Minority Women Lag In Health Care Access

MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

Coming up, why are so many Americans going bankrupt? It's not credit cards, it's not overspending - it's medical costs, even when they have health insurance. We'll talk more about this in just a few minutes. But first, another look at the charges facing our health care system. Yesterday, the White House held a meeting to talk about the gap in health care services between those available to the insured and the uninsured.

Today, a new study takes a look at another disparity. The Kaiser Family Foundation report reveals that across America, people of color, especially women in every state continue to fare worse than whites on a variety of measures of health and health care access. We wanted to talk more about this, so we called Cara James. She is the senior policy analyst for the Race, Ethnicity and Health Care Group and co-author of the study. Also with us is the former Secretary of Health and Human Services, the founding dean and the first president of the Morehouse School of Medicine, Dr. Louis Sullivan. Thank you both so much for speaking with us.

Ms. CARA JAMES (Race, Ethnicity and Health Care Group): Thank you for having us.

Dr. LOUIS SULLIVAN (Morehouse School of Medicine): Thank you.

MARTIN: Cara, in a nutshell, what's unique about this study is that it looks at every single state. What are the disparities that stand out?

Ms. JAMES: There are quite a few disparities that stand out. But probably the indicator that we had that had the largest disparity was that of new AIDS cases among women of color. And we found that with that indicator, the new AIDS cases among women of color was at a rate that was 11 times higher than that of white women. We also found disparities within people who have no health insurance and the rate for women of color was more than twice that of white women. As well as looking at some of the social factors that influence health and its access to care, such as not having a high school diploma. And there we found that the rate for women of color was more than three times that of white women.

MARTIN: You found that there are disparities that attached to specific ethnic groups in specific areas, you mentioned HIV/AIDS. What about obesity?

Ms. JAMES: So, obesity is another indicator in which we found large disparities among women of color. And specifically, some of the rates among Native American women were among the highest, as well as those for African-American women.

MARTIN: And you also found out that Asian-American women had some specific challenges. For example, their rate of cervical cancer, specific cancers was higher than the rate for other ethnic groups. Why would that be?

Ms. JAMES: Well, it wasn't actually that the rate of those cancers that we looked at. We had our cancer mortality indicator. Broadly speaking that covered all mortalities. But what we found for Asian-American women and Native Hawaiian and Pacific Islanders related to mammograms and Pap tests. And that they were least likely to get those screenings, which, you know, would detect those cancers.

MARTIN: And obviously, Cara, this is a very detailed report. But are the driving issues here lack of access to health insurance, or are there behavioral factors that are most relevant in these disparities?

Ms. JAMES: Yeah, I think that this, you know, report is - it is very complex in its amount of data that is there, but it also reflects the complexity of the disparities picture as a whole. And that there are a host of factors that include the health care delivery system. And what's available to women to access care, as well as some of the social factors that influence their ability to take advantage of the health care available to them, the neighborhoods in which they live, the healthy food choices, whether or not they are able to exercise influences their ability to make those healthy choices.

MARTIN: Dr. Sullivan, you've been working in this area for years. You actually started talking about health disparities, sort of 20 years ago. Are you surprised to see that these disparities are as pronounced as they are today?

Dr. SULLIVAN: No, I am not surprised. But I think the study puts us a further down the road in understanding the reality of what is going on. I think this study illustrates that health is something that touches everything and that it is influenced by everything. Level of education, health insurance, the behavior of individuals, their diets. And it also means that health is something that is influenced not only by national policy, the federal government but also by state and local governments, as well.

And what it really means is that to improve the health of our citizens overall, as well as to close these disparities in health status will require a number of actions from a number of fronts. The federal government and local governments have a role but also the private sector as well. Are employers providing health insurance for their employees? So what this means is, everyone should be vested in working to improve the health of our citizens and access to health care because everyone benefits.

MARTIN: Well, why aren't they though? I mean, it would seem to be intuitively obvious that the country would benefit if significant portions of the population were healthier.

Dr. SULLIVAN: Well I think…

MARTIN: That doesn't seem to be happening.

Dr. SULLIVAN: No, I think it really has been a situation where everyone has thought it's someone else's responsibility. It's the federal government's responsibility, or it's the individual's responsibility. The answer is, it is both. All of us have to be involved. I've often stated that improved health depends upon, first of all, having a health system that works. That means having the health professionals we need, having health insurance that we need, having the facilities, continuing with our development of technology.

But that by itself is not enough. We have to have the individuals working to protect and enhance their own health, such things as smoking. It's been really more than 40 years since the first surgeon general's report about smoking. Half of Americans smoked in 1964 but today with all the information that we know about the adverse health consequences of tobacco use, still one-fifth of our citizens still smoke. Now there's not a pill, there's not a health system that's going to address that. The individuals must understand that this is a health disadvantage that is resulting from their own health behaviors.

MARTIN: And Dr. Sullivan, can I just ask you about something, since you - you were very involved in this whole question of training the next generation of medical professionals. What about this whole question about the cultural competency of the medical profession? Is it part of an issue that the sort of medical establishment doesn't know how to talk to patients of different backgrounds about these health issues in a way that they can understand?

Dr. SULLIVAN: That is very important. Yes, cultural competency really is involved because I have often stated that really the health professions are science-based professions, whose activities are carried out in a social context. And by that I mean, we have to have well-trained individuals - the right number doing the right kinds of things. But they also have to understand the customs, the language, the value systems of their patients, so they can develop effective communication and can develop trust.

One of the problems we have is compliance of patients with their physicians or nurses' orders. Oftentimes, that's because they don't understand them or they don't trust them. So that's where cultural competence comes in. It means the health transaction is both scientifically based but also sociologically influenced.

MARTIN: If you're just tuning in, this is TELL ME MORE from NPR News. We're talking about new reports that talked about the disparities in health among different ethnic and - along ethnic and gender lines. And our guests are the former Secretary of Health and Human Services, Dr. Louis Sullivan, and Cara James, a health policy expert with the Kaiser Family Foundation. She recently was a co-author of a report examining these health disparities, particularly among women on a state by state basis. So Cara, the question to you then, what would be most powerful in addressing these disparities?

Ms. JAMES: Well, I think, you know, the hope with this report is that it articulates the differences that do happen across states. And so we hope that states will take a look at this, see where they are having the most challenges and attempt to address those. Dr. Sullivan mentioned the delivery system and its ability to care for the women who're coming into that. But we also see that there are implications with regards to women's health in general. And as we look at some of the disparities for all women regardless of race, we see that even in indicators where we have put efforts with regards to mammogram screenings and some coverage, we still have rates that are high for all women, regardless of race.

MARTIN: Cara, have you observed - forgive me if you're not prepared for this question. But where - are there areas in which the disparities are narrowest? Are there some states that have succeeded in narrowing this - these disparities. And have you figured out why that might be so? Why are some states more successful than others in narrowing the health gap, as it were, between minorities and low income people and others?

Ms. JAMES: So this study was not a trend study to look over time at whether or not people have been able to narrow gaps. But we did find that there are states that did have better than average performance across access and health status and the social determinants. And some of those states included some that surround our nation capital, including Virginia and Maryland, as well as Georgia and Hawaii.

And they were states that were better than average across all three indicators. And clearly as a next step we would want to investigate more whether or not some of these payments and policies that we've looked at the state level influence those outcomes with regards to health and access.

MARTIN: But we're not sure why that is? Why are - what - you're not sure what the critical factor is and why…

Ms. JAMES: Not at this point.

MARTIN: …the state can overcome these gaps that are so present? And you do make the point of saying that these gaps are present in every state, but you're not sure why they're narrower in some places than others.

Ms. JAMES: Not at this point, no, and I mean there are host of factors that play into this, as Dr. Sullivan and I have also articulated, that it's the social environment, it's the health-care system, it's the personal behaviors, it's the, you know, influence of the environment and the toxins, and some of the policies we would hope make a difference in state policies with regards to eligibility for Medicaid clearly influenced who is eligible to access the health-care system.

Some states are more generous in their coverage for, you know, pregnant women or working parents, and that has a difference.

MARTIN: So there's a lot more to find out, I guess.

Ms. JAMES: Indeed.

MARTIN: Cara James is a senior policy analyst for the Race, Ethnicity and Health Care Group and the director of the Barbara Jordan Health Policy Scholars Program at the Henry J. Kaiser Family Foundation. She joined us from the offices of Kaiser here in Washington.

And Dr. Louis Sullivan is chairman of the Sullivan Alliance to Transform America's Health Professions. He's a former secretary of Health and Human Services and he was kind enough to join us in our studios in Washington, D.C. Thank you both so much for speaking with us.

Ms. JAMES: Thank you.

Dr. SULLIVAN: Thank you.

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