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Dying For Basic Care

During that decade, age-adjusted mortality rates for white men and women averaged 29 percent and 24 percent lower than those of African Americans. The authors calculated how many deaths could have been averted if the two groups' mortality rates were equal. Woolf said that while the study is based on many debatable assumptions -- such as the possibility of equalizing the death rates of whites and African Americans -- policymakers should not wait for further research before taking steps to eliminate these disparities. Even if further studies with more precise calculations find a different estimate of lives saved, they would be "unlikely to change the direction of our findings," the authors say in the analysis.

Winston Price, president of the Washington-based National Medical Association (NMA), called the findings "staggering" and said the study sheds new light on a concern that has existed for decades. The NMA, which calls itself "the collective voice of physicians of African descent," recently launched the W. Montague Cobb/NMA Health Policy Institute, dedicated to eliminating racial disparities in health care.


Former U.S. Surgeon General David Satcher, a report co-author, says disparities in healthcare between African Americans and whites need to be corrected. (Horace Henry)

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Health Care Gap
The Post's January W. Payne reports that 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites.

Policymakers, doctors, community activists and other leaders need to "create an environment where the data and the best practices are communicated to the areas of need in a real-time sense, so communities where health disparities are most rampant will not need to wait . . . before interventions are brought" to them, Price said.

That means developing outreach programs to educate residents about their options for health care, he said. Community leaders and doctors should go to beauty parlors, barber shops, faith-based organizations and community centers in underserved areas to tell people about best practices -- such as taking medication to lower cholesterol and blood pressure, taking insulin to control diabetes and having testing done to detect heart disease, Price said.

But for this to happen, experts said, more funding is needed for programs that seek to deliver appropriate care to underserved groups. The study's authors also noted this need. "The prudence of investing billions [of dollars] in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration," the study says.

The authors write that their analysis has several limitations. It assumes that racial disparities could be eliminated quickly. "In real life, it would be a gradual approach" that would require a number of years," Woolf said. The research also looks at deaths averted by improving technology and eliminating disparities as mutually exclusive -- but the two could be done simultaneously, the authors state.

Another limitation, according to the report, is that the study focused only on mortality, but "racial disparities encompass morbidity [illness] and other domains." Mortality rates are also influenced by factors in addition to medical care, such as lifestyle and environment.

Other types of disparities -- affecting other racial groups and people disadvantaged because of their social and economic backgrounds -- are important to investigate, too, the authors write.

"Socioeconomic conditions represent a more pertinent cause of disparities than race," the study states. "An intriguing question is whether more lives are saved by medical advances or by resolving social inequities in education and income." •


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