Racial inequality found in healthcare coverage

BY KATIE SIMS | JUNE 24, 2009 7:21 AM

Despite findings showing persistent ethnic disparities in health care and health status nationally, Iowa scored better than the national average. But local health-care providers said inequality still exists in Iowa City.

“When you look at the minority population in Iowa, there’s no question the disparities are still there,” said Penny Dickey, the chief operating officer of Planned Parenthood of Greater Iowa.

According to a new report by the Kaiser Family Foundation, although Iowa notched a “Better than Average” score in the report — meaning it was better than the national average in such categories as health status and access and utilization.

The state lacks minorities in the first place. Four to 15 percent of Iowa women self-identify as an ethnic minority. But health-care workers in Iowa City still see the national trend.

At Dickey’s clinic, 83 percent of the clients are non-Latino whites, 11 percent are minorities, and 6 percent don’t disclose.

The Kaiser Foundation report found minority women have higher rates of certain diseases, unintended pregnancies, and abortions. Researchers found growing evidence that these trends stem from health behaviors and access to health care.

These are in turn subject to social determinants such as income, occupation, education, neighborhoods, and housing.

Barbara Vinograde, a codirector of the Iowa City Free Clinic — which saw 2,585 clients in fiscal 2008 — said she sees a disproportionate number of Latino and blacks coming into the clinic without health insurance. They accounted for more than 50 percent of the clients in fiscal 2008; 622 identified themselves as Latino and 507 as black.

According to the Kaiser report, more Latinas than any other group lacked insurance and a personal doctor, and they put off doctor visits because of the cost. Vinograde, who has worked at the clinic for more than 16 years, says it’s a huge problem.

“We often see people who don’t seek medical attention right away because they lack insurance, and their problems end up being worse because they put it off,” she said. “It is so different from 16 years ago — chronic illness has escalated.”

Birth control is also something that may be avoided because of cost. The study shows long-acting birth control methods such as intrauterine devices and Implanon are relatively expensive but more successful in preventing pregnancy than user-dependent but cheaper methods such as condoms and birth-control pills.

With complex reasons behind such health disparities, Dickey said, ethnicity has another role that may not be quantifiable in studies: solidarity. If a woman sees others of her ethnicity — or hears her primary language spoken at a health-care establishment — she might be more likely to feel comfortable enough to make regular visits, she said.

“It’s important for us to avoid having an attitude about our customers and treat everyone with respect and dignity,” she said.

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