An Ethical Indictment on Disparities

From Ansell et al., Cancer Causes Control, 2009

Chicago Breast Cancer Mortality Data, from Ansell et al., Cancer Causes Control, 2009

Steve Whitman joked that he didn’t know much about ethics. But he was deadly serious about the numbers on racial health disparities and their ethical consequences presented in his Oct. 27 talk for the MacLean Center for Clinical Medical Ethics seminar series. Extrapolating his data regarding the gap in health outcomes between whites and blacks in Chicago, roughly 3,200 African-Americans in the city die each year because of disparities – 9 people a day. Three infants a week die due to being born in a black neighborhood versus a white one, and two black females die every seven days due to the widening disparity in breast cancer mortality among Chicagoans.

The reasons behind these sobering numbers can be debated, with socioeconomics, biology, and institutional racism the most frequently mentioned candidates. But what’s undeniable is that most racial health disparities are getting worse, not better, at least in Chicago. Whitman, the director of the Sinai Urban Health Institute in Chicago, led off with the results of his group’s 15-year analysis (pdf) of the health gap between black and white populations in the city, which looked at measures such as mortality, low infant birth weight, and communicable disease.

The news is not good – on 11 of 15 measures, including all-cause mortality and deaths from heart disease and breast cancer, the disparity between blacks and whites widened, even as new treatments improved outcomes for one or both populations on most measures. The most startling gap is in breast cancer, where a black Chicagoan is nearly twice as likely to die from the disease than a white Chicagoan. Recent improvements in screening and treatment of breast cancer have dramatically lowered the mortality in the white population, but those advances have yet to budge the black population’s mortality rates, which remained flat over the 15 years analyzed.

Complementing his heath measures data, Whitman’s group also conducted a survey study (pdf) of health risk factors and attitudes in six different Chicago neighborhoods, reflecting the city’s black, white, and Hispanic populations. Here, many more startling differences are revealed, such as the predominantly black North Lawndale and its 39 percent smoking rate, more than double the national average. Perhaps most troubling for the future of the city’s health is the large numbers of overweight and obese children, which reached as high as two out of every three children in neighborhoods such as Humboldt Park and West Town. Yet, a survey question of how parents perceived their children’s weight found that nearly all (85 percent) of parents in those same neighborhoods thought their child’s weight was healthy.

“It’s a question of perception, and we need to take that into account,” Whitman said.

Whitman’s group has started several efforts intended to chip away at these disparities, targeting breast cancer, pediatric asthma, and diabetes in the neighborhoods lagging far behind national averages. The Sinai interventions are multi-dimensional, approaching the issues from political, educational, and medical angles, and dial down to an extreme local focus – in some cases going door-to-door in communities with high rates of chronic disease. Whitman hopes that such approaches both make a difference in Chicago neighborhoods and establish a model for other cities, in order to decrease disparities that have barely budged since WEB Dubois’ 1906 book “The Health and Physique of the Negro American.”

“We’re still talking about the same things today, and we have to figure out how to move forward,” Whitman said. “We have to regard this problem as if it was a problem in our family, and we have to fight like hell to change it.”

http://medicine.uchicago.edu/centers/ethics/videos/whitman/player.swf

[Each academic year, the MacLean Center for Clinical Medical Ethics organizes a series of lunchtime seminars by physicians, biologists, economists, social scientists and other experts covering the biggest questions in health care and ethics. This year’s theme is “Health Disparities: Local, National, Global,” and the series was put together with the Urban Health Initiative, the Global Health Initiative, and Finding Answers. ScienceLife will carry regular coverage of this unique series, often accompanied by video of the lectures provided by the MacLean Center.]

About Rob Mitchum (526 Articles)

Rob Mitchum is communications manager at the Computation Institute, a joint initiative between The University of Chicago and Argonne National Laboratory.

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