Equality in the 1990s would have saved 900 000 black Americans

Janice Hopkins Tanne

New York

Eliminating racial inequality in health care in the United States would have saved the lives of almost 900 000 black people from 1991 to 2000, says a report published in the
American Journal of Public Health ( 2004;94: 2078-81) . Equality of care would have saved five times the number of lives saved by new technologies and treatments, the investigators say. 

Health officials talk about the impact of HIV and heart disease on black people during a briefing at the Centers for Disease Control and Prevention, Atlanta Credit: JOHN AMIS/AP

The study used information from the National Center for Health Statistics to look at the effect on mortality of improved medical technology and treatments and the effect of eliminating differences in health care between black and white Americans. 

From 1991 to 2000, age adjusted mortality declined by an average of 0.7% a year. The study assumed that the decline in mortality was due entirely to improvements in medical care through better drugs, devices, and treatments. The investigators calculated that improvements in care prevented 176 633 deaths. 

However, if the death rate among black Americans was the same as that among white people, 886 202 deaths would have been prevented—more than fives times as many as were saved by improvements in care. 

"I was impressed by the size of the difference. I didn't expect it to be that big... I always knew the mortality rate of black babies was twice that of whites. I didn't know that mortality in middle-aged African Americans was twice as high as whites," said Dr Steven Woolf, one of the report's authors and professor of family medicine, preventive medicine, and community health at Virginia Commonwealth University. 

Age adjusted mortality among the white male and female populations was an average of 29% and 24% lower, respectively, than that among the black male and female populations. Mortality among black infants and black adults aged 25 to 54 was more than double that among the corresponding white groups. 

A co-author, David Satcher, a black American who is a former US surgeon general and is currently director of the National Center for Primary Care at the Morehouse School of Medicine, Atlanta, said that access to care was a big factor. Black and Hispanic Americans are more likely to be uninsured or underinsured and underserved. 

The authors noted the limitations of their study, including the assumption that racial disparities could be easily eliminated. The study also assumed that the overall decline in mortality was due entirely to improvements in medical care, rather than assuming that some of the decline may have been the result of factors such as environmental and lifestyle changes. 

Dr Woolf said "We need to re-engineer the system, to cope with increasing disparities in access to health care." 

Update: I forgot the link to this article from the electronic British Medical Journal.