HR managers mistakenly think minority workers' health care is fine

By Alaina Sue Potrikus
Knight Ridder Newspapers


WASHINGTON - Most benefit managers at big U.S. companies think minority workers fare as well as white workers when it comes to health-care services - despite strong evidence to the contrary - according to a survey released Wednesday. 

The survey's sponsor, the Washington Business Group on Health, wants companies to include in their health-care options providers that hire minority doctors, speak Spanish and recognize that some minority health concerns rate special attention. 

Bad fits between minority patients and providers may be a factor in health-care disparities among racial and ethnic groups, according to the health group. Consisting mainly of Fortune 500 companies and large public-sector employers, the group represents the interests of large employers on health-care issues. 

Among disparities the group cites: 

-American Indian, Latina and Asian women are less likely than non-Hispanic white women to be screened for breast and cervical cancer 

-Latino and African-American men are less likely than non-Hispanic whites to be screened for prostate cancer and, when prostate cancer is diagnosed, more likely to be at a later and riskier stage of the disease. 

-African Americans are two to four times as likely as whites to have strokes. 

Even when they have the same health insurance coverage and disease of equal severity: 

-Latinos and African Americans are less likely than non-Hispanic whites to undergo cardiac catheterization, angioplasty and bypass surgery to treat heart disease. 

-African Americans are less likely than whites to have asthma-related health conditions treated before they require hospitalization. 

"Patients in minority communities arrive at doctors late in terms of disease prevention," said Dr. Brian Smedley of the Institute of Medicine, an arm of the National Academy of Sciences. "The increased costs and premiums impact everyone's pockets - not to mention the human toll." 

The Washington Business Group on Health didn't offer any explanations for the disparities. 

The group suggests that minority workers let company benefit managers know when their health-care providers don't speak Spanish, fail to provide translators or make minority patients feel belittled. The counsel comes as millions of employees nationwide prepare to annually re-enlist in or switch health-care plans. 

One obstacle to better health care for minority workers, the business group's survey suggests, is often a company benefit official. 

More than half of 1,505 who responded said they'd never considered whether they were providing services or measures to ensure quality health care for racial and ethnic minorities. 

In addition: 

-Seven out of 10 said they thought minorities were as likely as whites to get appropriate care for heart disease and cancer - two chronic conditions in which the disparities are especially well documented. 

-Eight out of 10 said they'd never asked minority workers if the quality of their health care had suffered because of their race. 

-Nonetheless, nearly half said disparities in minority health weren't a problem for their employees. 

The survey, conducted in August and September by Princeton Survey Research Associates, was a random sampling of 7,500 U.S. firms that employ more than 1,000 workers. Four out of five benefit managers who responded were non-Hispanic whites and three-quarters were women. The survey has a margin of error of plus or minus 3 percentage points. 

Some companies, Texas Instruments of Dallas among them, are treating minority health disparities by offering disease-prevention seminars for high-risk employees. 

"If employees are not referred for the appropriate testing at the appropriate time, we will pay more for that," said Lola Chriss, a benefits manager for Texas Instruments. 

The Kellogg Co., of Battle Creek, Mich., offers its 25,000 employees bilingual health seminars on diabetes and hypertension, illnesses for which minorities have been deemed at particularly high risk. 
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For more information about the Washington Business Group on Health's "Reducing Racial and Ethnic Disparities" project, go to www.wbgh.com and click on "Health Disparities project." Companies that want to learn more about handling disparities in minority health care can phone the group for helpful materials at 202-628-9320. 

White Men Survive Prostate Cancer Longer 

Carl Gilbert, M.D.

Nov. 18, 2003.- Black men do not survive as long as white men after treatment for localized prostate cancer according to a new study done by researchers at the University of North Carolina at Chapel Hill.

The researchers reviewed the records of 5,747 black men and 38,242 white men who had been treated for prostate cancer that had not spread (localized cancer). Their review showed that the median survival time for black men was 1.7 years less than the survival time for white men. For those treated by surgery, the difference was greater: black prostate surgery patients lived an average of 10.8 years while white patients survived 12.6 years

The reasons for the difference were not obvious to the researchers. Specialized radiation therapy is the preferred treatment for localized prostate cancer. Black may have less access to this form of treatment, or there may be biologic factors causing that difference, the study suggested. More investigations are needed to clarify this disparity.

Dr. Paul A. Godley of the Lineberger Comprehensive Cancer Center at the University of North Carolina was head of a team that conducted the research. 

Incidence of Invasive Cervical Cancer higher in Hispanic Women -CDC Reports

By Carl Gilbert, M.D.

According to a CDC report published recently from Atlanta (USA),  cervical cancer incidence for Hispanic women is approximately twice that for non-Hispanic women.

CDC analyzed incidence data for Hispanic and non-Hispanic women during 1992--1999 in 11 geographic areas.  The analysis indicates that the numbers of invasive cervical cancer decreased for Hispanic and non-Hispanic women. However,  the incidence of invasive cervical cancer was 16.9 per 100,000 women  for Hispanic women 30 and older, compared with 8.9  for non-Hispanic women.

During 1973--1999, both the incidence of and death rates for cervical cancer decreased approximately 50% in the United States.  In the U.S., for 2002, approximately 13,000 new cases of invasive cervical cancer are expected, and approximately 4,100 women will die from the disease.  Although invasive cervical cancer can be prevented by regular screening, the prevalence of Papanicolaou (Pap) testing remains relatively low among minority populations such as Hispanic women. 

It is believed that these women sometimes lack easy access to screening tests because of their age, low education, low income and lack of health insurance. 

In an editorial note accompanying this report, the authors state  that "nonuse of other screening tests  and unrecognized social-cultural factors also might play a role. Research is needed to better understand barriers to screening practices." They add that to decrease incidence of advanced-stage cervical cancer, public health programs should target women with culturally appropriate interventions that encourage screening, especially for Hispanic women aged 30 and older and non-Hispanic women 50 and older.  For women with abnormal Pap test results, appropriate diagnostic and treatment services also should be accessible.

The screening tests are recommended every three years for women who are sexually active. Cervical cancer is virtually always caused by the human papilloma virus, which is transmitted sexually.

Source: CDC

Suggested Links: - http://www.cdc.gov/cancer/nbccedp/info-cc.htm;  Intercultural Cancer Council (ICC)

Reports Show that Minorities in U.S. Receive Lower Quality-Health Care than Whites

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - Blacks, Hispanics and other minorities in the United States tend to get lower quality health care than whites, even when income, age and whether they have insurance is factored in, a report said on [March 20, 2002].

Minorities often pay for this with their lives, according to the report by the Institute of Medicine (news - web sites) which was commissioned by Congress.

"Stereotyping, biases and uncertainty on the part of health-care providers can all contribute to unequal treatment," it said.

"Relative to whites, African-Americans -- and in some cases Hispanics -- are less likely to receive appropriate cardiac medication or to undergo coronary artery bypass surgery, are less likely to receive hemodialysis and kidney transplantation and are likely to receive a lower quality of basic clinical services," the report said, citing several studies.

"Significantly, these differences are associated with greater mortality among African-American patients."

The report, written by 15 experts and reviewed by a panel of 11 experts, also found minorities get less-than-optimal treatment for HIV (news - web sites) and AIDS (news - web sites), now the eighth leading cause of death in the United States.

The panel's chairman, Dr. Alan Nelson, a retired physician and adviser to the American College of Physicians-American Society of Internal Medicine, said it was time to do something about the problem.

"The real challenge lies not in debating whether disparities exist, because the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them," Nelson said in a statement.

The report recommended first that health-care providers, the public and insurers be made aware of the disparities. It cited surveys showing most Americans believe minorities get the same quality of health care as white Americans do.

"A few studies have found that minority patients refuse recommended treatments more often than whites," the Institute, one of the National Academies of Sciences, said.

But it found that differences in refusal rates were small and did not fully account for racial and ethnic disparities. Overuse by white patients of some services did not explain the disparities either.

The report also recommended the federal government step up support and funding of the Office of Civil Rights in the Department of Health and Human Services (news - web sites). "The agency is charged with enforcing laws that prohibit discrimination in health care, but in recent years funding has been insufficient to adequately investigate complaints," it said.

Allabh Ed. Note:  This report is among several others which raised  concern about a virtual two-tier health care delivery in the U.S. when the overall care of  black patients care is compared with whites patients.  It is true that some hidden factors may contribute to those disparities.  But when study after study tends to show that black patients may be under-treated in some health institutions on many occasions, one is forced to wonder whether "racial profiling" is not a reality in the American health care system.  In that context, Rodney G. Hood, M.D., former president of The National Medical Association --which represents the interests of the African-American physicians and patients -- said, according to the Medical Herald (Issue 13, No.3), that "The National Medical Association is concerned that historic and current health information points to a modern-day form of health care racial profiling that must be addressed if we are to achieve parity in health care..."