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Research: A “Perfect” Record — Minority Women Face Health Care Disparities in All 50 U.S. States

  • August 13, 2009

by Susan Welch, Hewitt Research –

Sadly, the headline above is not unusual. Dating back to the 1990s, minorities have fared worse than whites in multiple health care issues, ranging from heart attack care to major surgery. The situation becomes worse if you are a woman. It was only in 1985 that the medical community acknowledged it did not include women in clinical research trials. Although they have been catching up in recent years, women still lag in some areas, notably heart issues. A 2005 report found that women remained less likely to get basic medical care to reduce their risk of heart attack or stroke; they are less likely than men to receive certain procedures and rehabilitation after a first heart attack.

Women of color, then, are doubly unlucky. For years, headlines have blared the news: ”Minority women have greater chance of dying during childbirth,” or “Minority women receive less health care for breast cancer,” or “Racial divide found across health plans,” or “Black women at higher risk for major diseases.” When one-third of American women self-identify as a minority—and that number is projected to reach 50 percent by 2045—the disparity impacts a significant chunk of the United States.

A recent Kaiser Family Foundation study explored health care disparities among women of color in every state. While disparities exist throughout the country, the study is careful to point out the nuances around these disparities. For example, the District of Columbia scored the most disparities across the indicators studied by Kaiser, likely due to large social inequalities between white and minority women in D.C. By contrast, West Virginia seemed to have fewer disparities—but only because white and minority women scored equally low on a variety of health indicators in that state.

As students of the Inclusion Paradox theory, we can’t be surprised to learn that different minority groups experience different inequities. For example, according to the Kaiser study, American Indian and Alaska Native women had the most health care difficulties. They struggled with more illnesses, such as smoking and obesity; they tended to have less insurance and participate less in preventive screenings; and they had greater socioeconomic difficulties, including the highest poverty rate of any minority group studied. Asian American/Native Hawaiian/Pacific Island women, by contrast, tended to have better health across the board, but lower participation in preventive screenings. Black women were the most proactive about preventive screenings, but nonetheless had more health problems than most other groups. White women did not fare as well as minorities in some areas, including smoking and psychological stress.
What these data suggest is the difficulties for women go beyond simply skin color. Some of them are cultural, some of them are socioeconomic, and some of them are racially inherited tendencies.

As the Obama Administration tackles health care—incorporating efforts to address racial and ethnic inequalities—employers have a role to play in helping level the playing field. In fact, employers face financial repercussions if they don’t tackle this issue—while the actual cost of health care disparities is not known, disparities do result in increased utilization and medical costs, as well as claim costs.

Incorporating the teachings of the Inclusion Paradox, employers readily can see that one size hasn’t fit for quite some time. Designing benefit programs that target a variety of populations is a great first step. This doesn’t mean developing the “African American plan,” the “Asian plan,” and the “Hispanic plan.” Rather, it means understanding the different cultures at play, and developing a plan with multiple options and flexibility to meet the needs of a variety of cultures and ethnic backgrounds. As described in the Inclusion Paradox, providing an on-site clinic acknowledges the needs of several different cultures: family-oriented Latinos who may wish to bring their children to their workplace for a checkup, time-pressed working mothers who suffer through an illness because they can’t fit in a quick off-site visit to their physician; on-the-go Millennials who wouldn’t otherwise take the time to visit their doctor.

Of course, the best-designed benefits program—laden with options that would appeal to multiple cultural and ethnic groups—can’t help if it isn’t understood or used. Here’s where an effective, targeted, and again—flexible—communications approach comes into play. Understanding when and how employees like to receive messages can go a long way toward increasing the message’s reception. Some ethnic groups, for example, prefer face-to-face meetings and tend not to use online vehicles. Offering the message via several vehicles, in multiple languages if it’s appropriate, gives employees lots of chances.

According to the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” Employers have a role to play in helping everyone achieve this well-being.

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