Poverty, lack of access and distrust of the medical system are the root causes of the disparity of health care and clinical outcomes between minority and white populations in the Youngstown area.
Lack of access to preventive care, healthy food, transportation and medical literacy are part of the mix of obstacles, said Felicia M. Alexander, director of the Youngstown Office on Minority Health.
Poverty and access, which go hand-in-hand with lack of education and training, jobs that pay a living wage, adequate health insurance for the working poor and awareness of a healthy lifestyle are prime motivators, say Alexander and Dr. David Davis, Youngstown City Health District medical director.
The mission of the Youngstown Office on Minority Health, which opened in 2008, is to reduce health-care disparities.
According to the National Center for Minority Health, health disparities are defined as the difference in the occurrence, death rate and burden of health conditions that exist among specific population groups in the United States.
The YOMH is working with other local health-care organizations and community groups to increase awareness among minorities and improve health-care education, advocacy and support to reduce the disparities, Alexander said.
According to the “Years of Potential Life Loss” study, the leading causes of death for minorities, African-Americans, Asian Americans, Hispanics, Latinos, Native Americans, and all ethnic groups in Mahoning County are heart disease, accidents, cancer, respiratory disease, premature birth, homicides, suicides and liver disease.
“We need to get more engaged with community-based organizations such as schools and their nurses, churches and their nurse guilds and health ministries, block-watch groups and community centers,” she said.
Part of the problem is inadequate reimbursements from health-care providers such as Medicaid and Medicare and even private insurance companies.
Even when people have insurance, such as Medicaid and Medicare, not all doctors will accept them as patients, said Dr. Davis, a primary-care physician with a private practice, DMHD Family Practice at 1320 Belmont Ave., Youngstown.
Part of the answer is to give all people access to all physicians, primary-care and specialists, by increasing Medicaid and Medicare reimbursements to cover the cost of services and allow a profit, which would drag private-insurance reimbursements up with them, said Dr. Davis, a graduate of Morehouse College in Atlanta and Ohio State University College of Medicine.
Dr. Davis said he believes the Patient Protection and Affordable Care Act, commonly called Obamacare, will benefit masses of people, but thinks physicians probably will make less money.
That could lead to physicians having to see more patients for less time to make the same amount of money, a cycle in which quality of care could suffer, depending on the physician, he said.
Dr. Darrell Grace, a primary-care physician who is a hospitalist at St. Elizabeth Health Care Center and Northside Medical Center, says distrust of the medical system by minorities is a major obstacle to access to health care.
Distrust is alive and well and passed on from generation to generation about subjects such as the Tuskegee syphilis experiment conducted between 1932 and 1972 by the U.S. Public Health Service, Dr. Grace said.
Under the experiment to study the natural progression of untreated syphilis in rural black men, 600 impoverished sharecroppers were enrolled: 399 who had contracted syphilis before the study began, and 201 without the disease. The men were given free medical care, meals, and free burial insurance, but were not told they had syphilis nor were they ever treated for it.
“I’ve had people say to me, they are not going to use me for a guinea pig,” said Dr. Grace, a 1968 graduate of The Rayen School. She graduated from Youngstown State University as a registered nurse; received a bachelor’s degree in health services in 1987 from YSU and graduated from the Michigan State University College of Osteopathic Medicine in 1992.
The climate of distrust and suspicion that translates into hostility leads to minorities hesitating to seek early medical treatment that leads to a late diagnosis by which time the disease is more advanced, harder and more expensive to treat and life threatening, Dr. Grace said.
“It is our job as physicians to dispel that distrust,” Dr. Grace said.