Sick and Tired of Health Disparities A few months ago, I had the opportunity to spend a couple of days with an older sisterfriend, a retired teacher who fills her retired days with meetings, task forces and sorority work. I had always admired my friend for her spunk, her accomplishments and her standard of service. I also enjoyed the way that she had aged so gracefully, so sultry at 70 that she put questions of age to rest. But on this June day, she was limping a bit, and I asked her if she was okay. “Just a little pain,” she said. I asked if she had seen a doctor for the pain and she smiled, “No need to see a doctor for this, it will pass.” I thought of my friend’s stoicism when I read a recent study about racial disparities in pain. According to a research team led by Dr. Carmen Green of the University of Michigan Health System, African Americans and Hispanics are more likely to experience pain, but less likely to be treated for it, even when they are in a doctor’s care. Black folks in nursing homes are 64 percent more likely to do without pain medication than their White counterparts. Hispanics with broken arms or legs were twice as likely as Whites to go without pain medication. Part of the problem is that health care professionals see some patients through a stereotypical lens that colors (pardon the pun) their diagnosis and treatment. Part of the problem is that people of color don’t speak up as much as they ought to, shouldering little aches and pains as if they are an expected part of life.Fannie Lou Hamer once said she was sick and tired of being sick and tired. But did she tell her doctor? Come to think of it did she have a physician? The latest data on health insurance suggest that affordable health care is getting less, not more, available. More than 15 percent of all Americans — nearly one in seven — have no health care coverage. Twenty percent of all African Americans, and 32 percent of all Hispanics, still lack health care coverage.But even those with coverage shouldered too much of the pain, according to the study, “The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain,” that appeared in the journal, Pain Medicine, in September 2003. Even when researchers controlled for income, language skills and insurance status, African Americans and other racial and ethnic minorities were under treated for pain across a range of conditions, from cancer and chest pain to post-surgical and lower back pain. Additionally, access to pain care and pain medication varied by race, with pharmacies in the ‘hood far less likely to carry narcotic pain medicines.The pain studies remind us why California’s Proposition 54 is little more than an ill-conceived hoax. Titled the Racial Privacy Act, the legislation might better have been titled the Racist Gag Order. If it wasn’t for the racial data collected, we might not know about the pain gap, the income gap or the unemployment gap. And without this knowledge we might not be able to fashion solutions to close these gaps. Clearly, the gaps we observe in the levels of health insurance suggest that special outreach to some populations is important. Further, it seems essential that pain awareness education take place both among patients and health professionals. But it seems to me that social scientists might also look at this pain research and link it to a whole set of socioeconomic forces in the African American community. What is it about our experience in this country that makes us feel that pain is something to expect, not to treat? Why would so many of us, regardless of education, income and health insurance, so easily shrug off pain? Are there racial differences in the brain’s pain processing and pain-killing systems? Or is stoicism a cultural value assumed by a people who have accepted “sick and tired” as a way of being?“Don’t assume that pain has to be part of your life,” Dr. Carmen Green said in discussing the implications of her study. The University of Michigan researcher deals primarily with issues of physical pain, but in describing the status of African people in America, there are potential issues of psychological pain that might also be addressed. As I write this column, the radio-talk show host Rush Limbaugh has questioned the ability of Philadelphia Eagle’s star quarterback Donovan McNabb, suggesting that the media are so eager for a Black quarterback that they have been willing to overlook McNabb’s shortcomings. The hue and cry that followed the racist comments resulted in Limbaugh’s resignation from his ESPN gig, and McNabb is to be applauded for the maturity with which he handled Limbaugh’s comments. Still, imagine the gratuitous pain that racist comments like Limbaugh’s cause. Black folks and other people of color shoulder both more physical and psychological pain as we attempt to thrive in a society where race and ethnicity still matter. We spend one-seventh of our total gross domestic product on health care, yet many of our nation’s citizens still have unequal access to health care, especially when it comes to managing pain. Like Fannie Lou Hamer, I’m sick and tired of these inequities.
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