Minorities in medicine
 

WASHINGTON (Reuters) -- The United States needs more black, Hispanic and American Indian doctors and nurses if minorities have any hope of catching up to whites in terms of the quality and accessibility of health care, a special commission said Monday.

While blacks, Hispanics and Native Americans make up more than 25 percent of the U.S. population, they represent only 9 percent of the nation's nurses, 6 percent of doctors and 5 percent of dentists, the Sullivan Commission on Diversity in the Health Workforce said.

"Access to health professions remains largely separate and unequal," said Dr. Louis Sullivan, a former U.S. secretary of Health and Human Services, who chaired the privately funded commission that includes health, business and education officials.

"We know that minority physicians, dentists and nurses are more likely to serve minority and medically underserved populations, yet there is a severe shortage of minorities in the health professions. Without much more diversity in the health workforce, minorities will continue to suffer," Sullivan added in a statement.

Many studies have shown clear disparities in health care in the United States.

For instance, black men are far more likely to die of heart disease and prostate cancer than are white men, while black women are more likely to die of breast cancer than white women -- even though they have lower overall rates of the disease.

"The dearth of minority health professionals directly contributes to the nation's crisis of lower quality of health care and higher rates of illness and disability among a growing number of residents," said Dr. Georges Benjamin, executive director of the American Public Health Association.

"Our nation's population is becoming increasingly diverse, and our health work force should reflect that," Benjamin added.

The 16-member commission said one place to start rectifying the problem was at universities, medical schools and nursing colleges where only a small percentage of the faculties are ethnic minorities,

Minorities should be encouraged to go into the health professions, in part by offering more scholarships instead of student loans, the commission said.

The commission also recommended increased funding for research about racial disparities in health, language training for health professionals and federal legislation to ensure the development of a diverse work force.

CNN

Is this study really saying that the solution to low income individuals not having adequate health care is to get minority health care workers?
The premise of that would be that white doctors won't see patients without the means to pay for racial reasons, not monetary reasons. Do we really think medical workers who are from minority groups would pay for their education, pay to set up their practice and all that entails and then start giving their services free of charge to people with the same skin color?

i don't know about this. it seems like faulty reasoning to me.
Problem: many minorities don't get adequate health care
Reason: the vast majority of doctors are white
Solution: get minority doctors

What do you all think?

Why do they never include Asians when they talk about a lack of minorities in health care, in higher education, in higher income brackets?

Oh right, because they're over represented in all of those categories. I wonder what the difference is.

-sm

my $.02 is that nature vs nurture is the biggest factor here. it isn't about ability, or even necessarily desire - but about what you grew up with. i have no scientific facts or research on this, it's just an idea.

look at sports, for example, black men traditionally dominate that sport. why? is it really that the black man is genetically superior in the needs for this game? or is it more likely that when black americans were moving into the integrated professional sports world, black americans in large numbers lived in lower income, inner city areas. there are many basketball courts available and that is the game they played with their friends from the time they were small children. as black men started becoming famous basketball players, they were chosen as heroes and role-models to the black youth, who spent even more time on the courts until it became a cultural thing. you play what your friends play, and you want to be the best.

hispanics have traditionally been top notch baseball players. again, is it genetics or is it that they've grown up playing the game that their heroes play.

who is presented as a hero to minority children today? athletes and musicians that came from nothing and made it big. children emulate their heroes. that is what bill cosby has been railing against recently. in an lower income area, the role model isn't generally the person who got good grades, got a good job, and moved to the burbs. the only way for that to change is for the parents to instill education as a greater value than athletics or musical ability.

anyway, like i said, it isn't scientific, but it makes some sense to me.

I guess I must have read this differently, because I didn't see anything pertaining to "low income", just "race".

I think there are a few that already do that...I'd have to look up some things for verification, but I could have sworn that I've heard that being done.

fair question, maybe i completely missed the point. i thought their starting point was that minority groups are not getting adequate medical care for economic reasons. it that is the case, they would be saying that minorities are receiving inadequate healthcare because of their low income status.

maybe the point of the article is saying that members of minority groups just don't want to see white doctors?


i know there are some out there that do that. my son's pediatrician actually keeps seeing children absolutely free of charge for 18 months after a family leaves government assistance programs. i guess the question is whether they will do it in large enough numbers to make this the answer to the problem.

I think it's bullshit. I'm more inclined to think the quality of healthcare minorities get, or anyone for that matter, is economic. Now there may be cases of a black person not trusting a white Doctor as I know of white people objecting to Indian (from India) Doctors. But I think that's a pretty small percentage.
I don't have any hard evidence, only anecdotal, but it sounds like special commission is in the same boat. :confused:

I was about to say ... a friend of mine was just here in NYC over the weekend at a conference at NYU Med school about asian americans and health care. Interesting that asians still are not considered a major category in demographic surveys, btw.

Yes, I know we are not major in terms of numbers/percentage of population, but some stuff from the conference said asians composed an astonishing proportion of those in health care. No longer a mystery that asians are quickly climbing into the higher ranks of the "elite" professions - but one major topics discussed at the conference, my friend said, was the dichotomy of asians in the U.S. Rich getting richer, poor getting poorer, etc. Some theorized, though, that asians were more likely to open low-cost clinics in their communities - which at first I would agree with, but there are clinics all over NYC geared at other minorities as well. This, however, is the city; I'm positive the problem is much more exaggerated in the suburbs or rural areas.

Interesting...I just had a conversation on this subject about a week ago with my parents, both black and both PhDs and Specialists (Mother: cardiologist, Father: radiologist/nuclear medicine).

My parents once had their own practice. When they ran their own office, the majority (90%+) of the patients they saw were of a minority group, largely black. Many of the patients they saw were glad they were there and operating in Richmond VA because Richmond (at the time) was so supersaturated with white specialists who never seemed to want to help them or treated them like children ("This is your heart. Your heart is sick. Take this magic pill to make it better.") And for most of them, it wasn't so much a monetary/health coverage issue...it was an issue with the doctor's attitudes. This isn't too surprising, considering Richmond's history on being tolerant and accepting on the surface and harboring a racist undertone. I remember, my parents had a devil of a time just trying to get established with their practice (circa 1983-84).

My parent's practice has since dissolved and my mom is working for cardiologist group as one of several on-call cardiologists. In this office, there's a healthy mix of races as far as the doctors go, but most of the nurses are white and the largest portion of patients are white, followed by black. My Dad works for the VA full-time and moonlights at local area hospitals in MD and VA. At the VA down in Richmond, his department has a healthy mix of races in doctors too and the patients there are about the same for white and black with a sprinkling of other races in there.

This just sounds like a cop out to me. The article said a privately finded study - well privately funded by WHO? Access to health care in this nation is far more about the ability to obtain private health insurance than it is about race. No insurance = no health care. Real simple. Hispanics, blacks and Native Americans are under represented in ALL the professions - not just the medical ones. They don't have the good paying jobs that provide employee benefits like health insurance. Why don't they have the good paying jobs? At least in part due to lack of equal access to a good education. Let's face it, a school in the barrio or the ghetto or on the rez is just not going to prepare a child for college the way one in up scale suburbia will. Its not about race so much as it is about class.

I know a lot of people on medicare (of all colors) that get the same thing. I also have known a lot nurses over the years, including my mother, that tell me all doctors are like that, especially surgeons. :)

Marichiko i think you make an excellent case. If incomes divide along racial lines thne the services which are accessible to people will naturaly also follow along those racial lines. However, in much the same way that article lets the economic system off the hook yours to a degree lets the racists off the hook as individuals. Yes, problems arise partly because the system is skewed in favour of some groups and against other groups but they also arise because the nation which creates that system is threaded through with racism at an individual level. When individuals who have been given ( or achieved) the role of caregiver in any form, are themselves harbouring racist views or psyches then it stands to reason that those racist tendencies may influence the manner in which they give care to those of a different race.

In the UK we have a National Health Service which in theory means every British subject is entitled to basic all encompassing healthcare from cradle to grave regardless of their economic status. If you have a very low income you pay no fees for any service; if you have a reasonable income then you pay a nominal fee for prescriptions, dental care and chiropody. You can even get an NHS osteopath or physiotherapist though you may have to wait and in reality many areas cannot provide those facilities.

The economic factor is not an issue unless you are in the unfortunate position of being on a 6 month waiting list and are therefore considering a detour into the private sector; nonethless there is still a disgraceful disparity between the care given and recieved by ethnic minorities and the care given and recieved by the majority white population. This cuts across every discipline. A black man is far less likely to be put forward for surgery to deal with a heart problem. A black man or woman is 3 times more likely to be treated custodially for mental illness, and I believe also 3 times more likely to be given electro shock therapy whilst in psychiatric care.

The economic factor does play a part however in the ability of the patient to navigate the system. If you have been disillusioned by your country before you even completed your primary education and have dropped behind your white counterparts eduationally or if you have been ghettoised into an area with high unemployment and a school that cant cope with the number of students it serves; then you may well have grown up to find officialdom prohibitively intimidating. More importantly officialdom might find you prohibitively intimidating for a whole other set of reasons.

At the end of the day though, even if the economic imperatives could be wiped from your system right now, I dont think your healthcare professionals would become racist free. If people have fixed ideas in their heads about another race and they are in a position of import to people of that race it will affect how they deal with those people. It has to.

Dana, I agree with much that you say. To me, it seem a question of the chicken or the egg. Do minorities have unequal access to education, the professions and health care because of prejudice against them? Does prejudice result in poverty or is poverty responsible for prejudices of one class toward another? It's all interconnected and all the more insiduous because so many in the US refuse to acknowledge that prejudice - whether it be against minorities or the poor - does not impact people's lives to the extant that it truelly does. A neocon will tell you that a black man is poor because he is too lazy to better himself; a working mother who brings home a wage that keeps her family below the poverty line is responsible for own poor choices (she should have KNOWN that the husband she fled was an abuser or had 6 other wives before she married him and deserves what she gets). Native Americans are poor because they'd rather drink than work; black Americans in the ghetto are poor because they are happy dealing drugs amd living on welfare. On and on.

Last night we had stopped for gas, and a frightened looking woman with a baby on her hip and another child tightly clutching her skirt approached me to ask for money for food for her children. I'm pretty hip to the street scene, and I could see that this woman was not just using her kids to help her score spare change for booze or drugs. Mike, too, looked at her and said to me, "She's telling the truth." She said she'd lost her job, and made her land lord a partial payment on her rent. The payment wasn't enough, and she and her children and belongings were thrown on the street. She lost almost everything she had, and had scraped together her last bit of money for a motel room for her and her kids. There was none left for to buy the kids supper. Tomorrow, she'd ride the bus to the food bank (if she had the bus fare, otherwise she'd walk), but tonight there was nowhere she could get food. I gave her what money I could spare. She thanked me, grabbed her toddler tightly by the hand and hurried quickly across the street in the cold night air and disappeared into one of the rooms of a shabby run, down motel.

Watch the conservatives of this board jump all over this story and then tell me there's no such thing as class warfare here in the States! :mad:

Well duh, of course there is class warfare, it's called capitalism. Make as much as you can and keep as much as you can.
She lost her job, I wonder why. Single mother with 2 little kids? Might have missed to much time. In the wilds of Colorado? Business closes and it's the only horse in a one horse town? Tough spot to be in with no family or friends to form a support group.
Now what's a landlord to do? If tenents don't pay the rent, how will he pay the mortgage? If Catwoman goes into hock to buy a rental property and the tenant doesn't pay, she's up a creek without a paddle.
Sad story,...real shame for her and the kids.
Is it my problem? No. :eek:

If she's so destitute, how is she paying for the seedy motel room, which costs more than monthly rent in a shitty apartment?

Hope she enjoys the crack you bought her.

Man, remind me to never travel to Philly! :eek: Your motel room rates must be outrageous! In the off season here (which it now is) a motel room can be found for $40.00 for one night. Rent typically starts at around $400 for a one bedroom in the least expensive neighborhoods, and then throw in damage deposit and first and last month's rent before you can move in = $1200. She said she was there for the night only and was going down to see what she could find through the local charity outfits, social services, etc., the next day. I gave her $2.00. If she bought crack for $2.00, the dope dealers must all be going broke. The people around here know pretty much who the street people and pan handlers are - it's a small enough place. Neither Mike nor I had seen her before.

Who knows, Bruce? One could come up with a thousand equally plausible stories. I live in a funny sort of place. Its a small town in the mounains with a city near by. In my town the jobs vanish after labor day weekend. I agree, the landlord has bills of his own to pay - most of 'em aren't in to act as charities. It's a difference in philosophy. Let's just say hypothetically she did loose her job because of too much time out with the kids. I'd say that as a society, we'd be better off making low cost, decent day care more available. That means one more productive person in the work force and fewer unsupervised kids out on the streets getting into God only knows what trouble.

Well if she had a "summer" job, she knew it was coming. Sound reasoning, but who's "We'd"? Organized on a local level, in the neighborhood, in the town, great. But another federal or even state program, no thanks.

Several guys I work with have wives that are at home taking care of related and unrelated kids on a daily basis. It's what the government calls "unlicensed daycare"; it's cheap and it's available. "Licensed" is a euphemism for expensive and unobtainable for those that need it most. Any time the government gets involved, the rules and regulations become a bureaucratic nightmare.

Don't bother bitching about the money they're wasting in Iraq or any of the myriad of domestic pork barrels. That's exactly why I don't want anymore government programs, no matter how well intentioned. :headshake

Well, again, who knows if she had a summer job and just couldn't find another in time or if she refused to sleep with the boss, or she DID sleep with the boss and his wife found out, etc., etc.?

I actually am skeptical of much of what "big" government does myself. So many of the rules and regulations are damned hard on the person who is trying to run their own business, never mind the fact that some of those regulations are just stupid and wrong. On the other hand, without some kind of regulation, many big corporations will just run rough shod over the workers.

Case in point: the big uranium mining outfits that operated in western Colorado from the '40's till sometime in the '70's or '80's. In the '40's and '50's there was no EPA, and no one from OSHA wandered out from DC or even Salt Lake or Denver to make sure safe working conditions were being maintained by the big mining conglomerates. The result: The water out there became contaminated. Not just the rivers, but the water table as well. There are parts of the Dolores River that to this very day are completely dead. Its spooky to go look at that river. No fish, no aquatic insects, not even any damn algae along the banks. The area is slowly getting cleaned up (sort of), but at a frightful cost. It would have been much cheaper to put the right environmental controls in place from the start and make sure they were enforced.

Then there are all the former uranium workers who are dying or have already died of uranium induced cancers. The folks out there are simple working stiffs and in the 40's and 50's they didn't understand about something called an LD50 or just how rich in uranium the ore from any given mine was or when they needed to use extra precautions, and the corporations weren't about to enlighten them to these things either. Guess who foots the bill for the whole mess? You and me because the original corporations have morphed and merged and disolved into off shore banks somewhere, so there's no one left to be held accountable.

Now, Bruce, you can say "it's nothing to me" if a man is dying or uranium induced cancer, but, personally, I can't do that. That miner was producing uranium that went for the national defense of this country and love nukes or hate 'em, we're all still Americans and this is our country and our government, so I can't turn my back on that miner.

Its not an easy question and there are no winners on either side except possibly for a few fat cat CEO's of international corporations that thumb their noses at the rules whenever possible.

The people that profited from that mining operation are responsible to take care of the miner, even if it's just providing legal counsel for him to collect workman's comp. Not to make him rich with a huge settlement, punitive damages, and outrageous legal expenses.

But I still don't believe a day care center should be required to provide little boys with little urinals. They can use a toilet like they do at home. :Flush:

Well, the miner's are mostly dead or dying, and I didn't see any driving around in mercedes benzes. The companies morphed themselves out of existance like I said. Meanwhile the guberment is concerning itself with urinals for 4 year olds in home run day care centers. I think we can both agree there's something wrong with this picture.

Mari I know this will sound like heresy but I am convinced the entire world was different in 1940s and 1950s and that applying modern concepts of safety and employment issues and such to the previous day is not really informative.

For starts the poverty rate was about 30-40% and the country was trying to quickly transition to an industrial economy where there would be far less scarcity.

The life expectancy was different. People died a lot. They smoked a lot -- because they died so much of other things that it wasn't obvious that cigarettes were bad for you.

It was a shock to me to take the Hoover dam tour and learn about the handful of guys who died building it. It wasn't that OSHA didn't exist. It was that it couldn't be done any other way at the time. Safety is a cost that we build into things routinely now, but we simply couldn't afford to do it at the time.

Things were different in the '40s and '50s. I was there...

Hell, things were even different in the 70s when I was a kid. Our playgrounds were paved, even under the equipment. Kids wearing casts were a common sight. Now playgrounds have a foot of mulch under the swings, etc. I can't remember the last time I saw some kid with a leg or arm in a cast.

Everything has a warning label now, to the point that people routinely ignore them. When something is truely dangerous, ignorant people don't know because they assume the warning label has no meaning. For example, my father teaches electronics labs in college. Today's students see "Warning high voltage" on circuits they are working in, and they take it as seriously as a warning label on a cup of coffee. My dad's really nervous that some student will kill themselves when a big fat capacitor discharges through their hearts and it stops beating. He tells them "this is really dangerous" and they hear the "blah blah blah" of Charlie Brown's parents on TV.

In the '50's the poverty rate was around 16%:

http://www.census.gov/income/histpov/hstpov2.lst

I couldn't find statistics for the '40's doing my quick and dirty search techniques. I believe you are probably thinking about the depression era of the 30's, not the war years of the '40's or the post war boom in the US which started after WWII. I am talking about cancer related deaths from the '60's to present due to uranium exposure, not historical differences in longevity (which by the way haven't changed all that much - our current life expectancy is due mostly to changes in the infant mortality rate where children no longer die of epedemics caused by bacterial organisms).

My point is that there does need to be SOME government oversight of mega-business concerns. The little guy has his hands tied while the multi-national conglomerates do as they please.

This is the case sometimes, if only to save the idiots from themselves. Some will take notice while others will take on the classic Teenage Mentality "You aren't the boss of me! It's a free country, I can do what I want!" then promptly get themselves into trouble or worse.

But in terms of the littly guy vs the conglomos, it's all about money. The littley guy very...VERY rarely has the fincancial backing to stand toe to toe with a large company. Even if lots of little guys get together, the large company will more often than not still have the financial standing to keep those little guys from getting too rowdy. If the government gets involved, you can be sure that its attention will tip and sway with the passing of cash, be it for 'fines' or 'pay-outs' or 'special interests'. They have contingencies for the uncommon occasion a situation finds itself in the Court of Public Opinion too. Big companies have whole teams of people whose job it is to take blame and reallocate it, making the company seem more like a victim and largely at the whim of other factors. Shouldn't oughta be that way, but it is.

This source only goes back to 1959 where the rate was 22.4%. here are some of the stats you want. Scroll down the page and look for row "H". We start at 40-45% in 1937 at the tail of the depression, and poverty pretty much slowly drops until its low at 11.1% in 1973.

The source you give appears to be someone with some sort of political agenda. I try to refer to Bureau of census statistics whenever possible because, in theory at least, such information should be somewhat less biased. The figure I got was further down on the page. It all depends on what factors you use in the definition of poverty. A government researcher states:

"The force of this American historical evidence is strengthened when one realizes that the income elasticity of the poverty line results from social processes that have continued--indeed, have perhaps even intensified--since the 1960's. These social processes can be summarized as follows: As technology progresses and the general standard of living rises, new consumption items are introduced. They may at first be purchased and used only by upper-income families; however, they gradually diffuse to middle- and lower-income levels. Things originally viewed as luxuries--for instance, indoor plumbing, telephones, and automobiles--come to be seen as conveniences and then as necessities. In addition, changes in the ways in which society is organized (sometimes in response to new "necessities") may make it more expensive for the poor to accomplish a given goal--as when widespread car ownership and increasing suburbanization lead to a deterioration in public transportation, and the poor are forced to buy cars or hire taxis in order to get to places where public transit used to take them. Finally, the general upgrading of social standards can make things more expensive for the poor--as when housing code requirements that all houses have indoor plumbing added to the cost of housing."

http://aspe.hhs.gov/poverty/papers/relabs.htm

It should be noted that your source places a question mark after his estimate of 40-47% for 1937. I was talking about the 40's and 50's, and poverty levels are beside the point to what I was stating. I don't care if the whole god damn country was living below the poverty level, it was still unconscionable for uranium mining outfits to knowingly expose their workers to high levels of radiation without informing them of the risks involved and then for these companies to vanish off the corporate map by some financial slight of hand, and thus escape all accountability.