn away from it entirely or pursue the cheaper alternatives. In either instance, the health of these marginalized individuals is vulnerable, and this further increases the racial divide in our healthcare system.
Over the past 250 years, the story of African Americans and the United States health care system has been one of incompatibility. The bitterness began with the slave health deficit, and it has never truly been made up. Even though policies like the Affordable Care Act have expanded health care access to the uninsured population, there is still a racial fissure in American medicine. African Americans consistently have the highest probability of losing health insurance and are expected to live approximately four more years without insurance than white individuals, and this continuing problem has led many to have a negative perception of medicine. Although partners in a relationship can choose to separate and live their own lives, African Americans living in the United States can’t. Therefore, more work needs to be done to restructure the healthcare system to be one that is based on equality.
References
[1] W.M. Byrd and L.A. Clayton, “An American Health Dilemma: A History of Blacks in the Health System,” Journal of the National Medical Association, vol. 84, no. 2 (1992): 194.
[2] W.M. Byrd and L.A. Clayton, “An American Health Dilemma: A History of Blacks in the Health System,” Journal of the National Medical Association, vol. 84, no. 2 (1992): 196.
[3] Heeju Sohn, “Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course,” Population Research and Policy Review, vol. 36, no. 2 (2017): 9.
[4] Heeju Sohn, “Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course,” Population Research and Policy Review, vol. 36, no. 2 (2017): 9.
[5] University of Connecticut, “Medical Mistrust Impacts African American Men’s Preventative Health, but Racism also Matters,” Science Daily (2019).
[6] Albrea Crowder Interview, 0:03:53 – 0:04:20.
[7] Lyman Henderson Interview, 0:27:34 – 0:28:10.
[8] A. Kleinman, “Conflicting Explanatory Models in the Care of the Chronically Ill,” The Illness Narratives: Suffering, Healing, and the Human Condition (1988): 132-133.