Survey Finds Black Veterans Come Home to a Fight for Health Care

Hortensia Amaro, Director of Northeastern University's Institute of Urban Health Research, talks to Farai Chideya about new research that shows African American veterans are chronically dissatisfied with the quality of their health care.

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FARAI CHIDEYA, host:

This is NEWS & NOTES. I'm Farai Chideya. It is Thursday, time for our regular talk about health and fitness. In just a few minutes, NPR's Tony Cox and New York Times columnist William C. Rhoden are going to break down the latest sports news.

But first, a surprising new study from the world of health. For more than a century, black troops have served in America's military. But what happens when they come home? Northeastern University's Institute on Urban Health Research found that black vets are rarely happy with their health care. That's despite the fact that veterans, unlike many civilians, have government-provided health insurance. For more, I'm joined by Hortensia Amaro. She directs the institute. Welcome.

Professor HORTENSIA AMARO (Northeastern University's Institute on Urban Health Research): It's nice to be here, thank you.

CHIDEYA: So tell me why you did this study.

Prof. AMARO: We did this study because we were approached by the Triad Veterans Group in Boston. It's a grassroots organization of African-American veterans; and also the city's health department, the Boston Public Health Commission, and they were concerned about experiences that vets were reporting to them about the responsiveness and issues of cultural competencies of providers in the health care system and specifically the VA.

And they were also concerned about the health status of the vets, and we were asked to help - to do a study, to start, as a first step, looking at these issues.

CHIDEYA: So who did you study and how?

Prof. AMARO: We - this was actually a small study of 141 participants that were recruited through community outreach, flyers, radio announcements, TV, local TV, outreach to the local VA organizations, veterans organizations. And it was primarily men, all African-American. To meet - to participate in the study, they have to have received health care in the last year. They were mostly middle aged, about a fifth was married, 62 percent were not working, some were looking for work, and others were disabled. In fact, about 28 percent had a service-related disability. And about 30 had seen combat while they served.

CHIDEYA: Well, what was the most important finding of this study?

Prof. AMARO: I think the most important finding pertains to what they reported to us related to their experiences of discrimination in the process of obtaining health care.

We asked them how much they agreed or disagreed with a statement like, doctors treat veterans of colors and - of color and white veterans with some - with the same amount of respect. And 40 percent of them agreed or strongly agreed with that statement, but the rest didn't agree with the statement. So that suggests to us that a significant number are feeling like they don't get respect.

Also, we asked them - I can recall a situation in which I experienced discrimination when I received my - where I received my health care services, and 52 percent agreed or strongly agreed with that. So again, an indication of experiences of discrimination.

And veterans gave a number of examples, including, you know, they assumed I was a drug addict, they felt that they were made to wait longer than white patients, that they're - when they asked for specialized services, they didn't receive them, that they were not treated with respect, that sometimes providers didn't believe them.

The important thing - clearly not all veterans, African-American veterans -experience that. But I think a significant number did, based on what we found in our sample. And the other important reason why this finding is important is because the experience of discrimination was very importantly associated with lower ratings of patient satisfaction with health care, with lower ratings of — that perceptions from the patients of their quality of health care they received and lower physical health status.

CHIDEYA: Let's - let's dig into that a little bit. Your study says that two-thirds of the veteran - veterans used other health care services besides the VA. Does that mean that they really don't trust the veterans health care plan?

Prof. AMARO: Well, we don't know that. In fact, only 10 percent of the veterans said they - said that they would not consider using the VA. I think it's a little more complicated than that. I think that there is a number who don't use the VA because they have health care coverage through employers, through other sources that may be even more convenient; there's less waiting time; they have more access to certain specialized services.

And then there may be others who really are not using it because of their past experience with discrimination. So I really think this study gives us an indication that there's something going on here and we need to look at it further.

CHIDEYA: Well, let me ask you this. How are these findings going to be used, especially since we are in a time where there are U.S. troops fighting overseas, people coming back injured frequently. What do you hope these findings will be used for?

Prof. AMARO: Well, I - you know, there's been quite a bit of scientific work showing that there is discrimination in health care, that providers aren't aware that they make different - different clinical decisions based on race, but then nevertheless that exists. And what this study is suggesting to us is that of course this also happens in the VA system or with veterans wherever they go.

And so I think that it points to the need again to look at policies to monitor and to address unconscious discrimination and clinical bias in health care, including in the VA, and to address them whether they be through training of staff or regulations that are put into place, performance-based incentives, so that there aren't such biases in the provision of health care and the monitoring of that, and having veterans groups involved in providing input into this kind of oversight.

CHIDEYA: Well, Hortencia, we have to leave it there. Thanks so much.

Prof. AMARO: Thank you.

CHIDEYA: Hortencia Amaro at WGBH in Boston directs from Northeastern's Institute on Urban Health Research. The institute studied black veterans health care.

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