Public Health Week: The Skin You're In
The Titanic carried enough lifeboats for just 53 percent of its passengers — a fact that public health researcher Thomas LaVeist translates into today's public health terms.
"Space in a lifeboat was a scarce resource," he says. "And when resources are scarce, who you are determines who gets access." LaVeist says the Titanic is the perfect metaphor for the American health care system, because whether passengers survived or drowned in the 1912 Titanic disaster depended on whether they were traveling first class or steerage.
"Women and children first" was the official triage rule for space in the Titanic's lifeboats. But another factor — class — helped determine the life-or-death outcome, says LaVeist, who is the director of the Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health in Baltimore. As part of Oregon Public Health Week, his talk in Portland was titled It's the Skin You're In: Why African Americans Live Sicker and Die Younger.
African Americans are more than three times as likely as white Americans to have a leg amputated because of complications from diabetes. They are more than four times as likely to have to undergo dialysis for end-stage kidney failure. But an African American is much less likely to receive a coronary angiography — a key diagnostic tool for heart disease.
Racial disparities in health care for conditions such as diabetes, obesity and high blood pressure are found even among fully insured patients — and they cut across all education levels.
"This is ultimately about death — people dying sooner than they ought to die," says Tricia Tillman, administrator of Oregon's Office of Multicultural Health and Services. If African Americans died at the same rate as white Americans, there would be 84,000 fewer African American deaths each year.
Oregon's Action Plan for Health, created with statewide public input, guides the ongoing effort to bring affordable, high-quality health care to all Oregonians.
Oregon's Action Plan for health lays out the plan for better health, better care and lower costs for all Oregonians. Improving health equity is a foundation of this plan. It calls for reducing barriers — including racial and cultural barriers — to health care. A key step calls on the state to recruit and retain a workforce that is racially and ethnically diverse and culturally competent. Another step calls for using community health workers as members of the primary care team. Doing more to collect and analyze data with health systems, community groups, and consumers will help in better understanding quality and health outcomes.
The disparity is not simply medical, LaVeist agrees. Its sources are cultural, environmental, social and behavioral. The underlying problem is not genes or race, but the way a still-unequal society places people at risk unequally.
While health varies sharply with skin color, "the disparity is not in the skin," he emphasizes. "It's produced by what we make of the skin — that meaning we place on it."