(Mint Press) – In prosperous St. Johns County, Fla., life has never looked so good. Well-tended golf courses filled with youthful retirees, miles of pristine Atlantic Ocean beaches, miles of hiking and biking trails and copious amounts of recreational and fitness options have created a vibrant senior citizen population. The average life expectancy for women there […]
(Mint Press) – In prosperous St. Johns County, Fla., life has never looked so good. Well-tended golf courses filled with youthful retirees, miles of pristine Atlantic Ocean beaches, miles of hiking and biking trails and copious amounts of recreational and fitness options have created a vibrant senior citizen population. The average life expectancy for women there is 83, while males can expect to see 78.
However, in neighboring Putnam County, the good life falls short. Incomes and home values are half what they are in St. Johns County, as reported in the Washington Post. There is less access to the comforts of life here — and with a life expectancy of just over 78 for women and 71 for men — the difference between the two counties is noticeable.
St. Johns is 90.92 percent White with an African-American population of 6.29 percent and a Hispanic population of 2.63 percent. Putnam is 77.91 percent White, with an African-American population of 17.04 percent and a Hispanic population of 5.92 percent.
“Life expectancy has increased mainly among the privileged class,” said Monique Morrissey, an economist who focuses on retirement issues at the Economic Policy Institute, a liberal-leaning research organization. “For many people, raising the retirement age would amount to a significant benefit cut.”
In Washington, politicians debate trimming social entitlement, or life-enhancement programs. This economic connection to longevity displayed in such comparisons between St. Johns and Putnam Counties and throughout the nation raises inescapable questions of the morality of such budgetary cuts. Questions regarding raising the minimum retirement age, cuts to Medicaid and rollbacks on early childhood development have direct implications to the livelihood of the nation’s poorest populations.
“People who are shorter-lived tend to make less, which means that if you raise the retirement age, low-income populations would be subsidizing the lives of higher-income people,” said Maya Rockeymoore, president and chief executive of Global Policy Solutions, a public policy consulting firm. “Whenever I hear a policymaker say people are living longer as a justification for raising the retirement age, I immediately think they don’t understand the research or, worse, they are willfully ignoring what the data say.”
Recently, Republican efforts to repeal the Affordable Care Act (ACA) has been making getting attention, including Rep. Paul Ryan’s (R-Wis.) attempt to strip the ACA of its benefits while keeping its tax payment system to justify provisions in the House Republicans’ budget. For many, ACA represents the possibility of health insurance that would otherwise be impossible. However, some believe that ACA will not be the cure-all many expect.
“Clearly the Affordable Care Act will help a lot of people,” Dr. Marshall Chin, the Richard Parrillo Family Professor of Medicine at the University of Chicago, told TakePart. “More people will have access to care — getting their foot in the door. But once you have your foot in the door, it’s about having the highest quality care possible.” The other part of closing the disparity is providing the best possible resources to those that needs them most.
The problem at hand
There are 43.9 million Americans of African descent living in the United States, constituting 13.6 percent of the U.S. population. According to the U.S. Census Bureau, by 2060, the African-American population will grow to 77.4 million, or 18.4 percent of the total population. Despite the growth of the African-American community (only the Hispanic community is growing at a faster rate), the disparity in health and access of health care between the Black community and other ethnicities is unproportional and alarming.
According to the Centers for Disease Control and Prevention (CDC), the average life expectancy for an American is 78.5 years, but for an African-American, it is only 74.5 years — compared with 78.8 years for the average White American. African-American men and women aged 45 through 74 have the largest death rates from heart disease and stroke compared with any other racial or ethnic population.
For women aged 20 through 39, the prevalence of obesity is greatest among African-Americans. Infant mortality rates for African-Americans are twice that of White Americans. African-Americans aged 15 through 39 are the most likely to be victims of homicide and the HIV (Human Immunodeficiency Virus) infection rate among African-Americans is higher than with any other ethnicity.
Despite the obvious need, the percentage of African-Americans without adequate health insurance is rising. From 1999 to 2010, the percentage of poor — household incomes below the federal poverty limit — African-Americans without health insurance rose 3.6 points, from 16.8 percent to 20.4 percent. For the near-poor — those with household incomes between 100 and 199 percent of the federal poverty level — there was also a spike of 3.6 points from 2002 to 2010, from 15.8 percent to 19.4 percent.
In comparison, only 11.2 percent of all non-Hispanic Whites have no health insurance and 29.4 percent of all Hispanics are uninsured.
An analogy presented by Harvard University to demonstrate the severity of this problem is a jetliner carrying 260 African-Americans crashing every day with no survivors for a year. That roughly represents the mortality rate and financial and psychological toll of the American health care system of the African-American community.
From 2003 to 2006, the economic toll of the health disparity between minority communities and White America amounted to more than $1 trillion, according to a 2009 report by the Joint Center for Political and Economic Studies.
Harvard University recently held a symposium — “Eliminating Health Disparities: Transdisciplinary Perspectives” — on the persistent and stubborn problem of disparity in health between America’s majority and minority populations. “It is a social justice issue,” said symposium panelist David Williams, Norman Professor of Public Health at the Harvard School of Public Health and professor of African and African American Studies and of sociology in Harvard’s Faculty of Arts and Sciences (FAS). “It’s also a drain on the economy.”
Symposium panelists pointed out that issues of health disparity are not new; the abolitionist and journalist W.E.B. Du Bois examined the issue more than 100 years ago. This problem is reflected from the nation’s urban neighborhoods to its Indian reservations. The health disparity issue today is a complex array of racism, economics, public policy, perceptions on poverty, taxation and historical interpretation.
Lack of access to healthy food
The lack of health care, however, is only one reason why health disparity exists. Recently, a state judge struck down New York City’s ban on sugary drinks that are over 16 fluid ounces. New York State Supreme Court Judge Milton Tingling declared that New York Mayor Michael Bloomberg (I-N.Y.) overstepped his authority by issuing a de facto law without the consent of the City Council.
“It would be irresponsible not to try to do everything we can to save lives,” Bloomberg said following the ruling, who earlier that day called for jurisdictions across the nation to follow suit.
Besides the fact that the law was unevenly enforced (it did not apply to grocery stores or convenience stores, so some of the largest drinks available — such as 7-Eleven’s Big Gulp — was unregulated), the law failed to take into consideration the underlying problem.
The reason African-American communities gravitate toward large sugary drinks is simple, actually; it’s the cheapest source of calories available. While African-Americans are currently twice as likely to develop diabetes as their White counterparts, this is not the reflection of poor choices, but limited choices.
Many minorities live in a “food desert,” or an area where healthy food is not easily available. What this means is that a green grocer or a supermarket is not within walking distance — within a radius of a mile. While there may be small stores or bodegas available, these stores tend to stock processed foods and rarely have fresh fruits and vegetables. Even in areas where there is a rarity of produce, people will not simply settle for what is available, and would do without instead of settling for wilting or poor-quality product.
“Simply providing fruits and vegetables may not be enough if [they] don’t meet the expectations of those people who are supposed to buy them,” said Jonathan Blitstein, a research psychologist at Research Triangle Institute.
As stated in the National Center for Public Research’s website “Food Desert:” “Mainstream grocery stores are more likely to carry a wide range of food and fresh produce than smaller stores. NCLR [National Council of La Raza] reports that Hispanic neighborhoods are about one-third less likely to have a chain supermarket. For obtaining healthy foods, reliable transportation is important. Low-income families relying on public transportation may be limited in the quantity and quality of foods they can purchase, especially fresh produce.”
Another problem is the cost of food. As the United States Department of Agriculture (USDA) has pointed out, when comparing serving size, unprocessed foods are cheaper than processed foods, and when compared by caloric count, unhealthy food is significantly less expensive.
The University of Washington examined the prices of 370 supermarket-sold foods in the Seattle area. As reported in the New York Times, “The survey found that higher-calorie, energy-dense foods are the better bargain for cash-strapped shoppers. Energy-dense munchies cost on average $1.76 per 1,000 calories, compared with $18.16 per 1,000 calories for low-energy but nutritious foods. The survey also showed that low-calorie foods were more likely to increase in price, surging 19.5 percent over the two-year study period. High-calorie foods remained a relative bargain, dropping in price by 1.8 percent.”
According to this study, a 2,000-calorie diet would cost just $3.52 per day if it consisted of junk food and $36.32 a day if it consisted of low energy-dense foods. As most people eat a mix of processed and unprocessed foods, an average American spends about $7 a day on food, while low-income individuals spend about $4.
“If you have $3 to feed yourself, your choices gravitate toward foods which give you the most calories per dollar,’’ said Dr. Adam Drewnowski, lead author for the study. “Not only are the empty calories cheaper, but the healthy foods are becoming more and more expensive. Vegetables and fruits are rapidly becoming luxury goods.”
The Affordable Care Act and the health care gap
For the most part, it is too early to guess if the Affordable Care Act (ACA) will have a significant effect of the health disparity. The federal government has taken the position that an increase in the number of individuals that will have basic medical insurance will help to decrease the health disparity.
In a June 2011 Health & Human Services (HHS) press release, HHS Secretary Kathleen Sebelius points out the benefit improved data collection under ACA will provide. “Health disparities have persistent and costly effects for minority communities, and the whole country,” Sebelius said.
“Today we are taking critical steps toward ensuring the collection of useful national data on minority groups, including for the first time, LGBT populations. The data we will eventually collect in these efforts will serve as powerful tools and help us in our fight to end health disparities.”
“The first step is to make sure we are asking the right questions,” Sebelius continued. “Sound data collection takes careful planning to ensure that accurate and actionable data is being recorded.”
In a 2010 factsheet, HHS pointed out that ACA will help end insurance discrimination, expand affordability for insurance coverage, increase funding for under-served communities and strengthen cultural competency training for all health care providers. The Center for American Progress also pointed out that the ACA will eliminate “gender rating,” or the practice in which insurers legally charge women more than men for identical policies, and will promote funding for community health centers.
However, this will not close completely the disparity in health between majority and minority populations. The solution toward accomplishing this will require investment of effort and capital in areas other than insurance.
This includes hiring more doctors and nurses to service underrepresented areas, more funding to expand services for minority-serving health care providers, an improved transportation network for those that cannot drive and ready access to quality, inexpensive foodstuffs.
“You don’t want to just put in a program and say, ‘OK, we’re addressing disparities,'” Chin said. “The idea is to raise the quality of health care provided across the board. How can we make sure that care is delivered in the best possible way for everyone?”
However, ACA is seen as a step in the right direction. “We see high rates of diabetes in our patients and for the African-American community as a whole, we know this is an issue,” said Lauren Astor, director of public affairs for AltaNet, a network of nonprofit community centers serving the Southern California’s minority communities. “Being able to manage diabetes so that patients aren’t ending up in hospitals, or needing advanced care will be a great benefit. So we think this [ACA] is a great start to bring the disparities in treatment for minority communities.”
“Another item is the relationships that primary care sites are making with local hospitals,” Astor continued. “The care coordination is something that has been lacking for poor and uninsured individuals. Now that more people will have health care, the primary care providers and case managers will be tracking hospital stays, after care, etc. to ensure the patients are getting the wrap around care they need. Is this the best approach to raising community health? That’s hard to say, we still see some big gaps that can be addressed. However, it is the most significant step we’ve seen in the industry and we believe it will go a very long way to making change for poor communities.”