Black-White Health Gap Grows

Jan. 16--Disparities in health care for blacks and whites widened in Chicago during most of the 1990s, even as they began to narrow nationally, according to a groundbreaking new study.

More blacks than whites in Chicago were diagnosed with tuberculosis and died of cancer, heart disease, stroke and other causes, while fewer blacks received prenatal care in the first trimester of pregnancy, the report found.

Breast cancer death rates for black women in the period soared over similar rates for white women by almost 20 percent. Motor vehicle death rates for blacks topped rates for whites by nearly 70 percent.

Overall, the discrepancies translate into lower life expectancies and higher health risks for blacks, and the difference is growing.

"We would like the numbers to be moving toward equality. Instead, in Chicago, they're moving away from equality," said Steven Whitman, director of Sinai Urban Health Institute and one of the report's authors.

The study, published in the January issue of the American Journal of Public Health, is believed to be the first to examine the health of blacks and whites in a major urban center over time and put findings in the context of national trends.

It shows that an especially troubling feature of the U.S. health-care system--persistent disparities in the kind and quality of medical care received by different racial and ethnic groups--appears to be a worsening problem here.

The study looked at data from 1990 to 1998. Data for 2000, which was not included, indicate the trends remained consistent through the end of the decade.

"This is a huge issue. Unfortunately, providers are not blind to the color and economic circumstances of our patients," said Dr. Hugo Alvarez, an internist who works largely in the Pilsen neighborhood.

Why racial disparities are widening in Chicago is not clear. Growing numbers of people without health insurance, the increasingly unequal distribution of doctors and hospitals across the city, changes in the culture of medicine, and poor lifestyles could be contributing, said Dr. Quentin Young, a past president of the American Public Health Association.

Data for New York, Los Angeles, Houston and Philadelphia haven't been analyzed yet, making it impossible to determine whether Chicago's experience is characteristic of large cities or an anomaly.

There were some positive developments in Chicago. Syphilis rates and rates of low-birthweight babies declined among blacks, and the gap with rates for whites narrowed. But overall, inequality is becoming more pronounced in the city, even though improvements in health are being made.

Both nationally and in Chicago, blacks did better in 1998 on 14 important indicators of health than they had in 1990, in large part because of medical advances and interventions, according to the Centers for Disease Control. That means fewer blacks died from heart disease, stroke, cancer, motor-vehicle accidents and homicides, and rates dropped for infant mortality, low-birthweight babies, tuberculosis and syphilis.

In Chicago, however, whites showed even more substantial improvement than blacks on 11 indicators, widening the gap between the races. This is in stark contrast to national results, which showed the racial gap narrowing for 11 of 14 indicators.

"This is an enormous challenge to our public health community," said Young, who chairs Chicago's Health and Medicine Policy Research Group.

Though Hispanics are not included in the new Chicago report, other local studies and national data indicate their experience with the health-care system has many similarities to blacks'.

There are many reasons why minorities tend to fare more poorly than whites in the medical arena, according to a 2002 study published by the Institute of Medicine, an arm of the National Academies of Science.

Disproportionately large numbers of minorities run into financial barriers to medical care because they are poor and lack insurance. Nationally, 14.2 percent of whites have no health insurance, compared with 20.2 percent of blacks and 32.4 percent of Hispanics, according to the latest Census Bureau data.

Gabrielle Union, who is African-American, lost her health insurance a year ago when she left her job as a controller for a recycling company. Since then, she has put off seeing doctors, even though migraine headaches and fibromyalgia, a muscle disorder, have caused her intense pain.

"It's not easy being sick and lacking resources. It puts a real strain on," said Union, who lives in Oakbrook Terrace.

There are fewer doctors and hospitals serving largely minority neighborhoods in Chicago than there are in largely white neighborhoods, making access to care more difficult. Substandard housing, inadequate education, language barriers, pollution, unhealthy lifestyles and crime all contribute to poorer health in these areas.

Alvarez, the Pilsen doctor, tells an altogether too-typical story of a 23-year-old Hispanic woman who came to see him after consulting six doctors. Though her periods were irregular and her skin darkening, the other physicians had dismissed the complaints.

Alvarez was the only doctor to order tests; they showed the woman had Addison's disease, a rare disorder of the adrenal glands that can be fatal under certain conditions.

Dr. Randall Maxey, a Los Angeles kidney specialist and president of the National Medical Association, which represents black physicians across the U.S., tells of a woman who had exceedingly high blood pressure.

A previous physician had told the woman she didn't need medication because "you're African-American and it's expected your blood pressure will be higher," Maxey said.

Many years ago, the doctor's own young son was told by a school nurse "all little black boys have skin rashes" when he went to her office for medical advice. "Black people's [medical] problems are discounted all the time," he said.

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