Racial gap in health appears persistent Studies show stubborn disparity between black and white Americans


WASHINGTON -- A robust economy and years of government pressure have helped move minority groups closer to the mainstream. But when it comes to health, studies show a stubborn, daunting and in some respects growing disparity between black and white Americans.

For decades, blacks have suffered higher death rates from nearly all major causes. Although life expectancy has increased for all groups, differences persist. And government and academic research shows a widening gap between blacks and others in the incidences of asthma, diabetes, major infectious diseases and several forms of cancer.

The national Centers for Disease Control and Prevention reports that from 1980 to 1994, the number of diabetes cases rose 33 percent among blacks, three times the increase among whites. The gap in cases of infectious diseases has grown by the same magnitude.

With breast cancer, the CDC reports that from 1990 to 1995 the death rate for all women fell 10 percent, from 23.1 per 100,000 to 21. But black women's higher rate did not budge from 27.5 per 100,000.

The erosion of black Americans' health in relation to the health of Americans at large stands in stark contrast to blacks' advances in areas such as jobs, education and housing that three decades of civil rights laws have helped promote.

In the economy of the 1990s, poverty among blacks has shrunk, and gaps in income have narrowed. Sociological barriers to economic progress, such as a high teen-age pregnancy rate, have receded, too.

But blacks often receive less, and worse, health care than whites, analysts say, meaning that they are sicker than whites and typically die at about age 70, six or seven years earlier than whites.

"We have a two-tiered health care system," said Dr. Randall Morgan, an orthopedic surgeon and a former president of the predominantly black National Medical Association.

Limited education, violence and addiction remain partly to blame. But Clinton administration officials and analysts of health systems say they are finding growing evidence that race, discrimination and social and cultural factors influence the care people receive and, consequently, their health.

The chief White House adviser on health issues, Chris Jennings, said economic status was a big source of the gap. "But even if you control for that, race is huge," Jennings said. "If you pull out education, race is still huge."

The White House is grappling with new ways to address the problem, most likely in the president's budget proposal early next month.

In response to a White House request, officials of the Department of Health and Human Services and the Health Care Financing Administration said they were compiling proposals to try to eliminate the gap after 2000.

Dr. Donald M. Berwick, a pedia- trician in Boston and a member of President Clinton's commission on health care quality, said: "Tell me someone's race. Tell me their income. And tell me whether they smoke. The answers to those three questions will tell me more about their longevity and health status than any other questions I could possibly ask. There's no genetic blood test that would have anything like that for predictive value."

Pub Date: 1/26/98

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