Health Disparities

A conference on Health Disparities and Disability among African Americans was held at the Harvard School of Public Health (HSPH) in Boston February 5, 2003, co-sponsored by HSPH and the Massachusetts Department of Public Health (MDPH). The lecture honored the memory of Dr. William A. Hinton, one of the first African American graduates of Harvard Medical School (1912), who founded one of the first schools for laboratory medical techniques. During the 1920’s he developed and perfected the Hinton test for the diagnosis of syphilis used throughout the world for over four decades. In 1959 Dr. Hinton’s estate began funding scholarships for graduate students in memory of his parents who "although born into slavery and without formal education, nevertheless recognized not only the highest ideals in their personal conduct, but also the true democratic principle of equality for all."

Presenters described the differences in health care among various ethnicities in the United States. Part of the problem is economic, and another part is in the attitudes of the health care system. Dalene Basden of the Parent Professional Advocacy League (PAL) is the Parent Support Coordinator of the City of Lynn. As the mother of two sons with special needs, she has seen first hand the differences in treatment received by her own two African American sons versus others with the same disease.

Ethel Briggs, Executive Director of the National Council on Disability, shared a number of statistics: 12% of Americans are African American. The life expectancy of African Americans is 6 years shorter than for white Americans. By age 50 African Americans have a higher rate of chronic disease. 30% are uninsured (versus 20% of whites). 50% have job-based insurance (versus 70% of whites). 28% have no regular doctor (versus 19% of whites). 22% have no choice of where to go for health care and are less likely to receive preventive care. Rates of heart disease, cancer, and diabetes are all higher among African Americans. The rate of prostate cancer is three times other men. The rate of HIV is six times the rate among whites, and two times the rate among Hispanics. The rate of HIV among child-rearing women is 15 times that of whites. These conditions tend to be identified later, with more morbid consequences.

In Washington, D.C., alone, black mothers have the highest rate of death in childbirth, mostly due to the lack of prenatal care and distrust of the health care system. One effort being tried there is to provide free transportation to appointments, and to give women points when they keep their appointments, which they can cash in for cribs and baby supplies.

The rate of disability among African Americans is also disproportionately high. 17.8% of people with disabilities are African American. 19% are in special education classes. The school drop-out rate is 13.6% in the general population. Among people with disabilities, the drop-out rate is 28%. Among African-Americans with disabilities, the drop-out rate is 44%. 72% of African Americans with disabilities are unemployed. They are less likely to receive rehabilitation services, job training, financial aid, private funding, or health care services. Surveys reveal that African Americans are less likely to receive aggressive treatment or therapy.

Lisa Sinclair, MPH, is a Health Science Policy Analyst with the Center for Disease Control (CDC) in Atlanta. Over the past nine years she has been involved in developing the "Healthy People 2010" documents and was instrumental in creating a chapter on Disability and Secondary Conditions.

Ms. Sinclair described her analysis of the need for public health interventions targeting minorities with disabilities. The highest rate of disability is among Native Americans (20%), followed by Blacks (14%), Whites (12%), Hispanics (10%), and Asian/Pacific Islanders (7%). Among people with disabilities in general, 82.4% are white, 13.4% are Black, 2.1% are Native Americans, and 1.1% are Asian/Pacific Islanders.

People with disabilities are often very healthy, but they live with limitations, impairments, and/or chronic disease. Among ethnic communities, chronic conditions tend to emerge earlier. Among children with Down’s syndrome, for example, the life expectancy for a black child with Downs is 25 years, compared to 50 years for a white child with Downs. The difference is reflective of the frequency of aggressive treatment for the morbid heart defects of these children.

Health differences are influenced by the majority behavior of the society, the institution, the individual, and the health behaviors and resources of the minority itself. For example, traditional values and beliefs among Native Americans preclude vocational rehabilitation (Mille and Joe, 1993). The other five key factors found to influence a person’s ability to find the necessary health resources needed are the level of education achieved, whether people are employed, whether they have health insurance, whether they use a computer, and whether they are married or have a close partner.

The NIH and the CDC are working to address these various factors for all Americans, and in particular to identify and resolve the barriers of language, culture, economics, transportation, and literacy that make it particularly difficult for some minorities to obtain the preventive health care and rehabilitation they need to maximize health and minimize disability.