Health Care Reform
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Story of the Week | May 20, 2008

Being Poor and Sick in the U.S.

Health system reform for the "Two Americas"

Since I started medical school nearly 40 years ago, I’ve seen a lot of changes in health care. Not all of them have been for the better. A recent study by Dr. Majid Ezzati and colleagues at Harvard, for example, lays out some sobering facts about the inequities in our U.S. health care system. Dr. Ezzati’s key finding is that, while U.S. life expectancy is up for the country overall, the gap in health between rich and poor in America has widened over the last several decades. We appear to have two tiers of health – in essence, two Americas.

This newest report documents what global and national public health experts have been stating about American health care for more than a decade.

In 1999, the U.S. health care system received a shot across the bow from the World Health Organization, which ranked the United States a dismal 37th worldwide in the overall quality of its health care. One of the reasons for our low ranking is the disparity of health outcomes and access to care by class and race.

As stated by health policy experts Stephen Isaacs and Steven Schroeder in the New England Journal of Medicine in 2004, "Race and class are both independently associated with health status, although it is often difficult to disentangle the individual effects of the two factors."

A few simple numbers illustrate this point. Whites have a median net worth in the United States that is 10 times greater than blacks. While 11 percent of whites live below the poverty line, 27 percent of blacks struggle with poverty. The life expectancy of blacks is seven years less than that of whites. And blacks suffer higher rates of cardiovascular disease, diabetes, hypertension, infant mortalities, homicides, and a variety of cancers.

What contributes to the inequity more, race or class? Hard to say, but socioeconomic status, which is often a byproduct of racial discrimination, may be the dominant contributor to poor health. Factors previously associated with low socioeconomic status and poor health include poor nutrition, increased smoking, decreased exercise, increased stress and fear, unsafe neighborhoods with high crime levels, substandard housing, inaccessible and expensive services, environmental hazards, and poor schools.

The Harvard study above dramatically links health to poverty. With the 2008 election just around the corner, we need to remember John Edwards’ emphasis on "two Americas" and understand that we will not be able to successfully address health care in America without simultaneously addressing poverty.

To learn more, watch the video embedded with this blog post, or read the full transcript, below. Then share your thoughts on what you think we should do about our country's growing health inequities.


Transcript

Read the full transcript of this story.

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Comments
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May 22, 2008

Poor Cannot Afford Junk Food

Poor cannot afford the medical cost of junk foods

The poor people (especially blacks) cannot afford to eat processed junk food such as wheat, corn, cereals, milk products  which all lead to  the modern so-called diseases such as cancer, heart disease, and diabetes. All of these are directly related to eating junk foods as above and severe mineral deficiency.

Only wealthy irresponsible people can afford the medical costs associated with junk lives.

Those wanting to be healthy will follow this diet:

  • STOP all starchy carbohydrates (breads, pastry, cookies, breakfast cereals, rice, potatoes, and pasta), processed foods and milk products.
  • Eat some of the following foods every 2 hours.
  • Eat 14 portions of fresh or frozen veggies daily (in soups, juiced, stir-fried, steamed etc) 50% raw juiced (use the pulp in soups) (Organic if possible).
  • Eat 5 portions of beans, nuts and seeds (soaked and mashed for the nuts and seeds)
  • Eat 5 portions dark skinned fruits, (blueberries, cherries, red grapes (especially the minimum of 2 avocados daily) etc).
  • Wild fish most important and grass fed meats or chicken (only a small amount and better grass fed)
  • Hemp, Omega 3 or Krill Oil and other healthy oils such as olive oil etc
  • Drink 8 glasses of distilled or filtered water per day with a pinch of bicarbonate of soda.
    Take 3 x 1/2 teaspoons of sea or rock salt daily in food or a little water.
  • Exercise every day: gentle rebounding, fast walking for 3 miles and low weight training ( all to the music of your youth).
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May 22, 2008

Heath Disparities Among Plenty

Minorities receiving less than quality health care

Sadly, to say you do not necessarily have to be poor and sick to receive poor health care in the United States.  You can be among the working class, insured, and receive very poor care. I will first speak on a personal issue and then I will speak on a very general level from what I have assess from the general public in talking to the poor.  My late husband was over weight, insured, and received very poor health care from more than one physician.  I have had two years of medical school, and I wonder if some physicians not value the life of some of their patients.  His cause of death was pulmonary emboli.  Initially, my husband complained about leg pain and the first physician told him at your age you just start feeling pain.  His age was forty at the time.  Starting in December my husband complained about flu-like symptoms.  The physician treated the symptoms.  These flu-like symptoms continued into the second week and he was not getting any better.  The Friday before his death, he returned to his doctor for the third time still complaining of flu-like symptoms and not feeling well.  The doctor only prescribed more medication.  That weekend he remained in the bed.  I told my husband, if you do not feel well why not go to the emergency room.  He thought since he had just seen his doctor that he was okay.  That following Monday, I drove my husband to the doctor.  This time I was with him because I was concern about his medical care.  In this visit the doctor did an EKG, my late husband asked how was his EKG and the doctor just patted him on his back.  He was denied his medical information.  The EKG was not a good one.  Later the doctor disclosed that he thought that he was having a heart attack. This doctor never indicated that his life was in danger.  My husband was an Afro-American.  I often wonder if he was Caucasian would he have received different care.  Needless to say, my late husband died that day.  The doctor did nothing to intervene at the hospital even though I had made multiple calls to him.  Here is an example of a patient who had health insurance yet he was denied quality health service.

      On the other hand, just yesterday I spoke to a woman who has two children.  She and her children have asthma.  I could relate this woman because I have asthma and so do my children.  Please note my children have never had an asthma attack.  My children’s doctors give them an asthma plan teaching them how to manage their asthma.  This mother had signs of severe allergies with maybe some sign of difficulty breathing.  I asked how long she had had these symptoms and how what was she taking in order to give herself some relief.  In this conversation, I found out about her health and her children.  Her children have had several asthma attacks and she was trying to treat them with over-the-counter drugs.  In my conversation to her, I explained that my situation was similar and that my children have an asthma plan.  I also informed her that my children have never had an asthma attack.  I went on to explain how the asthma plan is designed.  I believe she understood.  I also explained to her when she takes her children to the doctor to ask for an asthma plan.  This is just an example on how someone who has a lower socio-economical status receives different care.   I do believe that it is a shame that if you are a minority that you have to be so educated to receive quality health care.  In the midst of plenty, so many American are wronged.

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May 23, 2008

It's neither!

race vs. class

 My baby sister, having just died under abomnible circumstances, I have this to say, we are upper Middle, my Dad was part of management, being a tech writer...

Unlike most of my classmates, I didn't go to college, since I wanted to write... and hated school which was the most perfect example of the Peter Principle I ever saw. ( people are advanced to the  position of their greatest incompetence)... just 2 examples, an English teacher, who had a minor in History, who in teaching Scott's Ivanhoe, thought that the Knight's Templar were a creation of Scott. As a Demolay- a fraternity based upon the concepts of chivalry, honoring Jacques De Molay- the last Grand Master of the Knight's Templar, I, of  course, didn't

agree. Another teacher, this time History, tried to tell us that whereas the North treated Confederate POW s with contempt, almost brutality, the Southern gentleman,offered Yankee POWs... the use of their mansioin and mint juleps. Since, my Uncle James was one of the few to escape from Andersonville(which has been compared to a concentration camp- when freed by the Union, some of the prisoners were almost walking skeletons! If that's Southern hospitality, I'll take vanilla!)I could go on about the abject stupidity I encountered in the public school when I was a kid. But, today, it's worse!

 Anyway, I worked at odd jobs to pay my rent and wrote. Then, Uncle Govt. raised his ugly snout and, to avodid being drafted, I joined the Navy , to see the Sea. Ironicaly, this was the time when "Blue, Navy, Blue" ('64) was popular on the radio... my own lyrics for the song are rather colorful ! Well, short story long: when we got back from "Nam", I complained to the First Class Corpsman, in charge of the crew, that I was : constantly HUNGRY, constantly THIRSTY, weight had dropped from 165 lbs, down to 135 lbs., had legaches, and cramps,itched all over, and was going to the bathroom  eveery HALF HOUR. Obliviously, those are the CLEAR symptoms of DIABETES, his diagnosis? It was ALL IN MY HEAD!

And, you think that medicine is bad today? This was in 1965... I'm a Middleclass white male... so, when you ask is it race or class, my answer is neither, it's just good ole stupidity, and THAT's growing- daily... MADjimp

 

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May 27, 2008

Its both race and class and a whole lot more

To Robert Redfern:  I have no idea where your getting your ideas from but have you been to the grocery store lately? Have you ever watched, listened to or seen ads for food?  They focus on foods that are completely unhealthy for all.  If you have listened to any of the other health commentary episodes you would know that these foods and a lack of emphasis on prevention costs this country billions of dollars in healthcare each year.  It is definitely just not the poor who can't afford to eat junk food it's everyone.  The poor buy more junk food becuase these foods are often much less expensive than organic and natural foods.  When you're poor, your concern is less on how good the food is for your body and more on the fact that you're just getting something into your body.   Similarly, in poorer neighborhoods, grocery stores such as whole foods and AJ's aren't available.  The people depend on corner stores who are given incentives to display junk foods when at the register.  It is also an educational problem.  Many people are not fully informed about there conditions.  this is a problem for both the healthcare industry and the patients.  Doctors should be able to learn from the patients and vice versa.  It is not just an issue of poor people it is an issue with everyone.

W. Rainbow:   I am so sorry to hear that your husband had to go through that process.  that should never have occured.  Some doctors do not always probe like they should.  Once they find a symptom that might be the cause they often focus on that instead of looking for other clues that could also lead to a diagnosis.  I would have to say that this is a minority of doctors.  Most undersatnd that there are dealing with a person's life and that finding the correct diagnosis can only lead good healthcare.  The patient might not always like the diagnosis and prognosis but at least they know what's going on and have the time to prepare whatever the outcome maybe.  

On education:  i feel that you are wrong in saying that african-americans don't have to be educated about their own healthcare.  Being african-american myself and a strong advocate of prevention, I feel there is not enough emphasis in minority communities on healthcare.  Smarter choices need to be made when it comes to food and exercise.  Questions need to be asked if situations are not understood before leaving the physician's office.  Do not accept mediocrity.  Make the doctors do their job and anyone else involved in your healthcare.  This not only makes that doctor more prepared the next time he/she has a patient but it also gives you control of healthcare.  you have a responsibility to yourself and those around to understand your own health.  not to mention it'll probably save you a lot of money in the long run.  Education about health even in leymans terms is very important for all.

Jim Bell:  I think your situation is more to do with a military mind set than anything else.  The military has a "suck it up" attitude now.   So it was probably even more so then.  I agree that healthcare can be bad no matter what.  But I also say that people with more money are more than likely informed about their health and often have access to better facilites than the neighborhood clininc or county hospital. 

Healthcare is worse for poor and minorities.  However, this country in general has poor healthcare for all due to HMOs and insurance companies.  There are a lot of reason for poor healthcare but it should not be accepted for what it is.  It is the duty of everyone to find someone (maybe themselves) to bring about change.

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