Of all the forms of inequality, injustice in health care is the most shocking and inhumane. -- Dr. Martin Luther King, Jr.

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A report on the racial inequalities in the healthcare system paints a grim picture of the shocking and inhumane racial inequities in Indiana. Released on July 15 by Health Care for America Now! (HCAN), Unequal Lives: Health Care Discrimination Harms Communities of Color in Indiana says Indiana's 1.05 million people of color are a lot sicker than whites and have less access to quality care.

"Throughout the nation's history, communities of color have been forced to accept health care that bears little resemblance to what is experienced by members of more advantaged groups," the report's authors say. "For people of color in Indiana and nationwide, life is shorter, chronic illness more prevalent and disability more common. These are predictable side-effects of a health care system that provides these communities in Indiana with narrower opportunities for regular health services, fewer treatment options and lower-quality care."


Read the Report
Unequal Lives: Health Care Discrimination Harms Communities of Color in Indiana

Health Care for America Now! is dedicated to "quality, affordable health care we can all count on." The Unequal Lives report includes sections analyzing individual states. The Indiana section was released by Central Indiana Jobs with Justice, an HCAN member organization.

The infant mortality rate, for example, is a solid indicator of a population's well-being. Whereas the infant death rate is 7.1 per 1,000 live births among whites, Unequal Lives says it is 15.1 among African Americans in Indiana.

The report says African American infants are more than twice as likely as white infants to die within a year of birth in Indiana. For African Americans, the life expectancy is six to 10 years shorter than that of whites.

Nine percent of adult white people in Indiana have asthma. The figure for African Americans is 13 percent.

Mortality rates from various diseases are notably higher for people of color than for whites. For example, the mortality rate is 25 percent more for African Americans than whites and 200 percent higher than for Latinos.

"The report says African American infants are more than twice as likely as white infants to die within a year of birth in Indiana."

The mortality rate from diabetes is 25 percent for whites and 54.5 percent for African Americans. The annual case rate (per 100,000 population) for AIDS is 3.8 for whites, 28 for African Americans and 12.1 for Latinos.

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These facts about the health of Indiana citizens of color are not surprising considering the proportion of people living in poverty in Indiana is 9 percent of whites, 31 percent of African Americans and 22 percent of Latinos. Further, the proportion of people without health insurance is 11 percent, 18 percent and 32 percent for whites, African Americans and Latinos, respectively.

The proportion of Hoosiers enrolled in Medicaid is 9 percent of whites, 31 percent of African Americans and 22 percent of Latinos.

Many questions about the health of people of color in Indiana, Unequal Lives points out, will remain unanswered as long the state lacks a system for collecting statewide and local data on the racial disparities in health status and medical services. For instance, no one knows how many African Americans and Latinos, as opposed to whites, "have forgone care because they can't afford it," the report says.

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As Unequal Lives demonstrates in detail, the health care system in this country is racist in myriad ways that affect all 50 states. People of color have higher rates of heart disease, diabetes and cancer than whites. But they have less access to the healthcare system. According to a 2002 Institute of Medicine study, "Even when their incomes, insurance and diagnoses are comparable to those of whites, people of color with cancer, heart disease, HIV/AIDS and other life-changing ailments often receive fewer diagnostic tests and less sophisticated treatment."

"No one knows how many African Americans and Latinos, as opposed to whites, 'have forgone care because they can't afford it.'"

Because the health care system favors the wealthy, it is "relatively indifferent" to the reality that people of color suffer disproportionately from serious illnesses. "Racism has more of an impact on health than race does," the report asserts. "African Americans and Latinos are more likely to avoid health care because they can't afford it. They are only half as likely as whites to have a regular physician and undergo regular cancer screening. They have trouble getting time off from their jobs to see a physician and tend to seek health care late, when illnesses are more advanced."

Racism is built into the treatment system. Unequal Lives reports that physicians are much more likely to refer whites for advanced treatment, and, in one study, physicians viewed African Americans as less intelligent, less likely to comply with treatment and more likely to miss appointments. Physicians who treat African Americans are less likely to be board certified.

African Americans with cancers of similar types and stages don't receive the same combinations of surgical treatment and chemotherapy as whites do.

Hospitals and clinics with a clientele of people of color "are more likely to be deficient in quality of care and have fewer resources for patient care than those serving white communities," the report states.

Hospitals are often located far from communities of color, without adequate public transportation. Clinics with limited resources can't afford to provide an effective level of care, and preventive services aren't available. The list continues.

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What can be done to correct these daunting problems? The answer, in Unequal Lives, is ambiguous.

"The health care system in this country is racist in myriad ways that affect all 50 states."

On one hand, the report asserts that the answer is a universal, not-for-profit, single-payer system modeled on an expanded and improved Medicare. A Medicare-like public option would resolve racist disparities in health access and outcomes, as Medicare itself has done.

But on the other hand, Unequal Lives recommends a health care system that supplements current health insurance and leaves the industry intact: the only way to "ensure that the private health insurance industry adopts practices aimed at eliminating disparities is by introducing a competitor with a provider network available to everyone."

Social factors, Unequal Lives declares, are critical in changing the health system. "Substantial improvements in health and life expectancy will be achieved by addressing the social determinants of health, including a clean environment, occupational safety, access to nutritious food and safe neighborhoods."

Linda Greene can be reached at lgreene@bloomington.in.us.