Note: This is the second in a series of three essays about Health Care reform in the United States. Yesterday I discussed the lack of civility in the public debate. Tomorrow I will focus on what each of us can do to make a difference.

A significant factor in the need for health care reform that has, for the most part, not been part of the national discussion is the impact that race and racism has on one’s health and access to health care.

According to a study by the Institute of Medicine,

a consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.

Relative to people of European descent, people of African descent fall on the negative side of a wide array of important social indicators that impact health and access to health care. The lack of health insurance coverage is 42.3% more likely for black folks than for white. The median income rate is 55.3% lower and poverty rates are 173% higher. The average white American will live five and one-half years longer than the average black American (7 years for males). Infant mortality rates for black babies are 146% higher than for white babies. (1)

An example in the state of California is indicative both of the crisis we face throughout the nation, and the unfortunately far-too-typical response to that crisis. This past June, I spoke in San Jose at the invitation of the Santa Clara County Black Infant Health Advisory Board. California created the Black Infant Health program specifically to provide health education and services to pregnant and parenting African-American women due to the high risk noted in the previous paragraph.

Governor Schwarzenegger cut many social service programs, including Black Infant Health, as part of massive budget cuts to balance the state’s budget. The impact to women and children in general is significant; to pregnant African-American women… devastating. Karen Bass, Speaker of the California Assembly, believes the governor’s actions are illegal. At the very least, such cuts are unconscionable and negatively impact California’s most vulnerable citizens.

Employment and economic status impact one’s health and access to health care. Income inequality is at an all-time high. Starting in the early 1990s the balance of economic power shifted more strongly in favor of the the top tier of American earners. The top 1 percent of incomes captured half of the overall economic growth over the years 1993-2007. The disparity was even more striking during the last five of those years. Between 2002 and 2007, the top 1% of incomes captured 2/3 of income growth. This is a higher level of disparity than at any time since 1917. Who, then, has the best access to health care? Who has the resources to influence the national debate? And what do you suppose is the racial makeup of those at the the top compared to those left behind?

Yes, race matters when it comes to health and health care. And the issue is complex. All people at the bottom of the economic ladder clearly have a great deal in common regardless of their ethnicity. Yet we see predominately white people opposing universal health care coverage and a government-run program. Why is that? What do corporate interests and white elites have to gain by inciting frustrated, fearful, poor and middle class white people into a frenzy of ill-informed, intractable opposition to meaningful health care reform when, in fact, they stand to greatly benefit? I encourage you to pause here to read what fellow Beacon Press author Kai Wright had to say about it recently.

Check the website for the film The Angry Heart and learn about the impact that racism has on heart disease among African Americans.

Death rates from cardiovascular disease in the United States are 49.4% higher for black men and 67.2% higher for black women than their white counterparts, according to National Center for Health Statistics and the American Heart Association. Studies show that even when both races are given the same medical treatment, African-Americans have a significantly higher risk of suffering a second heart attack than do white Americans.

Spend some time at the Unnatural Causes website. This acclaimed PBS documentary series is used by thousands of organizations around the country (including the Black Infant Health program in San Jose) to understand and confront the root causes of both the socio-economic and racial inequities in health. Learn more about how inequality is making us sick by clicking here. Download the first pdf file on the page– “10 Things to Know about Health”–and read the two powerful pages of information that show just how much race matters in one’s health and in health care distribution in the United States.

Some will no doubt take issue with the merits of my argument. As a person of European descent I understand the difficulty many white people have in accepting that race still matters so much. But it does. For those readers interested in a deeper understanding of the impact that race continues to have on all of us I recommend two books: Privilege, Power, and Difference, by Allan G. Johnson, and The Many Costs of Racism, by Joe R. Feagin and Karyn D. McKinney (the latter of which has an excellent chapter devoted to “Racism and the U.S. Health Care System”).

I also believe we can sometimes ponder and debate these challenging subjects in light-hearted ways. Truth does come wrapped in humor. So I’ll close here with a link to The Daily Show’s Senior Black Correspondent Larry Wilmore when he recently discussed the powerful nexus between health care and racial politics. My guess is that you will laugh… and that you’ll also feel a little uncomfortable. I hope so.

And for those who question my conclusions I hope you’ll take the time to research the links I’ve provided here with a sense of curiosity and wonder. I believe you’ll reach the same conclusion I have: race has a lot to do with health in the United States.

(1) Du Bois Review, 3:2 (2006) 261–297. Institute for African and African American Research, Mazzocco, et al (2006).