About one-third of the money spent on health care for African-Americans, Asian-Americans and Hispanics in the United States is excess cost, created by health inequalities associated with higher rates of chronic, debilitating diseases among those groups, according to Brian Smedley, PhD, of the Joint Center for Political and Economic Studies in Washington, D.C.
Speaking at an APA 2011 Annual Convention session on health disparities, Smedley said that for too long, the discussion about why those disparities exist has focused on individual habits: what people eat and whether they smoke, get enough exercise or see a physician regularly. What's missing, he said, is an acknowledgment that racial segregation continues to affect racial and ethnic minorities' health, by channeling them into areas of high poverty that lack things like schools with good resources, grocery stores that sell healthy food and public parks that offer opportunities to walk, bike or run.
For Smedley, using psychology to reverse this pattern isn't just a matter of justice, but of national economic importance. "Health inequities have an enormous economic burden for the nation because one of the drags on the recovery is the fact that we have tremendous health gaps," Smedley said.
Looking at direct medical costs combined with the indirect costs of lost wages, diminished productivity and lost revenue caused by sickness and early death, Smedley estimated the drag on the economy at $1.24 trillion between 2003 and 2006. "It's very expensive to do nothing to solve health inequalities," he said.
One study in Chicago found that 60 percent of all African-American children, regardless of family income, lived in neighborhoods where 30 percent or more of inhabitants were in poverty. By contrast, 75 percent of white children from poor families lived in neighborhoods with poverty concentrations below 10 percent, Smedley said.
Other participants at the convention session also pointed out that:
- Health disparities research is becoming better coordinated. This was according to Joyce Hunter, PhD, deputy director of the National Institute on Minority Health and Health Disparities. Her institute is finalizing a five-year strategic plan to coordinate minority health disparities research across the 27 centers and institutes of the National Institutes of Health. The institute also funds a loan repayment program for health professionals conducting health disparities research, and has a research endowment for institutions with a significant enrollment of students from underrepresented minorities and disadvantaged backgrounds.
- Research funds are available. The Patient Protection and Affordable Care Act signed ito law in March 2010 significantly increased funding for patient-centered outcomes research, said Garth Graham, MD, deputy assistant secretary for minority health at the U.S. Department of Health and Human Services. That research focuses on determining which interventions work best for people with more than one health condition, in real-world settings, he said. Yet when Graham reviewed the initial applications for the first round of funding, he noticed that applications for behavioral health and psychology research were not well-represented. "This is a particularly good arena to get into because we're building it from the ground up," he said.
- Nonetheless, rates of health-care access disparities have not yet improved. In looking at the indicators measured by national surveys of disparity in quality of care for African-Americans, Hispanics and Asian-Americans, two-thirds have shown no improvement since 2003, said Larke Huang, PhD, a community clinical psychologist with the Substance Abuse and Mental Health Services Administration.
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