Eliminating disparities more effective than expanding technology
American Journal of Public Health
December 2004
The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data
By Steven H. Woolf, MD, MPH, Robert E. Johnson, PhD, George E. Fryer, Jr, PhD, MSW, George Rust, MD, MPH and David Satcher, MD, PhD
Abstract
The US health system spends far more on the “technology” of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans.
Medical advances averted 176,633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths. Achieving equity may do more for health than perfecting the technology of care.
From the Discussion
Improvements in the technology of care did save lives during 1991 to 2000, but the deaths averted were considerably fewer than the potential lives saved by reducing the mortality rate of African Americans to the rate of Whites. Five deaths could have been averted for every life saved by medical advances.
This contention assumes that racial disparities could be abolished, a formidable premise. Elsewhere, we discuss the immense societal challenges such an effort must overcome. Here, our intent was to offer policymakers a sense of perspective about how the potential gains from overcoming these challenges would compare with continued investment in the technology of care.
… our fundamental finding: resolving the causes of higher mortality rates among African Americans can save more lives than perfecting the technology of care. Policymakers could act on this information without waiting for more precise projections. The prudence of investing billions in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration. It is an imbalance that may claim more lives than it saves.
http://www.ajph.org/cgi/content/abstract/94/12/2078
Comment: As they have with other similar reports, the opponents of reform will undoubtedly dismiss this study by attributing the differences to the blame-the-victim flaws in personal choice that are cultural rather than due to a failed health care system.
Although the causes may be complex, the disparities are very real. Close to a million African Americans died prematurely in the 1990s because of racial disparities. We already know that lack of health insurance results in a greater risk of premature death, and that larger percentages of African Americans are without insurance.
Although there is much to be done, an important first step would be to provide comprehensive health care coverage for everyone. That way, affordability of health care would be eliminated as one of the more important racial disparities that negatively impact health.
A few numbers:
3000 died prematurely due to a terrorist attack on 9/11.
1300 U.S. soldiers died prematurely due to combat in Iraq.
18,000 young adults die prematurely each year due to lack of insurance.
100,000 Iraqi citizens died prematurely due to (fill in your own explanation).
886,000 African Americans died prematurely in the 1990s due to national policies that tolerate inequitable disparities.
(What is very telling is the next step that those of us who really do care will take. We’ll delete this message and return to our daily routines.)