The first study, appearing in the most recent issue of the Journal of the American Medical Association, observed the post-treatment health of 334,204 members -- black and white -- of 151 different Medicare plans, and discovered that only one plan covered blacks and whites evenly, and even then, only in two of four important standards. Cholesterol and blood sugar levels for diabetics, blood pressure for people with hypertension, and cholesterol levels for heart attack or heart surgery patients were all measured, and the study found that racial gaps were about the same no matter how well each plan scored.
"Many plans eliminated racial disparities on a single measure," said senior study author Dr. John Ayanian, associate professor of medicine and health care policy at Harvard Medical School. "But only one achieved both high quality outcomes and small disparities on two of the measures. No plan achieved those goals on three or four measures."
The researchers theorized that the reason for these discrepancies occurring -- even as previous studies have found the overall quality of health care is improving -- could be because blacks find they are less able to afford expensive medication than whites, and their communities tend to limit their options for exercise and proper nutrition. To start on dealing with those issues, the study authors suggested the government make monthly payments to Medicare plans to help meet the needs of members. Ayanian proposed the money be used to fund support programs such as meetings with nutritionists and health educators and follow-up visits for patients having trouble controlling their cholesterol, blood sugar or blood pressure. While such programs would be expensive, Ayanian noted they would still be cheaper than paying for the consequences of inaction.
The second study, appearing in the journal Ethnicity and Disease, focused on whites, blacks, Hispanics and Asians in New York City. An analysis of data from each zip code found that people were 10 percent more likely to report their health as poor in highly segregated neighborhoods, especially those with a high concentration of black residents.
"We know that there's a correlation between how people rate their health and greater mortality under the age of 65," said study author Luisa Borell, assistant professor of epidemiology at Columbia University's Mailman School of Public Health. "It relates to the poverty level, the quality of food, the quality of life, the quality of health care. In poorer areas, there are fewer green spaces to play in, fewer shops selling fresh fruits and vegetables, more cigarette ads. We're not blaming the victim. We're blaming the social structure."
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