There’s been a long-standing debate in U.S. policy circles about the intersection of race, economics and health care quality. In the January/February issue of the Washington Monthly, senior editor Phillip Longman offers three articles that reflect the most recent research on this subject.
The first, entitled “Is Inequality Shortening Your Lifespan?”, reviews the basic statistics on health conditions and concludes income is the most important differentiating factor:
[T]he health status of both blacks and whites improves dramatically with higher income while the gap between them remains small. Among blacks and whites living at just four times the poverty rate, for example, the percent who report poor or fair health drops to 8 percent and 6 percent respectively. Your race per se, in other words, plays little role in predicting your health compared to your income.
What explains the residual difference in the health status of blacks and whites who have the same-size pay check? Researchers suggest it may reflect in part the reality that at any given income level, blacks tend to have fewer assets than whites, such as home equity and financial savings…. Middle-class black families are also more likely than middle-class white families to bear the health consequences of having lived in poverty in the past.
In “To Live Longer, Move To a New Zip Code,” Longmann reviews a study by HUD which found that moving out of inner-city low-income neighborhoods had a significant positive effect on obesity levels and thus health conditions:
Though it might seem strange to say that obesity is contagious…it does seem that people’s risk of it is affected by the weight of their neighbors, as well as by such environmental factors as whether most of the food for sale in their environs is junk food, as is often the case in America’s most impoverished neighborhoods.
Finally, in “Color-Blind Medicine?”, Longman sees evidence that race does affect the quality of medical care received, but not necessarily by way of racism among providers:
[I]t is place, not race, that overwhelmingly determines what specific treatments patients receive for specific ailments. Blacks tend to live in parts of the country that have a disproportionately large share of low-quality providers. But as researchers from Dartmouth Medical School have demonstrated, within poor-quality hospitals, which include not just inner-city “St. Elsewhere”s but often well-known academic medical centers, both whites and blacks tend to be equally mistreated, often by being subjected to unnecessary surgery and unproven treatments.
All of these snapshots of the intersection of different factors could be significantly changed, of course, if the Affordable Care Act is fully implemented. But it’s extremely helpful to know where we are starting: in a system where inequality remains the rule rather than the exception.