CDC: More than half of U.S. population not receiving preventive services

Less than half of Americans get the preventive clinical services we need. Clinical care aimed at preventing HIV infection, cancer, stroke, and heart attacks is delivered on a regular basis to only half the population, according to the Centers for Disease Control and Prevention (CDC).

Moreover, there are huge inequities in who does receive this care. African-Americans, Latinos, and other minorities are less likely than whites to receive appropriate clinical preventive services. For example, about 46% of white patients with hypertension have their blood pressure under control, compared with 32% of Mexican-American patients. Racial and ethnic disparities in the delivery of clinical services may result from physicians’ unconscious biases toward these patients. However, the greatest proportion of this inequities no doubt stems from the unequal distribution of health care services and other problems of access.

Physicians, nurse practitioners, and other health care providers tend to be located in urban and more affluent communities. Inner-city ghettoes, barrios, and other working-class or rural communities have a dearth of health care services. In addition, the populations in these communities are the very same ones with little or no health insurance, which means that — even when available — health care is not accessible.

We need a single-payer, national health care system, with universal coverage. We need to incent health care providers to locate in minority, rural, and working-class communities. And we need to develop the housing, education, and industrial resources of these communities to address all the social determinants of their health.

Monday, July 9th, 2012 at 04:31
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U.S. Supreme Court decision on health care reform bill: A Pyrrhic victory

We have nothing to celebrate with the U.S. Supreme Court’s decision to uphold the Affordable Care Act. The ACA is pain management and palliative care for a terminally ill health system. The U.S. health system needs a truly revolutionary transformation, and the ACA seeks to shore it up by pumping billions of taxpayer dollars into it. What we really need to do it s to pull the plug on a fee-for-service, capitalist market-driven system, substituting universal health care provided by a single-payer, national health care system.

The ACA is actually a boondoggle for the insurance industry. More than $400 billion in taxpayer funds will be channeled to private insurers through government subsidies of private premiums. The federal government will pump billions more into the U.S. health system through expanding Medicaid to some 16 million poor people currently uninsured.

Meanwhile, insurers will exploit loopholes to dodge the law’s restrictions on their misbehaviors. For instance, the limit on administrative overheads predictably will elicit accounting gimmickry. For example by relabeling some insurance personnel as “clinical care managers.” While insurers are prohibited from “cherry picking” — selectively enrolling healthy, profitable patients — they’ve circumvented similar prohibitions in the Medicare health maintenance organizations (HMOs).(2) The ban on revoking policies after an individual falls ill similarly replicates existing but ineffective state bans.

The so-called individual mandate, requiring uninsured people to buy insurers’ defective health insurance policies is a boon to the insurance companies. Nothing in the ACA contains any more teeth than existing state regulations on the insurance industry. Therefore, we can expect that the insurers will continue to find loopholes and other ways around restrictions on the denial of the human rights of their policyholders. We can expect the insurers to find ways to “cherry pick” those they cover – selectively enrolling only the most healthy and profitable patients. They will continue to find ways around restrictions against revoking policies after an individual falls ill. The restrictions on this practice in the ACA are no different than those that exist in many states in which the private insurers have found a way to avoid circumvent them.

It’s infuriating that the ACA is touted as a mechanism for universal health coverage. Under this act, some 23 million people will remain uninsured in 2019. Millions of undocumented workers will be denied health coverage under the law. These working people will be denied adequate health care coverage by the ACA, and the so-called safety-net hospitals upon which they rely for their care will lose $36 billion in funding because the law mandates an end to federal government funding for indigent care.

Meanwhile, employers are forcing workers onto high-deductible health insurance plans; in effect, shifting health care costs onto working people themselves. Many people, as a result, are unable to pay their medical bills, with a serious illness sending many into bankruptcy. At present, illness and medical bills account for 62% of all bankruptcies – and three-quarters of those bankruptcies occur in people who have insurance.(1)

A similar health care “reform” was instituted in Massachusetts in 2006, and it was clearly a model for the ACA. What have been the results? In the first 2 years after the Massachusetts health reform was instituted, the state’s health care costs increased 15% — twice the national rate.(2) The physician workforce was woefully inadequate to meet the increased demand for primary-care and other services, and the state began cutting back on services.

Let’s face it: the ACA, drafted in close collaboration with the pharmaceutical and insurance industries, funnels billions of taxpayers’ dollars into the coffers of big business. To win support for this conservative legislation, Obama and the Democratic Party threw in a few sobs – expansion of Medicaid, $1 billion a year for community health centers, no denial of coverage for pre-existing conditions, and coverage of dependents until age 26. We shouldn’t buy into a plan designed to enrich the insurance and pharmaceutical industries in exchange for these modest reforms. Let’s really transform health care in the United States. We need a non-profit, single-payer, national health insurance program that covers everyone in the country. Anything short of that is putting a Band-Aid on a festering wound.

References

1.  Himmelstein DU, Wright A, Woolhandler S. Hospital computing and the costs and quality of care: a national study. Am J Med 2010;123:40-6.

2.  Kowlaczyk L. Call to cap medical payments is likely. Boston Globe 17 Mar 2010.

 

Thursday, June 28th, 2012 at 09:37
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Primary-care physician shortage in Black, Latino neighborhoods

Primary-care physicians are in short supply in Black, Latino, and other minority communities.

Last month, Medical News Today discussed a study that showed that African Americans and Latinos are more likely than whites or Asians to live in neighborhoods that are low-income, inner-city, or rural, and have access to few or no primary care physicians.

The article reported on a study published in Health Services Research that found that African Americans and lower-income Latinos are more likely to live in neighborhoods with few or no primary care physicians. Dr. Darrell J. Gaskin, lead author and deputy director of the Hopkins Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health, said, “What this says to us is that we really need to encourage physicians to locate in these areas.” The study used data collected by the U.S. Census and American Medical Association from 2000 to 2006. An area with a shortage of health professionals was defined as having one or no physician per 3,500+ people in an area. The results found African Americans and Latinos were 25.6 percent and 24.3 percent, respectively, more likely to live in an area with few or no primary care physicians, compared with 13.2 percent of whites and 9.6 percent of Asians.

In a health system based on fee-for-service payments to physicians and hospitals, the market will drive physicians and other clinicians away from communities with large numbers of uninsured, unemployed, and low-income people — in other words, working-class African-American, Latino, and other minority neighborhoods; as well as rural areas, even those with predominantly white population.  As Gaskin noted, “You can’t pay physicians less for a service under Medicaid and expect them to want to practice in that kind of area. We’re talking about areas where doctors won’t be able to practices because they can’t sustain themselves.”

In addition to this maldistribution of the physician workforce resulting from capitalist market forces, I believe that African Americans and Latinos also lack primary-care health services because of racial discrimination. One of the main drivers of this discrimination is the continued residential segregation of these communities. The June 2012 issue of Health Services Research is dedicated to exploring health disparities in the United States and includes an article on the effect of racial residential segregation on health.

Financial incentives, such as loan repayment, increased payment for Medicaid, or increased payment for services provided to underserved communities, would help shift the distribution of the clinical workforce. However, a better solution would be eliminating the fee-for-service payment structure. Pay clinicians for keeping whole populations or communities healthy, rather than paying us for doing things to people.

Monday, June 4th, 2012 at 04:36
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Millions of unemployed added to ranks of uninsured

Unemployment lines continue to grow, swelling ranks of uninsured

As we all await the U.S. Supreme Court’s ruling on the so-called Affordable Care Act (ACA), the number of uninsured working people continues to increase. A recent Gallup poll shows that 17.1 percent of U.S. residents lacked health insurance in 2011 compared with 14.8 percent in 2008. Millions of U.S. workers have lost their jobs and, with their job loss, lost their health insurance.

Workers who have managed to keep their jobs in the current depression still have a tough time maintaining their health insurance. Between 1999 and 2008, family health insurance rose 119 percent — far outstripping wage increases in the same period. Part-time workers, whose ranks also are increasing, are even less able to afford health care insurance. Latino workers fare the worst, as many are unjustly victimized because of their undocumented status.

The ACA is not a solution to this country’s healthcare crisis. We need single-payer, national health insurance program that covers everyone in the country. I’ll continue to argue for that solution no matter what the U.S. Supreme Court decides. I hope you do the same.

Monday, May 21st, 2012 at 04:25
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Black, Latino youth breathe toxic air, disproportionately die from asthma

Atlanta -- a city with a mostly Black population -- dubbed by Forbes "America's most toxic city."

African-American and Latino youth disproportionately suffer from asthma. Some one in four Latino youth living in poverty in the United States suffer from asthma compared with one in 13 white children living in more affluent families. (See the recent CDC report on health disparities.)

Working-class African-American and Latino families live in areas with markedly poor air quality. Power plants, industrial boilers, bus terminals, and highly trafficked roads and highways are commonplace in these communities. As a result, African-American and Latino youth breathe toxic air.

Added to the air pollution that plagues these poor, working-class communities is the fact that children in these neighborhoods are exposed to other environmental toxins and allergens at a higher rate than children in affluent neighborhoods. Toxic waste sites and contaminated water, for example, are more often near African-American, Latino, and other working-class neighborhoods. Dust, mold, cockroach droppings, and other indoor pollutants associated with increased asthma rates are more prevalent in the poor housing stock in these communities.

Asthma is a disease from which no one should die. To decrease its incidence among poor and working people, how about a massive public works program to clean up the environment of African-American, Latino, and other working-class communities? Such a green campaign would provide much-needed employment and result in improved health. Increasing access to primary-care clinicians would decrease the mortality from this disease.

Monday, May 14th, 2012 at 04:34
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Kaiser Foundation: Medicaid cuts opposed by the majority

Unemployment continues to ravage working-class communities throughout the country. One result of this scourge is that hundreds of thousands of people have been added to the Medicaid rolls. To listen to the U.S. Congress and all the radio and TV pundits, the problem with Medicaid is its burgeoning cost — not the human suffering it represents.

Instead, Democrats and Republicans alike have been arguing about how much to cut Medicaid. This year, 43 states have made fresh cuts to Medicaid. For next year, 45 governors proposed making new cuts, including proposals to cut payments to health care providers, cutting benefits to Medicaid recipients, and increasing the amount that Medicaid recipients must pay out of their own pocket.

Such cuts don’t sit well with working people. The Kaiser Family Foundation recently released its monthly tracking report, showing that half of people in the United States reject cuts in Medicaid. According to a news release from the KFF, “The May Kaiser Health Tracking Poll finds that 60 percent of people say they would prefer to keep Medicaid as it is, with the federal government guaranteeing coverage and setting minimum standards for benefits and eligibility. …Only 13 percent of Americans say they would support major reductions in Medicaid spending as part of Congress’ efforts to reduce the deficit, while 3 in 10 would support minor reductions and 53 percent want to see no reductions in Medicaid spending at all.”

“If you watch the debate about the deficit and entitlements, you would think that almost everyone has a problem with the Medicaid program and wants to change it, or cut it — or both,” said Kaiser President and CEO Drew Altman. “The big surprise in this month’s tracking poll is that one group who does not want to cut Medicaid is the American people.”

According to the KFF poll, about half of the U.S. population (51%) report some personal connection to Medicaid, including having received health coverage, long-term care, or Medicare premium assistance from Medicaid themselves (20%), or having a friend or family member who has gotten this type of assistance (31%).

While a national, single-payer health plan would provide the best health coverage for working people and their families, Medicaid, clearly, provides critical safety-net protection. With millions of unemployed joining the ranks of the uninsured, such protection is a life-and-death question. For this reason, support for Medicaid runs high, with nearly half of those polled in the KFF study (49%) saying that Medicaid is “very” or “somewhat” important for them and their family. Eight in ten adults (81%) said that if they were uninsured, needed health care, and qualified for Medicaid, they would enroll in the program.

Health care is a right, not a privilege! No cuts to Medicaid or Medicare! Let’s build a national health plan, with universal coverage.

Saturday, June 11th, 2011 at 15:26
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President’s Cancer Panel: Social factors affect cancer health inequities

Cancer screening, treatment, and outcomes differ by racial category and geographic location

Cancer doesn’t affect all people the same. African Americans, Latinos, and other minority populations suffer a disproportionate burden of morbidity and death from cancer. Rural populations also suffer from an unequal burden from this disease.

In a report released on April 28, 2011, the President’s Cancer Panel identifies an urgent need to improve our understanding of the social factors that influence cancer risk and outcomes among minority and rural populations. The Panel’s report, “America’s Demographic and Cultural Transformation: Implications for Cancer,” states that current knowledge of cancer risk, incidence, progression, and outcomes is based largely on studies of non-Hispanic white populations. Therefore, the current understanding of risk factors, screening guidelines, and treatment may not be appropriate for individuals of non-European descent. The Panel also calls for higher standards of “cultural competence” among healthcare professionals to better address cultural and language barriers that can negatively impact the quality of patient care.

The President’s Cancer Panel made several key findings and recommendations:

• While the effects of socioeconomic and sociocultural determinants of health outcomes have long been recognized, cancer research has focused primarily on using genetics to identify health differences. The Panel recommends that both biological and sociological factors be examined to truly understand racial, ethnic, and geographic health disparities.

• The Panel identifies a need to evaluate current cancer screening guidelines to determine their accuracy in assessing disease burden in diverse populations. In particular, the report recommends that researchers consider the patient population in its entirety and identify common genetic, sociological, and environmental risk factors on which to base screening recommendations.

• Researchers must examine the effect of changing demographics and expand the current understanding of related factors that influence cancer risk, incidence, and mortality. This knowledge must then be applied for the benefit of all subpopulations so that more accurate preventive measures can be implemented.

• The majority of health care providers do not adequately consider patient sociocultural and socioeconomic characteristics when addressing cancer prevention and treatment, even though these factors can have independent and sometimes profound effects on cancer susceptibility and outcomes in both native and foreign-born Americans. In addition, the Panel found that patient-provider language differences are a significant barrier to the provision of quality health care. The Panel recommends that cultural competency become an integral part of medical and research training curricula, as well as a continuing education requirement. The Panel also recommends that trained interpreters be viewed as essential members of the health care team.

• The Panel says that, although personalized medicine for all is the ultimate goal in cancer care, it is not universally feasible or affordable in the near future. Therefore, research is needed now to identify subpopulations at high risk of disease due to genetic/ancestral, biologic, sociocultural, and other factors that directly relate to risk or response to therapy.

• Weaknesses in existing vital statistics, census, public and private insurer, and cancer surveillance data may thwart efforts to characterize populations in a scientifically meaningful way. To address these serious data deficiencies, the Panel calls for improvements in data collection, as well as standardized data sets and definitions of race and ethnicity.

• There is a need for improved data sharing among government agencies at all levels as well as a need to address issues of data compatibility.

• Additional recommendations include increasing the diversity of the cancer research and care workforces; exploring and evaluating the benefit of patient navigation models; and continuing basic, translational, clinical, population, and dissemination research on cancer health disparities.

The Panel concludes that cancer and other health disparities will be eliminated only when the social determinants of poor health outcomes, such as poverty, low educational attainment, substandard housing and neighborhoods, and insufficient access to quality health care, are adequately addressed.

I couldn’t agree more, and I’ve used this blog to make many of these same points. I hope this report by the President’s Cancer Panel will lead to increased funding of research on the social determinants of cancer health.

Monday, May 2nd, 2011 at 04:17
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CDC report highlights glaring health inequities in United States

Poor housing conditions, like here in New Orleans, one of the social causes of racial health inequities

Earlier this month, the Centers for Disease Control and Prevention (CDC) released a report documenting glaring racial health disparities in the United States. This report marks the first time the CDC has reported officially on such health disparities. The purpose of the report, said CDC Director Dr. Thomas Frieden, is “to shine a spotlight on the problem and some potential solutions.”

As noted before in this blog, working people, the poor and impoverished, rural populations, and those without insurance die younger and die more often than others. This unequal burden of disease and death falls even more harshly upon people of color. African Americans, Latinos, Asian Americans, Native Americans, and Alaska Natives suffer in disproportionately higher numbers from disease. The new CDC report is yet another verification of these horrific inequities.

A few highlights from the report:

  • Infant mortality among African Americans is three times that of whites
  • The suicide rate among Native Americans is 18 times that of whites
  • African Americans die from heart disease at a younger age than whites
  • African Americans die at a younger age from heart disease than whites
  • African Americans die more often & at younger age from stroke than whites
  • Hypertension is twice as prevalent among African Americans than whites
  • African Americans, Latinos, and Native Americans have much higher rates of HIV/AIDS than whites

The report also discusses the glaring income inequalities in the United States. This and other social inequalities are the root cause of health inequities. Until we have social justice, health inequities will remain an intractable problem.

Friday, January 28th, 2011 at 10:15
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Women’s right to abortion under attack

Women with unwanted pregnancies being denied legal right to abortion

The legal right of women to abortion services is under attack. Abortion clinics are picketed. Women exercising their legal right to have an abortion are being harassed as they enter the clinics. Physicians who provide abortion services have been targeted by opponents, who have harassed these physicians and even murdered them — as in the case of family physician George Tiller in May 2009. President Obama’s Affordable Care Act — so-called health reform — denies insurance coverage for abortion services.

These assaults on a woman’s right to abortion are taking a toll on access to this legal contraceptive service. In a report for the Guttmacher Institute entitled “Abortion Incidence and Services in the United States 2008,” data indicate a decline in abortions. Despite population growth, the total number of women receiving abortions in 2008 was essentially the same as it was in 2005, which means the rate of abortions has declined. In 2008, the rate was 19.6 abortions per 1,000 women aged 15-44, whereas the rate in 2005 was 19.6.

On the bright side, women seem to have better access to medical abortions (where a combination of two drugs are administered instead of surgery). The number of medical abortions performed in nonhospital facilities increased from 161,000 to 199,000 between 2005 and 2008. According to the report, some 59% of abortion providers offer medical termination of pregnancy.

Unfortunately, the number of abortion providers remains abysmally low. In 2008, there were 1,793 such providers — not much different than the 1,787 who existed in 2005. The vast majority of the United States lacks abortion services, with 87% of U.S. counties not having an abortion provider. One of the aims of the campaign of harassment and intimidation of physicians who perform abortions is to terrorize clinicians and make them hesitant to provide this legal service. The Guttmacher Institute’s study reports that 89% of the large nonhospital providers report regular harassment from anti-abortion forces.

Thursday, January 13th, 2011 at 14:35
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Cuban health brigades battle cholera in Haiti

Cuban physician cares for Haitian infant

Cuban physicians and health care teams are on the front lines of the battle against the cholera epidemic ravaging Haiti. As the British news paper, The Independent, recently noted, the Cuban revolutionary government’s health aid far outstrips that given by the U.S. government – despite President Obama’s pledge to mount a monumental humanitarian relief effort.

Cuba doctors first arrived in Haiti in 1998. When the country was struck last year by a devastating earthquake, the Cuban corps of 350 physicians sprang into action, providing much needed medical assistance. Cuba sent hundreds of additional physicians, nurses, and other health care providers to aid in this relief effort. After a couple of months, most other countries had pulled their relief teams out of Haiti, leaving the Cuban health care teams, Partners in Health, Doctors Without Borders and their Haitian colleagues as the principal providers of health care services. Cuba now has some 1,200 health care workers in Haiti.

Not yet recovered from the earthquake’s devastation, Haiti now is gripped by a cholera epidemic. At year’s end, the death toll from the epidemic was more than 3,300 people, with more than 150,000 infected with the disease. According to The Independent, Cuban physicians are working throughout the country and have treated some 30,000 cholera patients since the epidemic began in October 2010.

The Cuban government’s commitment to helping ensure the public health of its population and the health of the world’s peoples dates back to the earliest days of the Cuban Revolution. Currently, 25,000 Cuban physicians and an additional 10,000 other health care workers are providing clinical and preventive health services in 77 of the most impoverished countries in the world. Meanwhile, the Cuban people have free health care and enjoy a health status that rivals – and, in some instances, surpasses – that of the United States.

Cuban health brigades are sent wherever they are needed and only at the invitation of the receiving country’s government. This aid is provided without any strings attached. In the wake of Hurricane Katrina, the Cuban government offered to send its Henry Reeve Brigade to aid Gulf coast victims of the storm. The U.S. government rejected this offer to help.

Monday, January 3rd, 2011 at 05:40
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