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How many birthdays?

The plain fact is different races have different chances for good health in this country. What's not so plain is why.

Tuesday, April 16, 2002

By Christopher Snowbeck, Post-Gazette Staff Writer

Watching the 1-year-olds tottering around the waiting room at a county Health Department nutrition clinic doesn't reveal many clues about whether any one child has a better chance for a long and healthy life.

They share a birthday, but statistically their expectations for long and healthy lives in Allegheny County couldn't be more different. Little Candice Hall, on the left, faces significantly more obstacles to care and risks for disease because of her skin color than Dennis O'Dell. Both were born on the same day last month at Allegheny General Hospital. (John Beale, Post-Gazette)
Among the youngsters at the Turtle Creek clinic office one April afternoon, for example, both Johnathan Duckett and Elijah Seigh seemed to be in good health as their mothers waited to talk with counselors -- the main difference seemed to be that Johnathan was a bit sleepy from his nap while Elijah was literally bouncing off walls.

Yet those with a knowledge of health statistics could immediately see why Johnathan is more likely to run into health problems.

Johnathan is one of the 2,715 African-American babies born in Allegheny County in 2000 and, as a group, black babies here have a life expectancy of 73 years. But Elijah and the other 10,971 white babies born in the county in 2000 can expect to live 78 years, on average.

To have a five-year gap in life expectancy between whites and blacks in a nation with some of the best medical care in the world is deeply disturbing to a growing number of doctors, civil rights leaders, public officials and everyday citizens. To those same people, it's similarly distressing to note that Johnathan was relatively lucky to see his first birthday, because an African-American baby is more than twice as likely as a white baby to die before turning 1.

The federal government expressed its commitment to ending disparities with an ambitious report released in 2000 called "Healthy People 2010."

The report laid out plans for improving health outcomes in 476 categories and, for the first time, set a goal of absolutely eliminating racial and ethnic disparities in health, not just shrinking the gap.

Similar efforts have been launched in Allegheny County and across the state.

"The next major gain in the civil rights movement in this country will come in the arena of health and it will improve the quality of life for all Americans," said Stephen Thomas, director of the Center for Minority Health at the University of Pittsburgh's Graduate School of Public Health, who has taken the lead on the issue locally.

What the future holds

Of the two boys visiting the Turtle Creek office, Elijah, the white child, has faced more health problems so far, including hospital stays to treat a rare condition that stunted his growth. But doctors believe they've cured the problem, so his mother is optimistic about his chances for a healthy life. It had never occurred to her that race could be a factor.

"I think it's a whole gamut of things that your health depends on, not just whether you're white or black," said Kim Seigh, 33, of North Braddock, as she scrambled to keep up with Elijah.

But Johnathan's mom, Treanice Duckett, does think about race when considering her son's future health. African-Americans have more problems with diabetes, and because of this -- as well as her family history with the disease -- Duckett said she limits his intake of sweets and salt.

"I just don't want him to have the problems my grandmother is having with these diseases," said Duckett, 27, who lives in Trafford.

The differences in health outcomes that Duckett recognized go beyond black and white.

There were 147 Hispanic babies born in the county in 2000, for instance. National averages suggest those children will have a greater risk of suffering from tuberculosis, high blood pressure and obesity than non-Hispanic whites.

But the county's 251 Asian/Pacific Islander babies in 2000 -- many of whom trace their lineage to India -- are part of the group that has the lowest age-adjusted death rate, according to government figures.

Still, in this part of Pennsylvania and many other sections of the nation, the health discrepancy that weighs most heavily is the one between whites and blacks.

Thomas, who came to Pitt two years ago as the first director of the Center for Minority Health, knows how difficult closing that gap will be.

One big reason is that the groups with the worst health also are the poorest and the least educated, according to "Healthy People 2010." In general, wealthier people have greater access to health care, live in better housing and safer neighborhoods, eat healthful food and get more exercise.

Central Baptist Church in the Hill District kicked off African American Health Promotion Month on April 7 with a place for blood pressure and other screenings in the fenced lot of a former gas station. Chilly temperatures kept participation at the outdoor part of the event down, but the church, just a few doors from this lot, was offering those services inside, as well. For more information on the program, call Nina Lynch at the Urban League, 412-227-4215. (John Beale, Post-Gazette)
A greater proportion of racial and ethnic minorities, by contrast, lack health insurance and have less money to pay out-of-pocket medical costs. More minorities also have a harder time affording the child care and transportation that's necessary to make regular doctor visits.

The health-care system is changing in ways that may make the problem even worse for minorities.

More doctors are joining health systems, which makes them less likely than doctors in private practice to provide discounted or charity care, according to a 2000 study by the county Health Department.

Factoring in biology, history

But health disparities go far beyond socioeconomic differences.

The disparities in U.S. prostate cancer rates, for example, are so vast that they suggest some sort of biological cause, said Claude A. Allen, deputy secretary of the U.S. Department of Health and Human Services.

Allen hopes advances in genetic research will help explain why black men have these higher rates of prostate cancer, and also show why Japanese men have an even higher rate of the cancer, but die at a much lower rate than African-American men.

Finding answers in the complex tangle of genetic information will be difficult, though.

In fact, some researchers think it's wrong to say that any disease is determined by race or ethnicity, because the Human Genome Project has suggested there is more genetic variation within each race than between races, and any genetic patterns of disease may have more to do with family histories than race.

A landmark study released last month by the Institute of Medicine contended that a significant part of health disparity is due to bias and stereotyping by doctors and other health care workers.


Let us hear from you

As part of The Colors of Care series, the Post-Gazette's Your Health section wants to hear what you think about the roles race and ethnicity play in health care.

Have you experienced or perceived bias against racial and ethnic minorities in the health-care system? Does your race and ethnicity affect your access to care or your likelihood of getting sick? What can be done to make sure people of different racial groups receive the best care?

You can respond by e-mail to health@post-gazette.com, by letter to Your Health, 34 Blvd. of the Allies, Pittsburgh, PA. 15222, or call Health Editor Virginia Linn at 412-263-1662.


One example cited was a 1999 New England Journal of Medicine study that asked 720 family physicians to watch videotapes of white and black actors discussing heart problems.

The physicians, who did not know that race was the focus of the study, were asked to make a diagnosis and determine whether to refer the patient for cardiac catheterization, an advanced method for determining a patient's risk for a heart attack.

The report found that even though the hypothetical patients were reporting the same symptoms and economic information, the white male actors were more likely to be referred for cardiac catheterization than blacks or women. The authors concluded that the race and sex of the patient influence the recommendations of physicians, independent of other factors.

Minority patients' perceptions of bias also play a role.

Allen, the HHS official, said discomfort with the health system can lead minority patients -- particularly blacks -- to shy away from care.

"We often delay seeking medical care and attention that could be preventive in nature," he said. "When we do that, it often narrows our choices in treatment and the choices we're left with tend to be the most dramatic. Often, our mortality rates are higher."

Minority patients, particularly Hispanics, also complain about communications problems with doctors. The situation isn't helped by the lack of minorities among the ranks of doctors and nurses.

Finally, health disparities don't always favor whites.

Whites die from chronic obstructive pulmonary disease at a rate higher than any other racial or ethnic group and they also run a greater risk of bone-thinning osteoporosis and death from skin cancer. (The Healthy People 2010 report also notes that whites run a greater risk of landing in an emergency room with a non-fatal dog bite, although public health officials are understandably not making this disparity a front-burner issue.)

Because raising public awareness is a first step to eliminating disparities, Pitt's Thomas has worked with a local coalition called the "African American Health Promotion Campaign: Countdown to 2010" to sponsor health awareness events in black neighborhoods this month.

He hopes the health fairs will encourage blacks and other minorities to exercise, eat healthful food and get annual checkups.

Heightened awareness is especially important for diseases that seem to be targeting the black community, including AIDS. The Healthy People 2010 report says that 1996 was the first year blacks accounted for a larger proportion of AIDS cases than whites and that the trend has continued.

Two paths diverge

Back at the Turtle Creek office, the mothers of little Elijah Seigh and Johnathan Duckett have different observations about all this.

Although blacks in particular are under-represented among physicians, Elijah's pediatrician is black, his mother said, and the physician's group practice also includes Asian and women doctors. That's part of the reason Kim Seigh is optimistic about the ability for people of all races to get good health care.

"I think they do their best to relate to everyone," she said.

But Duckett said she's already encountered bias in getting care for Johnathan.

One week after the boy was born, she phoned a Monroeville pediatrician's office to schedule Johnathan's six-month checkup. But when she and Johnathan showed up at the office, the receptionist greeted Duckett with a series of challenging assertions, first contending Duckett lacked insurance and then saying her health plan didn't cover Johnathan.

Neither point was true, but the receptionist capped the conversation by saying the office was no longer seeing patients covered by Duckett's health plan, an HMO that manages benefits for Medical Assistance recipients.

Duckett doesn't know if the receptionist was reacting to her race, her status as a Medical Assistance recipient or a combination of the two, but the bottom line is that she had to scramble to find another pediatrician who could provide a checkup for her son.

"I knew I could find him a good pediatrician," Duckett said. "But I did try to find him a black pediatrician, even though they're hard to find. Unfortunately, they don't list doctors by race."

Coming May 7: Should race matter in health outcomes?

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