Black Labor Summit Examines Health Care Disparities, Other Topics

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November 11, 1999

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By Ken Gewertz
Gazette Staff

Amputations are performed twice as often on black diabetics as on their white counterparts, according to Curtis Dance, health policy analyst for the American Federation of State, County, and Municipal Employees (AFSCME).

Dance blamed the disparity on the fact that, on average, black patients are not able to take advantage of therapies that would preempt such radical treatments. He said that the problem is part of a general pattern characterizing health care among African Americans.

"In my opinion, racism plays an important role in disparities in health care," Dance said.

Dance was one of the participants in a forum Friday, Nov. 5, on "Reforming Health Care in the U.S.: Politics, Economics and the Prospects for Change." The forum was part of the African American Labor Leaders Economic Summit, which was hosted by Harvard, Nov. 4-6.

Now in its second year, the summit is jointly sponsored by the Coalition of Black Trade Unionists, the Harvard Trade Union Program, the Taubman Center for State and Local Government, the Afro-American Studies Department, and the A. Philip Randolph Institute, with support from the Ford Foundation and the Jerry Wurf Memorial Fund.

The conference brought together 40 of the nation’s leading black labor leaders for an exchange of ideas with academics and policy experts. Major topics for discussion at this year’s summit were the criminal justice system, health care reform, and tax policy.

"These are all issues that have an impact on the black community, but they are also important policy issues for the country as a whole," said Elaine Bernard, executive director of the Harvard Trade Union Program.

The summit was designed, she added, to promote dialogue between labor leaders and academics as well as to establish networks.

"It’s beneficial for the labor leaders to be exposed to the academic perspective, but it’s also good for Harvard. This is an audience that the academics don’t usually have a chance to address," she said.

At the forum on health care reform, Dance went on to list other data that indicate blacks and whites receive unequal care. Blacks, he said, are less likely to receive surgery for lung cancer, black males under 65 are twice as likely to die from heart disease, and life expectancy for blacks is nearly 10 years less than for whites.

One factor in this disparity is that black patients tend not to trust white doctors, he said. Many blacks still remember the federally sponsored Tuskeegee Study (1932-1972) in which more than 400 black men suffering from syphilis were deliberately left untreated in order to observe the progress of the disease.

"The Tuskeegee Study still resonates among many blacks," Dance said.

Added to this element of mistrust is the fact that only 4 percent of doctors are black, a percentage that Dance believes will diminish as a result of attacks on affirmative action.

Laws, such as California’s Proposition 209, which outlaw race as a factor in admission to college, must be reversed, he said, to "ensure the survival of black physicians into the next century. The health of millions is at stake."

Stephanie Woolhandler, associate professor of medicine at Harvard Medical School, criticized for-profit managed care companies and blamed American society for leaving 44.3 million people without health coverage.

For-profit managed care companies, which account for most of the growth in the managed care industry, are "an instrument through which Wall Street is gaining control of the medical system," she said.

These companies also tend to discourage patients with expensive and complex conditions, she said.

"Sick patients become pariahs because they are money losers," she added.

Woolhandler noted that every other advanced nation provides its population with universal health coverage, and yet the United States, which leaves millions of people without coverage, somehow manages to spend 40 percent more per capita on health care than any other nation.

"We’re already paying the price for universal health care, but we’re not getting it," she said.

Professor of Economics David Cutler, who worked on Hillary Clinton’s task force on health care reform, said he believed there were more factors contributing to health disparities between blacks and whites than medical care.

"There are factors such as increased stress, poor diet, smoking, violence, and a whole host of social reasons. We should think about health, not just medicine," he said.

Cutler said that even people who have good health coverage receive too little care because there is no one to help them make difficult medical choices.

"They wind up managing their own health care in ways that are bad for them," he said, leading to such problems as adverse drug interactions.

"The system is not good at allocating resources. Just giving people insurance is not enough," he said.

Stephen Thomas, a professor of public health at Emory University, took up the theme of the Tuskeegee Study and its impact on black attitudes toward medicine. After showing a report by the television show Primetime on the study, Thomas commented, "The legacy of Tuskeegee is real. It is part of the collective memory. It’s become a code word, a metaphor for racism in the context of research."

Thomas said that the Tuskeegee Study and the suspicion it has aroused is a factor contributing to blacks’ reluctance to come for treatment and to take medicines prescribed for them.

In order to close the gap between health care for blacks and whites, Thomas urged support of HR 2391, a bill that would set up a National Center on Domestic Health Disparities.

"We must turn this legacy into a new beginning and mobilize all Americans to close the health status gap," he said.