African American (AA) women’s health care has been and continues to be unacceptably poor. Some AA women are numbered in the lowest socio-economic status for both wealth and education. Many of them live and raise their families under conditions of poverty with a primary concern for the basic needs of food, clothing, and shelter. Health care for some of these women is a luxury and is attended to in an emergency situation only. Many women who live in poverty were born into an environment of poverty and have had limited exposure to formal education. There are other AA women who are well educated and affluent—some are categorized as middle class and others as wealthy. However, research studies have shown that across the spectrum of class and socio-economic status, AA women’s health care remains unacceptably poor. The reasons for this seem to be multifaceted and reflect several barriers to health care for AA women.
The U.S. Department of Health and Human Services Office of Women’s Health describes some of the barriers as being related to: “the current state of medical practice, medical education, medical research and medical leadership in the United States creates its own obstacles for minority women. These four areas of medicine have traditionally ignored the health of women and minorities.” These obstacles take into account the physical location of medical practice facilities, many of which tend to be inaccessible to a sizeable portion of the AA female population who live under conditions of impoverishment. The lack of access to health care resources results in a decrease in the receipt of preventive care and continuity of care. This can result in an increase in hospitalizations and higher health care costs.
According to the census report for year 2000, while most women across racial and ethnic groups had an office-based usual source of care, white woman were more likely to have office-based care than non-white women. AA women were more likely to use a hospital outpatient department or emergency room for their usual care. Hospital outpatient departments often have high-volume practices and as a result physicians in these settings have less time to spend with patients. And sometimes these physicians provide less preventive care counseling than do physicians in other medical practices.
The lack of access to health care providers in minority communities does not address the full scope of the problem. In April 2000, The New England Journal of
Medicine published an article based on a survey by Dr. Sean R. Morrison et al. The authors reported that they had observed that many AA and Hispanic patients who were receiving palliative care at a major urban teaching hospital were unable to obtain prescribed opioids from their neighbourhood pharmacies. Dr. Morrison and colleagues surveyed a randomly selected sample of 30% of New York City pharmacies to obtain information about their stock of opioids.
Our data demonstrated that many New York City pharmacies do not stock sufficient medication to treat patients with severe pain. Furthermore, pharmacies in predominantly non-white neighbourhoods are significantly less likely to stock adequate supplies of opioids than are pharmacies in predominantly white neighbourhoods. These results suggest that non-white patients maybe at even greater risk for the under treatment of pain than previously reported…
This practice impacts the heath care of AA women who live in neighbourhoods that consist of a predominantly minority population.
There are many other health care system barriers related to medical practice; it would require a separate volume to address them all. Two additional issues that will be addressed here are AA women and mammography, and AA women and the practice of cardiac catheterization.
Many studies have focused attention on AA women and the use of mammography: the results have shown that AA women are less likely to undergo mammography and are more often diagnosed with advanced-stage breast cancer than are white women. The question that remains unanswered is why are AA women more often diagnosed with advanced-stage breast cancer? Is the access to providers for primary prevention the issue or are the providers not referring AA women for mammography? According to Ellen P. McCarthy et al., in their study “Mammography Use Helps to Explain Differences in Breast Cancer Stage at Diagnosis between Older Black and White Women”:
We previously found that greater mammography use was associated with an increasing number of visits to a primary care provider among Black and White women but receipt of primary care was not enough to correct the disparity in mammography use between Black and White women. Furthermore, many studies show that a physician’s recommendation is the most important determinant of mammography use.
In the case of cardiac catheterization, it has been well publicized that there is a clear racial difference in the referral pattern practice of physicians when presented with patients who have a complaint of chest pain. AA women are less likely than white women and men, AA and white, to undergo a cardiac catheterization or coronary artery bypass graph surgery, when they are hospitalized with a diagnosis of chest pain or myocardial infarction.
The Department of Health and Human Services has also listed medical education, medical research, and medical leadership as barriers limiting access to health care. Medical education was targeted because of limited training in the area of cultural competence in health care training programs. In addition, the enrollment of AA students into traditionally white medical school matriculation has declined as expressed by Jack H. Geiger in an article titled “Comment: Ethnic Cleansing in the Groves of Academe.” The article was published in The American Journal of Public Health in September 1998. As a consequence of the decrease in minority enrolment in health care training programs, there is, as well, a disparity in the number of minorities who serve in all areas of health care. This is especially evident in the lack of diversity among the medical school faculty members, researchers, and administrators. Disparity in the racial/ethnic mix of the providers can add to the stress and uncertainty of care that is experienced by the patient.
To accurately assess the issues of health care in AA women, we need researchers and participants. Lessons learned from the Tuskegee Syphilis Study have stressed the importance of informed consent and health care ethics in every research situation. It is imperative that AA women become more actively involved in research projects and fulfill the roles of both the researcher and the educated consenting participant.