Multiple studies have shown that racial and ethnic minorities frequently receive lower quality health care, are less likely to get routine care and have higher rates of morbidity and mortality than non-minorities. Even as medical discoveries improve health care over all, these disparities are cited over and over again as something that has to change. As we entered 2014, I wanted to know much has changed and when we will learn that new discoveries will not lead to a reduction in disparities.
Where our health is concerned, who you are and your life experiences determine the solution you find to address problems. If those tasked with making discoveries are not concordant with those who suffering the problems, you end up with the situation described by a recent editorial published by the American Medical Association. It said that despite all of the effort on addressing health care disparities, the gap remains and in some cases is getting worse.
As Jackie “Moms” Mabley once said, “If you always do what you have already done, you’ll always get what you always got.”
I moved my young family to Houston in 1980, taking a a joint position as an assistant professor in the Department of Gynecology and assistant biochemist in the Department of Biochemistry at the University of Texas System M.D. Anderson Research and Tumor Institute, as it was called then. I rose through the ranks there, becoming the first African American full professor and director of the Experimental Gynecology/Endocrinology Research Laboratory.
One of the driving reasons I had taken the UT position was to change the way we addressed the issue of the overall high mortality rate from breast cancer in African American women, especially among young women. In a 1998 interview, Houston Chronicle editorial board member Frank Michel asked me what had been achieved in addressing this issue. Other than policy changes over nearly two decades, I told him I was concerned that little true change had taken place. “Benign neglect, institutional discrimination and internal politics have left us with a system that has been unresponsive to both research and health-care needs,” I said in his September 21, 1998, editorial, “Racism can be cancer on the health system.”
Problems are ignored. Boat-rockers like Jones are ostracized or patronized or shunted off into corners by good-old-boy networks. Racial and ethnic biological factors are overlooked in research projects. Cultural differences are not factored into scientific data gathering. Minority doctors and researchers are paid less, promoted less, put down as troublemakers or just tolerated. Like cancer itself, the disease can take many forms and many disguises that often make it hard to detect, hard to prove and very hard to eradicate.
Little did Michel realize what responses his article bring. He received calls from readers saying that he needed a brain transplant and that he should blow his liberal brains out. People were angry that he reported how deliberate and unintentional discrimination within the nation’s medical establishment, especially the Texas Medical Center, led to a different, and sometimes deadly double standard. I told him I was not surprised.
Michel followed up in a subsequent Chronicle editorial that appeared February 1, 1999, titled, “No-brainer to broaden fight against cancer”:
In care, treatment and research efforts, differences among ethnic minorities have simply not been noted and treated with the same zeal as “mainstream” medicine and prevention. The same has been true with regard to gender, with women getting the short end of the proverbial stick until very recent times. And in the fight against cancer, the consequences have been particularly tragic.
Since that time, we have made progress regarding gender, specifically in white females, but what about others? “Health disparities” has long been part of medical research lexicon, but the New York Times recently reported the mortality rate from breast cancer in African American women in Texas remains almost four times that of white females. This, despite Houston being home to the largest medical center in the world and the number one cancer center.
How can this be? One factor often overlooked is that lack of concordance. The gap remains because, at the leadership and faculty level, the researchers don’t understand the problems.
So how much has really changed, other than more money, more papers being published and more meetings on the subject to point out that we have a problem?
With my retirement from the University of Texas M.D. Anderson Cancer Center, its name in the 21st century, there is now no African American full professor in the basic or behavioral sciences at that institution. The center I founded is on life-support. And I no longer have any relationship with the institution where I spent 33 years of my life bringing the issue of health disparities to the forefront.
One could say that I had been a one-man warning sign of what I see as cancers on the health-care system – benign neglect, racism and white privilege. On the other hand, it could be that there are others ready and willing to take up the mantle regarding these issues, others who must be sought out and heard.
We can’t continue to publish papers and get more grants without reducing the gaps that are acknowledged over and over again. It is a threat to the very being of this nation. If you don’t agree and think that we are making sufficient change, at the very least it is worth putting that position to the rigors of scientific and social inquiry. More importantly, it should not be dismissed as brainlessness or the rants of a boat rocker or malcontent, because so much is at stake for my children and yours.