In Nicholas Bakalar’s NYTimes article, “Minorities Get Less Pain Treatment in E.R.” he discusses recent study findings from the Centers for Disease Control and Prevention (CDC) regarding treatment in the E.R. for patients of various racial and ethnic backgrounds. This nationwide study was conducted over a four-year period using “a sample of 6,710 visits to 350 emergency rooms by patients 18 and older with acute abdominal pain.” Despite the fact that severe pain frequency was equal across all patients at 59 percent, Black patients and those of other minorities “were 22 percent to 30 percent less likely to receive pain medication” than White patients. In addition, they were “less likely to receive pain medicine if they were over 75 or male, lacked private insurance or were treated at a hospital with numerous minority patients.” The article ends with some remarks from the senior author of the study, Dr. Adil H. Haider of Brigham and Women’s Hospital in Boston. His remarks were as follows: “It may be that different people communicate differently with their providers. If we as providers could improve our ability to better communicate with patients so that we could provide more patient-centered care, we’ll be making several steps toward reducing and hopefully eliminating these disparities.”
As we discussed in class, health and illness are not only shaped by biological factors, but also, more importantly, by social determinants. Many social factors, including SES, race and ethnicity, age, sex and gender, and geographical location affect health outcomes. Specifically, there are profound differences between gender groups and ethnic groups. For instance, it is well-documented that African-Americans have higher mortality at each age as well as higher infant mortality, HIV disease, and homicide compared to their white counterparts. In “Social Death as a Self-Fulfilling Prophecy,” Timmermans writes, “Epidemiological studies, however, suggest that race, gender, and socioeconomic status play a statistically significant role in overall survival of patients in sudden cardiac arrest” (335). Timmermans continues to state that “black victims of cardiac arrest receive CPR less frequently than white victims” (336). Thus, to what extent are the mortality data that we currently have on the different ethnic groups and gender groups attributed to, in the case of African-Americans, a lack of CPR efforts? In order words, how many deaths could have been prevented by CPR, but were not as a result of racism or discrimination by the staff? It is sickening to me that “the staff rations their efforts based on a hierarchy of lives they consider worth living and others for which they believe death is the best solution” (Timmermans 336). As Dr. Paul Farmer said, “The idea that some lives matter more than others is the root of all that is wrong with this world.” It is unfortunate that society can decide which lives matter more, when, in fact, all lives matter.
In the Timmerman’s article “Social Death as Self-Fulfilling Prophesy,” he discusses, among other aspects of resuscitation efforts, advance directives: “advance directives, living wills, durable powers of attorney, and do-not-resuscitate orders” are all various legal methods to give a patient a say in what medical treatment they receive in the event of sudden death. If a patient does not wish to be resuscitated, they can make this clear through these advance directives, as they will be unable to do so if and when they do end up in this situation. Continue reading “Why even have advance directives?”
Article Title: “Many Schools are Failing on Type 1 diabetes care” by Catherine Saint Louis.
In this article, Catherine Saint Louis writes about a major issue that is plaguing numerous schools across the nation. Students with Type 1 diabetes are discriminated against in public schools because of their disease. Saint Louis provides numerous examples in the article in which students with this disease are forced to switch schools because the school is unwilling to provide care. There are many cases when children have been told that they cannot come on a class field trip due to their disease as well, nor are they given the opportunity to participate in athletic activities. Some schools justify their actions towards these children by stating that they do not have the resources to help the child in the event that the child experienced extremely low blood glucose levels. School officials are neither trained nor willing to administer insulin to a child in need, and thus, the student is not allowed to attend the school.
I found this article to be extremely discouraging because innocent children are experiencing discrimination over a disease in which they have no control. Type 1 diabetes is an inherited disease in which insulin is not produced in the body. The numerous schools that force students to change to another school is not abiding by the law that protects these students, as the article suggests. This discrimination resembles the medical underwriting that insurance companies do in order to screen out “unhealthy” people. Medical underwriting ensures that insurance companies can save money by only granting health insurance to those who are healthy. Thus, the way in which schools pick and choose who can attend their institution based on a child’s medical status resembles the unjust actions of insurance companies in choosing who they wish to insure.
Saint Louis’s article also suggests the immense effect of social factors on illness. For example, the geography affects the healthcare that children receive because in some areas, children with Type 1 diabetes are able to receive adequate care at their schools. However, as the article explains, numerous schools across the United States do not provide adequate care to children with this disease, and thus, those students who live in these areas either do not have access to appropriate care, or are forced to move to a different geographic location to attain adequate care. Therefore, the child’s illness is impacted by the location in which he/she lives in, which directly affects the education the child will receive. The effect of geography on illness was also portrayed in the film watched in class, in which one’s zip code greatly affects the health of a given community member. Therefore, the children with Type 1 diabetes are only one example of the many ways that geography impacts illness of individuals.
This year, thanks to the combined efforts of Nicolle Gonzales, Brittany Simplicio, and the nonprofit “Changing Woman Initiative,” a plan has been put into place to create the first ever Native American birth center. Gonzales and Simplicio are two of only fourteen certified nurse midwives who are Native American. The pair have a firsthand understanding of how frequently Native American women suffer the consequences of being minorities with a low socioeconomic status when it comes to health, and, more specifically, pregnancy, birth, and neonatal care.
On this topic, I have mixed feelings.
On one hand, Native American women will have better access to pregnancy and birth care, but I also wonder, how in the world is this first ever birth center for this already largely underserved group of people? How much has this group had suffer as the result their inability to access a birth center?
There is no greater illustration of how institutional racism and mishandled bureaucracy directly harm health outcomes for Native American people than what we see with Indian Health Services (IHS), particularly at the Santa Fe location where Gonzales used to work. Due to underfunding, native women only have access to prenatal care because the labor and delivery ward was shut down in 2008. When I see that, I immediately wonder and worry: when a native woman does go into labor, how far does she have to travel to safely give birth? Does she have access to a safe, clean place if she gives labor at home? How far is the nearest hospital if something goes wrong? The answer all of these to these questions are provided nowhere other than the disproportionately high rates of infant mortality among Native American people.
To add insult to injury, at the Santa Fe location, women are provided neonatal care through IHS, which is funded by the federal government, but for delivery at a hospital, they must apply for Medicaid. The interaction between IHS and Medicaid—for all medical procedures, not just birth—has created a confusing mess for native American people who don’t realize they’re eligible for both.
Gonzales and Simplicio explain that “poverty, discrimination, geography, and racism” have created cultural disparities that leave Native American people less healthy than they should be. These disparities manifest as “higher rates of gestational diabetes, increased rates of postpartum depression, and higher rates of preterm birth and low birth weights.”
It’s just amazing to me that it could take this long to finally give Native American people access to a service that might have saved an unknown number of lives had it been provided earlier.
In the article “Understanding Racial-ethnic Disparities in Health: Sociological Contributions,” Williams and Sternthal explain in detail the many factors that influence health outcomes, such as race and racial discrimination, gender, socioeconomic status, social structure, and migration history. Although all these factors are important, I felt like the article was just listing out all the problems that influence health outcomes and wanted to prove that these problems do in fact exist. However, we already know that these factors influence health, so how should sociologists and medical professionals take what they already know and create practical solutions for our communities today? At the end of the article, they say that policy needs to be changed and that there needs to be more awareness in the public. Are there any other effective solutions that can be created and implemented today? (Maybe create/influence government policies that assist underserved communities, provide health benefits for vulnerable groups, make farmer’s markets and groceries stores more readily available in poorer communities, etc?)
The article “Understanding racial-ethnic Disparities in Health: Sociological Contributions,” by Williams and Sternthal stresses four points. It challenges the biological understanding of race, it emphasizes how social structure determines racial differences in disease, it discusses how racism affects health, and finally it discusses how immigrant status can play a role in healthcare quality.
Specifically, in the section on Racism and Health, Williams and Sternthal discuss how segregation has played a role in minorities’ health, especially African Americans. Additionally, this section also discusses discrimination, but only generally, and not in the context of a healthcare setting.
Thus, this article leaves out some of the medical sociology factors, like racism and discrimination by health care professionals. Therefore, I question and wonder about how quality of care after one has access to and can afford the healthcare varies for different minority groups. How does discrimination by doctors and other healthcare professionals affect the health of these groups? What research has been done to challenge this and bring it to light?