Equality Agenda: Recommitting to better health care

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At her installation as the 106th president of the National Medical Association (www.nmanet.org), the nation’s oldest advocacy group for Black physicians and patients, Sandra L. Gadson, M.D., outlined an agenda for 2005 and beyond that addresses health care in the Black community. Here is an edited version of her remarks on that agenda.

The Challenge
The unscrambling of the human genome, advances in transplantation, the emergence of electronic patient management systems and myriad other 21st century medical technologies all herald a new era in cutting-edge health care. At the same time, the stalwart march of technology gives rise to new questions about opportunities for minority physician training and uncertainties about how American patients will access and speak the language of new medical innovations. In today’s health-care system, the interposition of managed care and thick layers of insurance bureaucracy displace the “house-call doctor” of yesterday. And while the cost of maintaining this system—at last count $1.3 trillion a year—continues to climb, the number of uninsured Americans continues to soar. In the midst of this glistening but troubled river moves an old and menacing phantom called “health disparities.” At every level of the U.S. health system the result is almost always the same: Blacks live sicker and die younger than their white counterparts.

National Health Plan
The NMA will continue to forcefully advocate for universal health insurance coverage, for a system where everybody has a health insurance card that allows them to receive all medically necessary services by the physician of their choice. Minorities comprise one-third of the nation’s population but over half of the uninsured. One out of five Blacks and one out of 10 whites does not have coverage. And 80 percent of the uninsured come from working families.

Transplantation & Organ Donation
To increase the number of African-American kidney donors, the NMA will be working more closely with the Minority Organ Tissue Transplant Education Program (MOTTEP) at Howard University, the Association of Organ Procurement Organizations, the National Kidney Foundation, The Gift of Hope and our other partners in the kidney-care community. African-Americans are four times more likely to develop ESRD (end-stage renal disease) than other Americans, and we have the highest rate of kidney failure in the country. African-Americans comprise less than 13 percent of the U.S. population but nearly one-third of all kidney patients. While it is most certainly true that there is a kidney “supply and demand” problem for all renal patients regardless of race or ethnicity, it is also true that Black ESRD patients tend to receive disproportionately fewer kidney transplants. In contrast to their white counterparts, Black ESRD patients are less likely to be referred for transplantation evaluation. And when they are referred, they must wait nearly two years longer for a kidney. Researchers tells us that even among kidney patients who want a transplant and who are considered appropriate for transplantation, Black patients are still significantly less likely to be referred for evaluation, to be placed on waiting lists and to undergo transplantation. Even after adjusting for biological matching and blood type compatibility, transplantation rates for Black ESRD patients are 34 percent lower than that of white patients.

The Institute of Medicine’s “Unequal Treatment” report suggests that physicians—at least at a subconscious level—can make stereotypic assumptions about a minority patient’s capacity or willingness to undertake certain medical options. Other factors—related to cultural competence and the quality of the patient-provider relationship—also play a role in these kinds of treatment disparities. We will be looking for ways to overcome misconceptions and distrusts pertaining to transplantation.

Health Disparities
The NMA will endeavor to fully support the W. Montague Cobb Health Policy Institute as it moves beyond just raising awareness about health disparities and homes in on the development of national policies and programmatic solutions that can eradicate health disparities. The NMA will also intensify the on-the-ground work of our national office and affiliate chapters to bring these health-disparity efforts to a new level. The national office will support its affiliates in identifying resources for local members to support a range of health-disparity initiatives—including health promotion and disease prevention; health literacy; and advocating at state and local levels for diversity, cultural competence and universal health insurance coverage. I am going to ask our affiliate members to reignite health-disparity collaborations with local institutions. And I will ask affiliate members to write a health editorial or column for their local newspapers, to work closely with community health leaders to support health fairs that provide screening for hypertension and diabetes and to develop local health literacy campaigns that educate community members on how to most effectively interact with their health-care providers. 

Lastly, we will focus this year on strengthening our health-disparity collaborations with two cultural giants in our community: the Black church and the Black press.