Closing the health care gap is a civil rights issue. That's the message Dr Adewale Troutman delivered at a networking conference in Portland, organized by United Way of the Columbia-Willamette and the Northwest Health Foundation.
"Creating health equity means focusing on fairness and justice," Dr Troutman said. "It means asking the right questions, such as 'How can we together tackle the health depriving conditions that render people vulnerable?'"
As things are today, only 1 percent of health expenditures go toward preventive care, Troutman said. "We have a non-system of sick care."
A strong supporter of a single payer universal health care system, Troutman said health care should be a right in the United States, as it is elsewhere in developed societies. But achieving health equality will take more than a functional health care system, he said. In the long term it will take redistribution of resources so that everyone has access to educational and employment opportunities and a healthy environment.
"Achieving health equality requires valuing all individuals and populations equally and entails focused and ongoing efforts," he said.
Health disparities between African Americans and Whites have been recorded from the early years of emancipation, Troutman said. But since we have kept records the only time the gap has narrowed was during the 1960s when the civil rights movement won improved conditions for Blacks, and President Lyndon Johnson created Medicare.
How does civil rights play into health care?
Troutman explained that research has shown many ways that living and working conditions impact our health. The kinds of housing we inhabit, the neighborhoods we live in, the schools we attend, the education we achieve, the jobs we work, and the day-to-day stress we endure, all have a powerful impact on our health.
"All policy is health policy," he said.
We live in a hugely unequal culture, Troutman said, and as a consequence we see huge health disparities. These health inequalities come with a cost. Every year, 83,000 Black Americans die prematurely – and that is just African Americans. Native Americans, Latinos, and poor Whites also experience severe costs. And too many health care dollars are spent on emergency care.
Yes, personal choices, such as whether to smoke, how much we drink, or what foods we eat make a difference to our health. But those choices are affected by our life situations, he said. On the most basic level, people of color often live in neighborhoods without supermarkets where healthy food is available. And they may not be able to afford the best choices.
On a deeper level, your feelings about life will affect your choices. Troutman points out that anyone who works with youth knows that many African American, Native American and Latino boys and girls already have given up on the American dream by the time they reach middle school.
"At 16 these kids had already got to the point where they had no hope and no vision for the future."
Troutman said Thomas LaVeist, a research scientist at Johns Hopkins Bloomberg School of Public Health has documented these costs in a report: ' The Economic Burden of Health Inequalities in the United States'.
"Between 2003 and 2006 the cost of health inequalities was $1.24 trillion," Troutman said.
"The civil rights movement didn't go far enough when it comes to the work we're talking about today. Perhaps it wasn't the time. But now is the time. The objective is that these kids (African American children of a single parent) have the same opportunities as everyone else. That's what we don't have and that is what needs to be done. So are you willing to take the risk?'
At the conference, staff from nonprofits came together with academics, county and state health workers to hear how their work can support health initiatives, and to discuss ways to work together. Some of those represented were: Central City Concerns, Self Enhancement Inc., IRCO, the Center for Intercultural Organizing, the Black Parent Initiative Concordia University, Portland State University, Kaiser Permanente, and the state Office of Multicultural Health.
Dr Troutman has a vision that if we all buy into it will be transformative," said Jill Murray of Concordia University Foundation.