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Vol. LXIII, No. 23
November 11, 2011

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Closing the Gap
LaVeist Addresses Race Disparities in Health Care

Photo of Dr. Thomas LaVeist

When Dr. Thomas LaVeist gives a presentation on health disparities, he shows a slide with a graph of age-adjusted mortalities by race. The information is from 2003, which may seem a bit outdated coming from the director of the Hopkins Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health.

“I used to update this slide every year, but then I just gave up,” said LaVeist, “because the pattern is the same every year. The differentials are exactly the same.”

The unchanging data reflect the disturbing persistence of serious health inequalities in the United States. LaVeist presented as part of NIH’s Mind the Gap seminar series and sought to clarify the real reasons behind health inequality.

In 2006, African Americans had a crude death rate (total deaths per 100,000 population for a specified period; rate represents the average chance of dying during a specified period for persons in the entire population) of 1,330.2 while Asian Americans had a crude death rate of 414.7, which is the lowest in America. If African Americans and Asian Americans had the same death rate, there would have been 170,831 fewer African-American deaths. “In the time it took me to do that math, there was at least one excess death in America of an African American,” said LaVeist.

Excess deaths come at more than just a social justice cost, explained LaVeist. There are also substantial costs to society and the economy that can be calculated through lost productivity, preventable use of health services and premature deaths.

LaVeist noted that many people automatically jump to socioeconomic status (SES) as the reason for health inequalities. This, he says, is incorrect. Rather, it is social and environmental exposures and unhealthy environments that are determining the outcome of people’s health.

In the same country, the same state, even down to the same county, people are experiencing different risk environments; these environments are determining residents’ health outcomes. LaVeist’s current research dissects disparities down to small geographic areas, looking at racially integrated communities where the environment and SES of individuals is similar. This allows the research team to examine if disparities persist when black and white Americans live under similar conditions.

Oftentimes, research data are not properly adjusted to account for varying levels of social stratification. For example, adjusting for educational attainment does not account for race differences in quality of education or differential opportunities that accrue to graduates from different schools. “These are the underlying problems in much of the research we’re doing. We often don’t account for the fact that there are systematic inequalities in the variables we rely on to equalize the samples,” said LaVeist.

Another popular response to the reason for health inequality is genetic and biological differences between races. “The folly of race is that we think because we can look at skin color we can understand what we need to know about the individual’s genome in order to make decisions for what’s happening underneath their skin,” said LaVeist. “The illusion of race can confuse the best of us.”

Understanding the reason for race disparities in health is the first step in going forward and closing this significant and costly gap, he said. NIHRecord Icon

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