White people should worry about racism. They should worry about racism because it’s wrong. But if that’s not enough of a motivation, they should worry about it for their own damn good. Philip Cohen of Family Inequality shows us how so with a discussion of a recent paper published in the Journal of the American Society of Nephrology.
The Figure below illustrates the percentage of black (grey bar) and white (white bar) residents who went into end-stage renal disease (kidney failure; ESRD) before ever seeing a doctor specializing in kidneys (a nephrologist). As we move from left to right, the zip codes in which patients live becomes increasingly populated by black people.
What we see is that, in any given neighborhood, black people are always less likely to get access to a kidney specialist before their kidneys fail; but also that white people living in a neighborhood with a higher percentage of blacks are less likely than whites in a more white neighborhood to see a specialist. So much so that whites living in neighborhoods that are more than 50% black are less likely to see a specialist than blacks living in neighborhoods that are less than 25% black.
Cohen specifies that…
…the relationship still holds even when individual socioeconomic status, and local-area socioeconomic status, are controlled. So it’s not just a poverty effect.
Somehow places that are “blacker”, even when they are not poor, are serviced with inferior health care compared to places that are “whiter.” And everyone suffers for it (though not necessarily equally).Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.
çøntraba|an¢e — August 11, 2010
What this tells me is that there seems to be a cultural predisposition amongst African-Americans to not seek proper medical treatment, and that this tendency can lead to a stigma against proper medical treatment for the rest of the non-black neighborhood. Thus, the proper response would be to move away from predominantly black neighborhoods.
Katsu — August 11, 2010
I work in a Nephrologist's office, and have for many years. From her 30 years of experience in this field, my boss avers that African-Americans tend to be less medically compliant than non-African Americans, despite predisposition to kidney disease.
fuzzy — August 11, 2010
When less-educated people, many of whom are black--unfortunately---encounter medical care, the system is scary, often impersonal by virtue of both volume and caregiver burnout. There is a tendency to avoid treatment: it is uncomfortable, expensive, and often makes you feel worse until optimized.
However much people may wish that doctors and nurses were angels on earth, we are humans, often overworked, yelled at, blamed for all aspects of the system as well as the expected side effects of treatment: sorry, your diet for your diabetes/renal failure doesn't mean you can live on McD's or eat 3000 calories a day, the antihypertensives may well give you erectile dysfunction, moving your body hurts if you haven't done it in 10 years.....
Educating a patient who doesn't want to learn about or take ownership of their disease is difficult if not impossible. Stating that certain groups are less likely to comply with treatment allows us, among other things, to try to devise ways to change that.
cjl — August 11, 2010
It is truly amazing that for a post about how discrimination adversely affects white people as well as black people, how quickly and completely the conversation turns to talking about how the "bad behaviors / attitudes" of black people are to blame for their disproportionately poor medical treatment. Seriously people, you're not even addressing the topic at hand.
If black people's "bad behaviors" are to blame for their poor medical treatment, how are you to explain the poor medical treatment that white people receive when they live in largely black neighborhoods. If doctors in largely black neighborhoods are predisposed to under-treat black people because of their non-compliance / distrust / etc., shouldn't this be a non-issue when the doctor sees that the patient is white?
Oh, and you notice how I keep using the terms "black people" and "white people"? You commenters who keeping refering to "blacks" might want to remember that black is an adjective that describes *people*, not a noun. Although, I'm sure it's easier to play a round of denying discrimination when you don't take the time to remember that you're talking about actual people.
Nana — August 12, 2010
Could it be that part of the discrepancy is because perhaps the white population is historically more comfortable (or more successful?) in advocating for their own medical needs? (e.g. petitioning to have more specialists or clinics opened in their area)
Another important thing to note from the abstract is that the quality of care received was no different for the white vs. black population and was not different in the different areas, so it was strictly an access issue. I wonder if that gap has anything to do with urban/rural differences, as it does not look like they adjusted specifically for that (although they did adjust for SES).
Health Disparities and Race | Erin V Echols — February 26, 2012
[...] white mothers who received absolutely no prenatal care. Similarly, blacks have worse outcomes in kidney failure, pre-term births and other conditions even when controlling for socioeconomic characteristics. [...]