Study Offers Solutions to Indian Health Care

A person’s skin color makes a significant difference in the type of health care they receive, even if their socioeconomic background equals that of whites, health experts said in a national report released Tuesday.

“The health care system as a whole provides vastly unequal access and treatment based on race, language and ethnicity,” said Will Pittz, an organizer at the Northwest Federation of Community Organizations and lead author of the report. “Racism within the health system is literally making people of color sick.”

The report, “Closing the Gap: Solutions to Race-Based Health Disparities,” focuses on the “rarely discussed crisis that afflicts a racially stratified U.S. society.”

The public health care system is failing people of color for reasons that include financially or geographically inaccessible services, low-quality care, unmet needs of limited-English speakers and a disregard for alternative medicine.

While the report covers racial disparities in health care, its primary focus is to offer solutions.

“We’re a lot closer than it seems,” said Makani Themba-Nixon, executive director for the Praxis Project, a nonprofit, community- centered health policy organization. “One of the amazing things laid out in the recommendations and policies in the report is that many of them can be implemented fairly cheaply and make a huge difference.”

Besides offering solutions, the report moves to debunk two common myths – genetics and socioeconomics – that are often used to explain racial health care disparities.

First, human genorne research shows that humans carry 99.9 percent of the same genetic material, making race a sociopolitical and psychological matter – not a biological one.

The second myth is that health disparities are attributable to socioeconomics. Research shows that when income, age and educational level are the same, people of color still have poorer health.

Scholars Dr. David Williams at the University of Michigan and Dr. Camara Jones of the U.S. Centers for Disease Control and Prevention say “living in a racially stratified society has profound health effects. Longer work hours, multiple jobs, more dangerous work environments, poor access to transportation and overt discrimination all affect physical, mental and emotional health.”

Physicians could help close the health care gap tomorrow if they began offering similar treatment for patients with the same symptoms, said Themba, who serves on the advisory committee for the Northwest Federation of Community Organizations, a policy, research and development support center for grassroots organizations in Washington, Oregon, Montana and Idaho.

“The question is not so much, ‘How far do communities of color have to go?’ ” said Themba. “The question is, ‘How far does the health care system have to go?’ “

It’s a matter of political will, Themba said. “Do we believe everyone is valuable? Our health care system, the way it’s currently constructed, says no.”

While health in the United States has improved overall, people of color still suffer higher rates of mortality and illness from asthma, diabetes, cancer, heart disease and a range of other diseases compared to white Americans. The report is online at the Applied Research Center Web site, www.arc.org.

One in four Native children suffers from asthma, as does one in five black children. Black Americans are 30 percent more likely to die from cancer than whites. In some parts of the country, Native men can only expect to live until their mid-50s.

“Indian people in Montana have long suffered higher rates of illnesses than whites, and these illnesses are often attributable to the failures of the health care system to provide equitable care,” said Lucille Tucker, co-chairperson of Montana People’s Action. “We hope that this report will help start a discussion about real reforms that will improve health care for Native Americans.”

The report highlights successful programs across the country that have lessened the racial health care disparity. Two Native organizations are included as successful models.

Arizona’s Tohono O’odham tribe took a community approach to reducing diabetes through a return to agricultural traditions. The tribe has the lowest per capita income of all U.S. reservations. It also has the world’s highest diabetes rate – 50 percent of adults have onset diabetes.

Additionally, Alaska’s Southcentral Foundation is being held up as a best-practice approach to improving health care for Alaskan Natives. The foundation and the Alaska Native Medical Center took over Indian Health Service operations in 1999.

Urgent care visits dropped by 50 percent after the center created new policies. Within three years, the number of asthma patients receiving inhalers increased to 85 percent. Under the Indian Health Service, only 35 percent of asthma patients received inhalers.

“It’s a model that has a lot to teach about better alternatives,” said Pittz. “Since that time, they really shifted the focus towards creating a welcoming and culturally appropriate environment.”

Study’s recommendations include better access to health care insurance

Key recommendations from the report “Closing the Gap: Solutions to RaceBased Health Disparities.”

* Eliminate disparities in access to health insurance. Expand public health programs such as Medicaid and work toward a universal health care system guaranteeing basic access.

* Improve health care in medically underserved areas, which are often communities of color. Support community health clinics that provide highquality care to underinsured and uninsured patients.

* Develop healthcare institutions that are welcoming and respectful to people of different races and ethnicities. Improve access to quality care for people of color by minimizing financial barriers to patient/doctor communication, training staff in culturally appropriate care and building a diverse work force.

* Track racial disparities in health care provision. With proper data collection, health care institutions can be held accountable for eliminating these disparities and meeting high quality-ofcare standards for all patients.

* Provide medical interpretation services for all clinical encounters. Federal, state and local governments, as well as insurers and health care providers, should fund language services as a medical necessity.

* Improve access to traditional and non-Western treatments. Insurers should be required to cover alternative and culturally appropriate health care. Health care providers should be provided training and access to research about alternative and non-Western medical practices.

* Adopt and enforce policies that promote safety and health. The adoption of worker protections and environmental standards are necessary to address root causes of health inequality.

* Include public health experts and community organizations in community development and planning processes. Health concerns must be at the forefront in discussions about housing, transportation and economic development.

* Provide funding and support for improved nutrition, physical education, and health education in schools. School environments that emphasize health can lead to improved health outcomes and higher academic achievements.

* Support programs that incorporate cultural traditions. Connecting people to their cultural heritage can be an effective way in improve individual and community health.

Copyright The Missoulian Jul 20, 2005