Detail | Center for Health Transformation

Racial Health Disparities Exact Moral, Financial Toll on Nation

September 28, 2009

By Thomas A. LaVeist and Darrell J. Gaskin
Originally Published: baltimoresun.com

The health-care reform bills making their way through Congress have focused on improving access to care for millions of uninsured Americans while slowing rapidly rising health-care costs. But there is another side to the health-care crisis that has been mostly neglected.

A study that we performed for the Joint Center for Political and Economic Studies, a Washington-based think tank, found that, between 2003 and 2006, 30.6 percent of medical care expenditures for African-Americans, Asians and Hispanics were excess costs that were the result of inequities in the health of these groups. Between 2003 and 2006, the combined direct and indirect cost of health disparities in the United States was $1.24 trillion (in 2008 inflation-adjusted dollars). This is more than the gross domestic product of India and equates to $309.3 billion annually lost to the economy.

In 2002, the Institute of Medicine released "Unequal Treatment," a comprehensive report that documented extraordinary disparities in the quality of health care received by the various American racial and ethnic groups. Since then, health-care advocacy groups have relied on a compelling social justice argument to press policymakers to direct resources to efforts to address racial and ethnic inequities in health, with the premise that doing so is in keeping with American values.

The social justice argument has mainly garnered support on the political left, but it has also found some friends on the right. Former House Speaker Newt Gingrich wrote in his recent book, "Real Change: From The World That Fails To The World That Works": "A key test for any new system is its ability to provide access to quality care for the poorest and sickest among us. The elimination of health disparities must be a critical goal: No American can be left out." And former President George W. Bush has said, "African American males die sooner than other males do, which means the system is inherently unfair to a certain group of people. And that needs to be fixed."

Of course, President Bush's words were not stated within the context of announcing a new health initiative to "fix" the problem. Rather, he was trying to win support among blacks for his effort to privatize Social Security by noting that African-American men often die prematurely - thus losing out on Social Security benefits - and proposing that families be able to inherit the balance of a deceased worker's Social Security account.

We suspected that there was more to racial health inequities than the moral argument, given the enormous social and psychic costs premature deaths impose on families and communities. The premature death of a working mother or father has negative effects on families that ripple throughout the economy in the form of lost income and wages, forgone taxes, increased need for social and community services and increased need for Social Security survivors' benefits.

There are some who believe that health disparities are due solely to genetic differences among racial groups or irresponsible behaviors among those who suffer higher rates of illness and death. However, this is not true. Health disparities are rooted in environmental and societal factors associated with poverty and discrimination. As the Robert Wood Johnson Foundation put it, health disparities have "more to do with your ZIP code than your genetic code."

The large number of premature deaths among American racial and ethnic minority groups represents a substantial loss of human potential, a loss of talent and productivity that might otherwise have contributed to the betterment of society. By imposing a substantial burden on the economy, health disparities visit suffering on the entire society, not just the minorities who live sicker and die younger.

But while the scope of the challenge in addressing these inequities is large, our research indicates that the same is true for the potential savings. Three hundred billion dollars a year is nothing to sneeze at. And while we continue to believe that the primary reason to act is a moral one, the enormous price tag of doing nothing may well sharpen the focus of all who are engaged in the current health care reform debate.

Usually we think of change as coming with costs, that doing something will cost more than doing what we are accustomed to doing. But in the case of America's unequal health, doing nothing has a cost - moral and fiscal - that our nation should not continue to bear.

Thomas A. LaVeist is the William C. and Nancy F. Richardson Professor in Health Policy and director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health. His e-mail is thomas@laveist.com. Darrell J. Gaskin is associate professor of health economics in the Department of African American Studies at the University of Maryland and a faculty associate at the Hopkins Center for Health Disparities Solutions and the Maryland Population Research Center. His e-mail is dgaskin@aasp.umd.edu.