Brand new research on health disparities - Timely for our discussions this week!
Tuesday, September 27, 2011
Arch Intern Med -- Black/White Racial Disparities in Health: A Cross-Country Comparison of Canada and the United States, September 26, 2011, Lebrun and LaVeist 171 (17): 1591
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This is a very interesting article. It is easy to assume that different health care systems will result in different levels of access, even to apply norms for one population in one health care system to the closest similar population in another. In the case of black people in Canada and black people in the Unites States and their health in comparison to their white counterparts, the results were far more extreme than I would have imagined.
ReplyDeleteI figured that as a result of the better access that Canadians have to health care overall, they would all be healthier and that black Canadians would be healthier than black Americans. I thought that whites would be healthier than blacks in both populations but, the results surprised me. Black Canadians overall are healthier than white Canadians, therefore making them healthier than black Americans and white Americans.
Yes, this is one study with a small sample size and is not really generalizable. However, it brings our attention to the relevance of one’s history in their health. American blacks are more likely than Canadians to be descendants of slaves which are impactful on how ideas on health and decision making are made. Canadian blacks are more likely to be immigrants or children of immigrants who relocated willingly.
Taking into account the history of a population tends to go unnoticed when blacks are studied. I am curious what the results of a health study of black Americans who are immigrants versus black Americans who are descendents of slaves would be.
Definitely very interesting article, particularly for me as a Canadian. Besides the big difference in health care system between US and Canada, I'm very fascinated by how history and perhaps sociology are related to this, like Twylla mentioned. Although there was some practice of slavery in Canada (until the 1830s), it involved marginalizing a different group of people-- the indigenous/aboriginals. Unlike America, trans-Atlantic trading of African slaves was not seen very much in Canada. (Thanks, Wikipedia.)
ReplyDeleteI think in many ways, African Americans might still be recovering from the effects of slavery. Even though it's been almost 200 years since the abolishment, the distinction between blacks and whites in America is still very clear... and this shows up in all the different ways that we've been reading about-- health disparities in life expectancy, health status, access to care, insurance status, income, education, poverty, crime, family structure, literacy, STDs, access to critical services, urban planning, community development, etc.
Going back to the study, I wonder how might the results be different if the authors lowered their data selectiveness to include also recent immigrants (e.g. individuals who immigrated within the past 10 years). Are blacks healthier in Canada because they are in an environment where health care is much more readily accessible? Or are they healthier simply because they started out at a healthier baseline? And what explains the finding of blacks being generally healthier than whites in Canada-- do they have greater utilization (assuming equal access between blacks and whites), or is it driven by some other determinants? This article opens up a lot of questions...
And I definitely share the same concern about sample size that Twylla mentioned. (Data = only 729 blacks and 280,672 whites in Canada & 14,211 blacks and 64,625 whites in USA.)
For some reason I cannot access the full article, but would love to read more.
ReplyDeleteFrom what I was able to read, I find it quite interesting that Black Canadians have trouble "accessing care." How can this be? I assumed that having National Health Insurance, would have eliminated access issues.
Are doctors just refusing care to these patients? Are there no hospitals in certain areas similarly to how there are no supermarkets in certain areas of Rochester, thus limiting one's ability to access these services?
From reading the comments above, I now I need to read the remainder of this article. HELP!