Racial disparities a concern in health debate

Val Jensen
William Mitchell Adjunct Law Prof. Val Jensen, pictured in St. Paul, Minn. on Dec. 4, 2009, teaches "Race and the Law" and has her own questions about race and health care disparities.
MPR Photo/Elizabeth Stawicki

Val Jensen and her family are African American, but they're not genetically related. She and two siblings were adopted.

Her parents, who were teachers, had good health insurance. They ate healthy foods, and exercised. But they all have Type II diabetes. When Jensen, 44, had children of her own, she also developed the disease.

"When I was pregnant I had gestational diabetes with both my kids so it was like 'OK, so you're predisposed to this so we need to watch it,' and I think that's true," said Jensen, of Saint Paul. "But the reality was I'm African-American and also a woman and predisposed to a higher incidence of breast cancer possibly."

Compared to whites, African-Americans are more than twice as likely to die as babies. They're also more likely to die of heart disease and other illnesses -- and more likely to have shorter life spans. That disparity is expected to be addressed when Congress continues debate on an overhaul of the health care system.

Researchers at Johns Hopkins and the University of Maryland found that from 2003 to 2006, higher rates of disease among African-Americans and other people of color cost the nation more than $230 billion in medical costs. When they added indirect costs to the economy like lost productivity, absenteeism, and premature death, the cost was more than a trillion dollars.

"Because we have populations that are sicker than they should be given that they live in this country and what we know what this country is expected to produce given health status," said Thomas LaVeist, who heads Johns Hopkins Center for Health Disparities Solutions.

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Read the LaVeist report here and the Kaiser report here.

LaVeist said the study in no way minimizes the human suffering inherent in the illness gap between whites and minorities and does not seek to ask why the gap exists. He said it instead asks, "What is the consequence that they are sicker?"

There are many reasons for the disparities, some understandable, such as lack of access to regular health care. Although people of color represent a third of the U.S. population, they comprise more than half of the uninsured. Both the House and Senate health care reform bills would expand health care coverage.

People of color in general are more likely to work low-paying jobs and have less access to employer-sponsored coverage. Jensen turned to the Minnesota Health Care Program after she was denied health care coverage because of her diabetes, a pre-existing condition.

The proposed legislation, with some exceptions, would require employers to provide coverage to their employees. In 2045, people of color will comprise more than half of the population of the United States,

Kaiser Foundation researcher Cara James said expanding insurance coverage is a good first step toward narrowing the health care gap between racial and ethnic minorities and whites. But she said it won't eliminate the gap.

"We know there are so many other factors that influence disparities many of which occur outside the health care system: poverty, education, housing," James said, adding that the bills in Congress don't address those issues. "So I think the overall impact of the bill with regard to disparities will be limited."

Researchers don't know why some African-Americans, like Jensen and her loved ones -- who did not live in poverty, are highly educated and live healthy lifestyles -- still have a higher rate of diseases like diabetes than their white counterparts.

The Senate bill would require collecting data on race, ethnicity, language, geographic location, income and education and disability.

Jensen, a lawyer who heads the non-profit Twin Cities Diversity and Practice association of law firms and corporate law departments, said another factor is at play. She thinks she wasn't taken as seriously by physicians as she would have been if she were a white man. She remembers taking her young son to a white doctor who assumed she was on government assistance and dismissed her concerns that her son had autism.

"When my son first started showing signs that there were problems, my pediatrician refused to refer us to anybody else," she said. "And I kept asking and asking and he said 'don't worry about it, don't worry about it.' He would just disregard my concerns until he found out that I was a lawyer."

Jensen said her son eventually was diagnosed with autism.