African American Bioethics: Culture, Race, and Identity

Chapter 3. Whitewashing Black Health: Lies, Deceptions, Assumptions, and Assertions—and the Disparities Continue

CHAPTER 3 Whitewashing Black Health: Lies,Deceptions,Assumptions, and Assertions—and the Disparities Continue Annette Dula O V E R the last several decades, the federal government and private foundations have focused on the appalling health disparities between racial/ ethnic minorities and whites, with their goal being to narrow the health status gap between nonwhites and whites. For example, the 1965 MedicareMedicaid legislation improved access to health care for African Americans and other poor populations. In 1985, the U.S. Department of Health and Human Services published the Report of the Secretary’s Task Force on Black and Minority Health, which acknowledged the tragic dilemma of persistent health disparities between whites and minority populations.1 In 1998, thenpresident Bill Clinton launched an initiative to reduce and eliminate racial and ethnic disparities by 2010. In 2001, the National Institutes of Health (NIH) established the National Center for Minority Health and Health Disparities (NCMHD), which received an annual budget of $132 million to fight health disparities. In 2002, its budget was increased to $157.8 million, and in 2003 the NIH requested $189 million for NCMHD. Similarly, the Robert Wood Johnson, Kellogg, and Kaiser foundations and the Common47 wealth Fund have all taken up the challenge to fight health disparities through research and education. Despite the many federal and private initiatives aimed at reducing health disparities, despite the numerous academic papers published that raise awareness of the issue, despite new cultural competency requirements of medical schools and continuing education, and despite the changing of African Americans’behaviors, the health disparities continue. In fact, gaps in health status between blacks and whites for some conditions have not changed since 1970, and in some cases may have worsened. For example, in 1970, infant mortality among African Americans was twice that among whites.2 In 2003, black infant mortality was still twice that of whites. Infant mortality even increased from 2001 for all racial/ethnic groups;3 tellingly, the increase was statistically significant only for infants of black mothers.4 In 1970, deaths due to asthma were about three times higher for blacks than for whites.5 More than thirty years later, the death rate from asthma for African Americans is still three times the rate for the white population.6 Several reports have acknowledged that increasing the number of underrepresented minority physicians and medical students is an “important strategy in the elimination of racial and ethnic care disparities.”7 Alarmingly, however, the number of black medical graduates declined by 17 percent, from a high of 1,246 in 1998 to 1,034 in 2004. In addition, minorities still account for only 4.2 percent of U.S. medical school faculties.8 One is compelled to ask, “Why are health disparities still with us after four decades of serious efforts to eliminate them?” I hypothesize that eliminating health disparities works against the vested interests of powerful political and economic forces. The current conservative agenda, along with a corporate-friendly Congress and White House, promotes and implements policies and practices that are at odds with the task of making health disparities a phenomenon of the past. These forces are not intentionally racist, nor do they aim to worsen disparities between minorities and whites. Rather, more subtly, their practices result in diluting or neutralizing progress toward eliminating health disparities. My purpose here is to point out how spokespeople for conservative think tanks––fueled by their corporate backers—are constructing narratives that undermine efforts to reduce and eliminate racial health disparities. First, I present five deceptive stories that some groups, individuals, and think tanks are purveying, which dismiss the role of race in the poor health of African Americans. Then I examine three assertions that underlie these stories. And, Annette Dula 48 Whitewashing Black Health finally, I discuss how these five stories and their underlying assertions are part of a larger corporate agenda that has bad side effects for the health of African Americans and other poor populations. The stories and assumptions partly explain why the disparities continue despite massive efforts to eliminate them. Deceptive and Misleading Information— Whitewashing Health Disparities Story/Lie No. 1: There is no physician race bias or negative stereotyping in health care. This is the belief of Sally Satel, a psychiatrist at the American Enterprise Institute. In March 2002, the Institute of Medicine (IOM) published a landmark study on health disparities.9 The Institute reviewed more than one hundred previously...