Minority Populations and Health

An Introduction to Health Disparities in the United States

Thomas A. LaVeist

• Publisher: Jossey-Bass
• Year: 2011
• ISBN:
  9781118046524
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

"The text is state-of-the-art in its analysis of health disparities from both domestic and international perspectives. Minority Populations and Health: An Introduction to Health Disparities in the United States is a welcome addition to the field because it widens access to the complex issues underlying the health disparities problem. "-- Preventing Chronic Disease/CDC, October 2005

"This is a very comprehensive, evidence-based book dealing with the health disparities that plague the United States. This is a welcome and valuable addition to the field of health care for minority groups in the United States."-- Doody's Publishers Bulletin, August 2005

"Health isn't color-blind. Racial minorities disproportionately suffer from some diseases, but experts say race alone doesn't completely account for the disparities. Newsweek's Jennifer Barrett Ozols spoke with Thomas LaVeist, director of the Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health and author of the upcoming book, "Minority Populations and Health: An Introduction to Health Disparities in the U.S." ( Jossey-Bass ) about race and medicine. "-- MSNBC/Newsweek interview with author Thomas L. LaVeist, February 2005

"The book is readable and organized to be quickly read with specifics readily retrievable. It is comprehensive and visual."-- Journal of the American Medical Association, September 2005

Minority Populations and Health is a textbook that offers a complete foundation in the core issues and theoretical frameworks for the development of policy and interventions to address race disparities in health-related outcomes. This book covers U.S. health and social policy, the role of race and ethnicity in health research, social factors contributing to mortality, longevity and life expectancy, quantitative and demographic analysis and access, and utilization of health services. Instructors material available at http://www.minorityhealth.com

CHAPTER ONE

HISTORICAL ASPECTS OF RACE/ETHNICITY AND HEALTH

The history of the relationship between the U.S. government and racial/ethnic minorities plays an important role in understanding why health disparities exist and how they might be eliminated. In this introduction I will provide a brief overview of the history that has led to the contemporary state of health disparities. I will then discuss likely future trends and why the study of minority health is important. I will then end the chapter with a discussion of decisions made in deciding the terminology that will be used to refer to the various racial/ethnic groups to be discussed in this book.

Historical Background

Figure 1.1 summarizes the status of African Americans throughout the history of the United States. The exact date the first Africans arrived in the country is in dispute. Some historians place this as early as Columbus’s first voyage, but the most commonly cited date is August 1619 (Quarles, 1987). From that point until President Lincoln issued the Emancipation Proclamation in 1863 (freeing the Africans who lived in the states that had seceded from the country, but not those in states that were not part of the confederacy), the country’s African population was primarily slaves, although in every state there were some who were not slaves. The period of slavery lasted 244 years—63.4 percent of the time between 1619 and 2004.

FIGURE 1.1. CHANGING STATUS OF AFRICAN AMERICANS IN U.S. HISTORY, 1619-2004.

BOX 1.1. THIRTEENTH, FOURTEENTH, AND FIFTEENTH AMENDMENTS TO THE U.S. CONSTITUTION.

The Thirteenth Amendment, ratified in 1865, outlawed slavery in the United States and all territories.

The Fourteenth Amendment, ratified in 1868, gave citizenship to all persons born in the U.S. or naturalized.

The Fifteenth Amendment, ratified in 1870, barred states from prohibiting any male citizen from voting. All females received the right to vote with the ratification of the Nineteenth Amendment in 1920.

The end of slavery throughout the country came when the Thirteenth Amendment to the U.S. Constitution was ratified in 1865. This also began the Reconstruction era and the “Jim Crow” period, in which the black codes relegated racial and ethnic minorities to second-class citizenship. These state laws limited or even prohibited racial minorities from exercising voting rights, reducing them to receiving substandard health care and education (Quarles, 1987; Smith, 1999).

In the early twentieth century, separate health care facilities for African Americans began to be developed, mainly by churches. Medical schools for Black doctors were created because most existing medical schools would not admit African Americans. These medical schools and Black hospitals were not as well funded as their segregated counterparts. When African Americans did have interactions with the White medical system (typically in segregated wards), the discourteous nature of the interpersonal communications during these medical encounters produced inequalities in medical treatment. These factors, along with other historical events such as the Tuskegee Syphilis Study, led to racial and ethnic disparities in the access to and utilization of health services and to distrust of the medical care system among racial and ethnic minorities.

In many ways the history of African Americans parallels the history of Native Americans. The arrival of the European settlers in the New World led to the introduction of diseases not native to the continent (such as measles and yellow fever). Disease outbreaks along with war led to the decimation of the Native American population. The importation of Africans to serve as free labor introduced a new group who, along with Native Americans, were barred from access to state-of-the-art health care, clean water, and good quality housing. In 1830, thirty-three years before the Emancipation Proclamation, the United States Congress passed the Indian Removal Act, which was signed into law by President Andrew Jackson. The act ushered in a period of forcible removal of the so-called five Civilized Tribes and their relocation (referred to as the Trail of Tears) to reservations in the Oklahoma territory.

BOX 1.2. THE FIVE CIVILIZED TRIBES.

The Civilized Tribes were the five American Indian tribes living in the southeastern United States before forced relocation. They were among the first tribes to encounter European settlers. Over time the settlers and tribe members intermarried. By the early 1800s, these tribes had established businesses and their own constitutions, codes of law, and judicial systems. The Civilized Tribes are

Cherokee (Muskogee Confederation): Georgia
Seminole: Florida
Creek: Alabama and Georgia
Chickisaw: Mississippi
Choctaw: Mississippi

BOX 1.3. BLACK MEDICAL SCHOOLS.

Today there are four historically Black medical schools: Howard University College of Medicine in Washington, D.C.; Meherry Medical College in Nashville, Tennessee; Charles R. Drew University of Medicine and Science in Los Angeles, California; and Morehouse School of Medicine in Atlanta, Georgia.

BOX 1.4. THE TUSKEGEE SYPHILIS STUDY.

The Tuskegee Syphilis Study, carried out in Macon County, Alabama, from 1932 to 1972, is an example of medical research gone wrong. The United States Public Health Service, in trying to learn more about syphilis and justify treatment programs for blacks, withheld adequate treatment from a group of poor black men who had the disease, causing needless pain and suffering for the men and their loved ones....

The study involved 600 black men—399 with syphilis and 201 who did not have the disease. Researchers told the men they were being treated for “bad blood,” a local term used to describe several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years....

In the summer of 1973, a class-action lawsuit filed by the National Association for the Advancement of Colored People (NAACP) ended in a settlement that gave more than $9 million to the study participants. As part of the settlement, the U.S. government promised to give free medical and burial services to all living participants. The Tuskegee Health Benefit Program was established to provide these services. It also gave health services for wives, widows, and children who had been infected because of the study.

Source: Centers for Disease Control and Prevention, ″CDC Tuskegee Syphilis Study Page,” http://www.cdc.gov/nchstp/od/tuskegee/index.html.

BOX 1.5. THE CIVIL RIGHTS AND VOTING RIGHTS ACTS.

The Civil Rights Act of 1964 prohibited discrimination in public accommodations such as mass transportation, restaurants, and hotels on the basis of race, color, religion, or national origin.

The Voting Rights Act of 1965 eliminated discriminatory election practices. Specifically, it suspended literacy tests and provided for the appointment of federal examiners (with the power to register qualified citizens to vote) in those jurisdictions that were “covered,” according to a formula provided in the statute.

In addition, under Section 5 of the Act, covered jurisdictions were required to obtain “preclearance” for new voting practices and procedures from either the District Court for the District of Columbia or the United States Attorney General. Section 2 of the Act, which closely followed the language of the Fifteenth Amendment, applied a nationwide prohibition of denial or abridgment of the right to vote on account of race or color.

Treaties between the U.S. government and the various American Indian tribes typically promised education and health care. The responsibility for provision of health care was left to the U.S. Army, which was neither equipped nor provided the resources necessary to provide adequate care. Later the U.S. government established the Bureau of Indian Affairs (BIA), which assumed responsibility for providing health care to the American Indian population. The establishment of the Indian Health Service in 1955 led to the creation of a federal agency whose primary mission was the provision of health care to Native Americans. That same year, Rosa Parks’s refusal to give up her seat on a Montgomery, Alabama, bus sparking the bus boycott that ignited the Civil Rights movement of the 1950s and 1960s (Morris, 1986).

Coming out of the civil rights movement were the Civil Rights Act of 1964 and the Voting Rights Act of 1965. These a...

Table of contents

• Table of Figures
• List of Tables
• Title Page
• Copyright Page
• PREFACE
• ABOUT THE AUTHOR
• CHAPTER ONE - HISTORICAL ASPECTS OF RACE/ETHNICITY AND HEALTH
• PART ONE - CROSSCUTTING ISSUES
• PART TWO - MORBIDITY, MORTALITY, AND RACIAL/ETHNIC DISPARITIES IN HEALTH
• PART THREE - ETIOLOGY OF RACIAL/ETHNIC DIFFERENCES IN HEALTH
• PART FOUR - RACIAL/ETHNIC GROUP-SPECIFIC HEALTH ISSUES
• PART FIVE - CONCLUSIONS
• APPENDIX A - CASE STUDIES
• APPENDIX B - ADDITIONAL READINGS
• REFERENCES
• NAME INDEX
• SUBJECT INDEX