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During the health care debate, we learned that 44,789 Americans die every year because they don't have health insurance. We also learned uninsured Americans between ages 17 and 64 were 40% more likely to die in a given year than their insured counterparts.

I always felt this statistic was understated, but I couldn't prove this. After all, how do you determine how many Americans had their lives cut short from years of undiagnosed and untreated illness such as diabetas,  hyptertension, heart disease, and failure to early detect cureable cancers and treatable diseases? How do you determine the death toll from plain hard lives?  I knew given the 50 million uninsured and the millions with junk insurance, the 44,789 statistic was way too low.

Then I read about a study published in the American Journal for Public Health that estimated "over 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites." That is 88,600 people dying prematurely every year among the African American population alone.

I wanted to write about just how many Americans have died prematurely because they couldn't pay for health care. We know that about 11.3% of whites, 19.5% of African Americans, and about 33% of Hispanics have no health insurance. And many others have what health care activists refer to as "junk insurance" or health insurance with high out of pocket costs people can't afford to use it. If whites are 65.1% of the population, African Americans 12.9%, and Hispanics 15.8%, I could make some assumptions and come up with a guess. But it wouldn't be reliable.  

But I did find a wealth of information on racial and class disparities in health care from the excellent documentary film UNNATURAL CAUSES: HOW INEQUALITY IS MAKING US SICK

I read some of the articles on this web site. I was very impressed but saddened by the interview with sociologist Troy Duster. He is asked the following question:

QUESTION #7: It’s all good and well to suggest that we have a shared obligation to one another and that’s why we need to address health disparities. However, that argument doesn’t mean much to my upper middle class white students who fear that the quality of health care they enjoy will suffer, or that they are bearing the burden for other peoples bad choices.

And he replies:

Well, you go back to the beginning of the 20th century, there was really a consensus that smallpox, tuberculosis, typhoid, cholera, yellow fever – all of these things were putting all of us at risk as a society....Now, move up to the last part of the 20th century. We all have running water, toilets; the streets aren’t full of feces... So it’s very hard when people say, "Well, my group is not at risk for cystic fibrosis, so what do I care about it?" If it were smallpox, since we’re all at risk, then it’s a public health problem

In other words, 100 years ago our major health problems were small pox, tuberculous, typhoid, and other serious diseases that affected rich and poor, white, black, and hispanic alike. If you were well to do, you were just as likely to get and die from these diseases. We were all in the same boat, so we were much more community minded and interested in our common health. Today our major health problems are diabetas, cancer,  hypertension, heart disease, mental health, HIV/AIDS, obesity, and more. The risks and prognosis are affected by both race and economic class. If you are well to do and have good health care, you are early diagnosed and treated for diabetas and other diseases and your prognosis excellent. If you are poorer and unable to pay for health care, you are late diagnosed and will probably develop complications such as kidney disease, heart disease, and even go blind or lose a limb. The result is a society less community minded and less interested in our common health. That's a big reason it is so hard to pass universal health care. That's even more true when there are so many unfair stereotypes about the poor. I've comes across people who believe the poor cause their health problems through unhealthy eating habits. Such claims ignore facts such as

Ironically, high-calorie food is cheap and plentiful in poor urban communities (due to the low cost of corporate food production heavily subsidized by tax dollars), while low-calorie, nutrient-rich food is harder to come by. This leads to a counterintuitive situation in which poverty tends to foster obesity rather than starvation.

There are those who believe enviornmental issues are what will finally force us to create a more equal, fairer society because the climate crisis will affect rich and poor alike.

RACIAL DISPARITIES IN HEALTH CARE

In September 2002 the New York Times reported that a black man living in central Harlem was less likely to reach 65 than a comparable man in Bangladesh. The article goes on to state:

from birth, a black male on average seems fated to a life so unhealthy that a white man can only imagine it.

We need to put ourselves in somebody else's shoes best we can. What would it be like to know or suspect you are seriously ill, but be unable to see a doctor because you didn't have the money? To have to wait until the situation is an emergency and you seek care in an emergency room? To know if you could have paid for health care, your life or a family member's might not have been cut short?  This is a reality for millions of people and for some readers on this site.

The article shows the following death rates per 100,000 population for black men and white men in the 55-64 age group:

                       ALL CANCERS            HEART DISEASE
BLACK MEN                   654                     669
WHITE MEN                  406                     359

Why would African Americans die at such a higher rate of diseases that are very treatable, if diagnosed and treated?  The answer was very simple: lack of access to health care. However, the Times article goes on to state even when African Americans have access to health care, they do not always get the same care

While access to treatment is one problem, there are also problems with the treatment African-American men actually receive. Last spring, the Institute of Medicine reported on a review of more than 100 studies, and the findings were startling: even when African-Americans and other minorities have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care. Biases, prejudices and negative racial stereotypes, the panel learned, may be poisoning the reaction of doctors and other health providers.

African Americans also have much higher rates of hypertension. One myth is this results from a "salt retention gene." The theory is African Americans came over on slave ships, and those who survived retained fluids better. But this theory has been disproven. Jay Kaufman, an associate professor of epidemiology at the University of North Carolina School of Public Health, had this to say:

But the evidence we do have suggests that the prevalence of hypertension among African Americans has a lot to do with the kind of risk factors that we do know about – things like obesity and alcohol consumption and the chronic stress of racism and poverty and eating processed foods.

The excellent article Racism's Hidden Toll talks about how African Americans deal with chronic stressors such as  overt racism, poor health care, high crime, that white Americans deal with less often. The continued "fight or flight" psychological impact leads to increased health problems over time.

Finally, enviornmental racism also plays a role because African Americans and the poor are also more often exposed to hazardous wastes because companies most often locate such dumps in minority and poor areas.  

CLASS DISPARITIES IN HEALTH CARE

During the health care debate, Republicans were falsely claiming the health care reform bill would lead to "rationing." They failed to point out health care in America is already rationed - rationed by ability to pay. The wealth gap has increased dramatically since 1980 and with that has come more health care inequality. In 1980, the U.S. ranked 14th in life expectancy. Today we rank 29th. We may have the highest GNP and the most powerful military, but we rank 37th overall in health care and that is the lowest for any industrialized country.

The documentary goes on to say that economic class is the strongest predictor of our health. The film starts out by featuring an executive who finally manages to get all his cars in one garage. The poor and less advantaged get sicker and die younger and those at the top who have the most resources live longer and healthier lives. Racism adds an additional burden. The United States has by far the most economic inequality in the developed world, but yet ranks worst in health care among industrialized nations. Economic inequality in the U.S. is now greater than at any time since the 1920s.

CONCLUSION

I found this to be a very rewarding diary to write. I've always been an economic populist at heart. This was a complex diary because health care disparities, race, and class are complicated subjects. I hope somebody more knowledgeable than me will be able to write a diary showing the true extent of America's health care catastrophe. Just how many people of all races have died prematurely because they couldn't pay for health care?

Ted Kennedy devoted his political life to universal health care. And President Obama was the second U.S. President (after Lyndon Johnson,   who passed Medicare and Medicaid) to make substantial progress towards universal health care. But much work remains, and as Ted Kennedy said   the "dream will never die" and we will keep working until health care in America is a right and not a privilege for all Americans.  

Originally posted to joedemocrat on Sun Aug 29, 2010 at 08:01 AM PDT.

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