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Shameful racial disparities in health and health care

Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study

By Lyndonna Marrast, David U. Himmelstein, Steffie Woolhandler
International Journal of Health Services, August 12, 2016

Abstract

Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children’s and young adults’ receipt of mental health and substance abuse care using nationally representative data from the 2006–2012 Medical Expenditure Panel Surveys. Blacks’ and Hispanics’ visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.

From the Discussion

The under-provision of mental health care for minority children contrasts starkly with the high frequency of punitive sanctions that their behaviors elicit. Black children suffer excessive rates of school discipline, such as suspensions and expulsions, starting at preschool ages. Minority teens also have disproportionate contact with the juvenile justice system, with higher arrest rates for nonviolent, low-level offenses such as drug possession and for non-criminal misbehaviors such as truancy and curfew violations. Most relevant to our study, youthful transgressions that might result in referral for treatment among non-minority children more often incur criminal sanctions for minorities. Overall, blacks and Hispanics account for 63% of the children detained in juvenile facilities.

http://joh.sagepub.com/content/early/2016/08/11/0020731416662736.abstract

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Active Life Expectancy In The Older US Population, 1982–2011: Differences Between Blacks And Whites Persisted

By Vicki A. Freedman and Brenda C. Spillman
Health Affairs, August 2016

Abstract

Understanding long-range trends in longevity and disability is useful for projecting the likely impact of the baby-boom generation on long-term care utilization and spending. We examine changes in active life expectancy in the United States from 1982 to 2011 for white and black adults ages sixty-five and older. For whites, longevity increased, disability was postponed to older ages, the locus of care shifted from nursing facilities to community settings, and the proportion of life at older ages spent without disability increased. In contrast, for blacks, longevity increases were accompanied by smaller postponements in disability, and the percentage of remaining life spent active remained stable and well below that of whites. Older black women were especially disadvantaged in 2011 in terms of the proportion of years expected to be lived without disability. Public health measures directed at older black adults — particularly women — are needed to offset impending pressures on the long-term care delivery system as the result of population aging.

The residential concentration of blacks in the United States is high, and related inequities in neighborhood resources — including access to medical and long-term care — reinforce black-white disparities.

From the Discussion

Older blacks and older whites in the United States have experienced different disability patterns since the early 1980s, as longevity has increased. For older whites, disability has been postponed to older ages, and the proportion of life expected to be lived without disability has increased. However, for older blacks, longevity increases have been accompanied by smaller postponements in disability, and the proportion of remaining life to be spent active has remained stable — about two-thirds at age sixty-five and one-third at age eighty-five. Consequently, the proportion of life expected to be active for older blacks continues to remain well below the proportion for older whites.

Our analysis also suggests that the black-white gaps persisted during the study period in large part because of the lack of progress for older black women in gaining years of active life. This finding is consistent with previous research demonstrating that black women experience a unique disability trajectory in later life that reflects accelerated impairment at older ages. We add to this literature by pointing out that in the aggregate, older black women have not experienced the gains seen for other groups since the early 1980s in either the number of years of active life or the percentage of life expected to be active.

http://content.healthaffairs.org/content/35/8/1351.abstract

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Comment:

By Don McCanne, M.D.

These two new studies demonstrate that we still have far to go in reducing racial and ethnic disparities as they relate to health and health care.

Particularly shocking is the study that shows that “youthful transgressions that might result in referral for treatment among non-minority children more often incur criminal sanctions for minorities,” especially for young, black males. Behavioral problems in white kids get treated whereas black and Hispanic kids are thrown in jail.

Also, black adults, especially women, are more likely to spend their later years with significant disabilities than are whites. Although the reasons for the differences are not fully elucidated, it is known that “inequities in neighborhood resources — including access to medical and long-term care — reinforce black-white disparities.”

In a message earlier this week we were reminded that one of the most dramatic reductions in disparities occurred very rapidly as a result of government action. That was the compulsory end to segregation in hospitals with the implementation of Medicare. Our government can do so much more than the private sector has been willing to do.

We do not have to wait around for another series of historical events funneling down into a grand political action. We can create that history and that action ourselves. But it does require, yes, action on our part. Citizen inaction crushes social movements.