Myrtle Oates M.D.: Let’s Get Real…Reducing Health Disparities

By Myrtle Oates M.D.

Recently, Reuters Health published that the life expectancy of a black man in prison is equal to that of his white counterpart. “Less than one percent of men died during incarceration, and there was no difference between black and white inmates. But outside prison walls, blacks have a higher rate of death at any given age than whites.” (Reuters Health, 2011) Of course I had to ask why? Well, prisons are the only provider of care accessible by these underserved and vulnerable populations. More to the story is these individuals in prison also must refrain from drinking alcohol, smoking and using illicit substances.

This has illuminated several thoughts on how we possibly are disempowering ourselves from reducing health disparities in underserved populations.

1. Disempowerment by Public Will. Public will seems to support the exemption of young people from participating in mandated access to health care. The thinking is that young people do not get sick. Therefore they would be paying for something that they probably would not use. Young people most certainly get sick and may be involved in accidents. Additionally, I have to ask “why wouldn’t a young person avail themselves of yearly check-ups?” And if they don’t, then our message should be more compelling. After all young people make decisions that impact their health 20, 30 and 50 years in their future.

How many cases of hypertension would physicians and medical practitioners diagnose if we had access to this population. How many kidneys would we save and dialysis centers would we close if we had aggressive treatment of diabetes, hypertension and lupus.?

But never mind treatment. If prevention were truly a priority then we could stress the importance of diet and exercise in this group who no longer eat at their parents table. If we could impact the diets of young families how much healthier would our society be and the generations that follow?

2. Disempowerment Economically. What could have been the motivation of an individual to lay aside compassion and empathy? Letting an individual die rather than treating him in an emergency in the face of the best healthcare in the world is unthinkable. Perhaps the circumstance he finds himself in is unacceptable to the society at large. Staggering rates of unemployment or under-employment persists today. Or perhaps he is employed with 2 jobs but neither provide health insurance benefits. Suppose he has pre-existing health concerns that makes him ineligible for health insurance.

Does it really matter?

Those that would deny a young individual treatment somehow blame him for his economic inadequacies. Maybe there are lines on their own curriculum vitae that, had they not been erased, would reflect similarly. The message from society is loud and clear. He cannot afford healthcare therefore he doesn’t deserve to be treated.

When does deserve enter into the equation of who gets treated and who doesn’t? Might I recommend to those who would treat only the deserving observe a few shifts in a Trauma unit. Their definitions of deserving may change.

3. Disempowerment Morally. It is not class, culture, ethnicity or economics but an intensely moral decision when we speak of rendering aid to someone in need. I submit that any excuse that is used for the setting aside of human decency is not the failings of the one in need but the disempowerment morally by one whose choice is to deny him aid. If we were given the opportunity to develop a relationship with our patients rather than 15 minutes behind a curtain in pod 2 then we could address lifestyle choices. These choices and circumstances such as substance abuse, smoking, drinking, domestic violence, and stress could and should be addressed if we are truly serious about caring for an individual ‘s health. Intervention must play a role.

I am a student of the Rev. Dr. Martin Luther King Jr. who places the parable of Dives (the rich man) and Lazarus (the one who perished in the midst of plenty) squarely in our faces at this juncture. He reminds us that Dives was condemned not because he mistreated, stole from or exploited anyone but because he allowed Lazarus to become invisible.

We are the greatest, richest and most powerful nation on earth. We have medical care that people from all over the world would access if they could.

“For some populations, being in prison likely provides benefits in regards to access to healthcare and life expectancy,” said study author Dr. David Rosen, from the University of North Carolina at Chapel Hill. (Reuters Health, 2011) In the land of freedom and democracy, why then do our citizens, community members, neighbors, family members and friends suffer for lack of access to healthcare?