Racial disparities plague Madison, study says

by Alex Brousseau

Thursday, May 8, 2008 00:00

A report on racial inequalities published last week by the Urban League of Greater Madison found a disparity between blacks and whites in education, economics, housing, political influence, experience in criminal justice and health care.

According to the report, which is called “The State of Black Madison,” blacks are generally less healthy than whites and also less integrated into the health care system.

The Urban League’s Center of Workforce Strategy compiled the report from a variety of research and statistics, according to Urban League of Greater Madison’s President and CEO Scott Gray.

“We also had leaders in each of the six areas, as well as local experts,” Gray added.

The study’s findings mirror other research about racial inequalities in health care, according to University of Wisconsin School of Medicine and Public Health professor Sherrill Sellers, who studies population health sciences.

“My own experience suggests that the report accurately characterizes the state of blacks in Dane County,” Sellers said. “[It] pulls together many of the things that are sort of ‘known,’ which really brings home the differences between blacks and whites that I hope will serve as a wake-up call.”

One of the best ways of indicating a population’s health is through infant mortality rates, Sellers said, whose findings were identical to those in the report.

“Infant mortality rates are at least double between blacks and whites,” Sellers said. “There is also other data when it comes to how long people are going to live. White men live between five and seven years longer than black men.”

Overall, blacks tend to die sooner and are often sicker, Sellers said.

Blacks are 10 times more likely to suffer cases of sexually transmitted diseases and about twice as likely to experience asthma and low birth-weight children than whites. These rates are higher than anywhere else in the nation, according to the report.

There is one positive disparity between blacks and whites nationwide in health: According to Sellers, blacks have good — if not better — mental health than whites.

“Studies show that life satisfaction and happiness are high in blacks, with the exception of social phobias,” she explained. “Depression among white women is the highest, and among black men it is the lowest.”

The causes of these negative health differences are complex and lie not only in one place, according to health care professionals.

John Frey, professor at the UW School of Medicine and Public Health and a family medicine practitioner at Wingra Clinic, attributed the disparities to social and genetic factors.

“A lot of African Americans have worse outcomes then Caucasians because of a lot of factors like socioeconomic status and education, and social determinants as well as genetic,” Frey said. “Mostly we focus on the outcomes of whatever diseases don’t go as well as with whites.”

One of the newest explanations lies in the difference in genetics between blacks and whites.

“For years, social sciences have been trying to say there is no biological difference between blacks and whites, that we are all the same under the skin,” Sellers said. “Studies (released last week) now show that we may be about 99.5 percent the same, but it’s that .5 percent difference that seems to matter for certain diseases.”

This is particularly relevant to heart disease and prostate cancer, whose rate among the black population is “eye-popping,” according to Sellers. Blacks may respond differently to heart disease treatments, she said.

“There seems to be a tiny genetic variant that suggests a medicine that works well for whites won’t work well for a certain group of blacks,” she said.

The causes for health disparities also seem to be rooted in the social environment, especially the living patterns of blacks versus whites. In Dane County, several predominantly black neighborhoods are located in Madison, like many other cities in the nation, according to UW sociology professor Pamela Oliver.

“Outside of the city of Madison, the county is overwhelmingly white with small pockets of people of color,” Oliver said.

An unequal system

The disparities in health are not just limited to the overall health of blacks, but also to their access to health care.

According to the report, 25 percent of blacks living in Dane County are uninsured, and blacks are 10 times more likely to rely on government health insurance programs than the rest of the population.

“Insurance impacts a lot of folks when they decide what to do with their health, because no health insurance means no visits to the hospitals or family doctors,” Gray said.

The report suggests the blame lies mostly with income disparity, noting that blacks in Dane County make more than $22,000 less than the overall community and are three times as likely to live below the poverty line.

“The treatment is the same for everyone who doesn’t have health insurance; [clinics] won’t take them,” Frey said. “Sometimes [clinics] ask for money upfront, but they are often directed to a federally qualified clinic. Even then, the waiting lists there are quite long.”

However, just obtaining health insurance is half the battle, the other half is getting successfully into the system, according to Frey.

“Access to care is a real impediment for people,” he said. “A higher percentage of African Americans have problems with being able to have health care and when they have it, often don’t have a source of primary care.”

Several services in the Madison area seek to overcome these disparities, including services available at UW Health clinics. The Cancer Health Disparities Initiative seeks to conduct research to reduce inequality in cancer testing and treatment in Wisconsin.

“Issues such as procedures for haves and have-nots and who has access to cancer screening have been widely discussed,” said UW Health spokesperson Toni Morrissey.

One of the services offered is an online resource center that provides information about cancer health disparities, funding, conferences and events. It also has a forum to provide resource information, technical assistance, research mentorship and training opportunities.

UW Health is currently discussing other services to deal with racial inequalities in health care, plans which have been in the making before this report was published.

A solution?

The goal of the report was not only to raise awareness of the racial disparities within Madison, but also to create a blueprint and foundation for the city to move towards being more racially inclusive, according to Gray.

“Our coalition of six members is working with a number of health institutions across Dane County,” he said. “We also want to talk to a number of key leaders in the health care area.”

Within the report is located a list of recommendations to overcome the disparities in health care access and quality of care. Among these include universal health care, non-emergency alternatives for walk-in uninsured patients, pre-tax medical savings and health education programs.

“One of my frustrations is that we study issues but often fall short on action,” Sellers said. “At least as related to health disparities, these matters are truly life and death.”