Notes & Insights
Disparities and Martin Luther King Jr.'s Unfinished Civil Rights Agenda
George C. Halvorson, chairman and CEO, Kaiser Foundation Health Plan and Hospitals
When most of us think about the legacy of Martin Luther King Jr., what comes to mind is his role in the real progress toward racial equity that this country has achieved over the 40 years since his death in areas such as employment, voting rights, housing, and education. Despite the major racial and ethnic gaps that still exist in each of these areas, concrete, measurable gains have been realized, and as a nation we should be justly proud.
We should be equally humbled and chagrined by the vast racial and ethnic disparities and inequities that continue—years after passage of the Civil Rights Act of 1964—in Americans' health status and access to health care.
That is why I view the bold proposals for universal health care by growing numbers of state governments, from Massachusetts to California, as the most important and promising development since the Civil Rights Act itself, in addressing America's unfinished civil rights agenda.
Shocking statistics
The evidence of racial and ethnic disparities in health care is shocking in a society committed to equality.
Asthma, for instance, is growing at epidemic proportions for all children, but African-American children face by far the heaviest asthma burden and receive by far the lowest level of asthma care, as documented by recent reports from the Institute of Medicine, the Commonwealth Fund, and the U.S. Agency for Healthcare Research and Quality. The death rate from asthma for African-American children is four times higher than the death rate for white children.
Fatality rates for African-American women with complications of pregnancy are two to three times higher than for that of white women. African Americans are twice as likely as whites to suffer from diabetes. The death rate from heart disease for African-American women is 36 percent higher than the death rate for white women. In fact, across 46 health care quality measures, African Americans of all ages fare worse than whites on almost half of all measures and about the same on most of the rest.
As caring Americans, we should find these and a whole raft of similar statistics unconscionable. A country committed to health care equity should not accept the numbers showing that any portion of our children routinely are deprived of health by an unaccountable and unavailable non-system of health care—or what California Gov. Arnold Schwarzenegger recently characterized as a "broken" health care system. We should be even more outraged when such deprivations are linked to race, ethnicity, gender, and culture.
Why do inequalities persist?
The reasons for the persisting inequalities in health are many and varied, including discrimination and bias in health care delivery, language barriers, cultural preferences, environmental factors, and genetics. But I suspect that no single factor contributes more to racial and ethnic disparities in both health and health care than access to health in the form of health insurance.
In fact, researchers point to a direct correlation between health insurance coverage and health care. Studies comparing Americans' health and access to care with that of Canadians, who have a universal coverage system, show that residents of the United States are a third less likely to have had a regular medical doctor, a fourth more likely to have unmet health care needs, and more than twice as likely to forego needed medicines.
Minorities in the uninsured population
In this country, the minority populations that suffer the greatest disparities have the lowest levels of health insurance. Nearly 70 percent of Latinos and 43 percent of African Americans were uninsured for all or part of the years 2002-03, compared to about 23 percent of white Americans. Minorities as a whole make up roughly one-third of our total population, but well over half our uninsured population. In California, 75 percent of the state's 6.5 million uninsured residents belong to minority populations.
These numbers make both health care delivery and health care coverage a very direct racial and ethnic equity issue, and that translates into a civil rights issue.
If we considered no other issue than racial and ethnic disparities, this nation's leadership—like the leadership of a number of states—should be moving this country down the path to an American form of universal coverage as quickly as possible. There is no more vital or meaningful way for us to honor and extend the great legacy of Martin Luther King Jr.
