I’ve invited Niko Karvounis, a colleague at The Century Foundation, to guest-blog. Niko is currently a Program Assistant at the Foundation and an Alumnus Senior Fellow with the Roosevelt Institution. His post follows below.

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Recently I was handed a report from Bronx Health Reach (BHR) entitled “Separate and Unequal: Medical Apartheid in New York City” that reveals some startling inequities right here in the so-called capital of the world.

Bronx Health Reach is a coalition formed by the Institute for Urban Family Health, with the mission of examining and addressing racial and ethnic health disparities in the southwest Bronx portion of NYC.

At the local level in the Big Apple, these disparities play out through discriminatory care tied to health coverage. Since “health insurance is a major determinant of access to medical care,” poor insurance increases the probability of “delayed care and poorer health outcomes.” And in NYC, health insurance status is closely linked to race: “52 percent of blacks, 63 percent of Latinos” and only “24 percent of whites are uninsured or publicly insured.”  This skewed distribution of health coverage ultimately “creates a de facto sorting of patients by race.”

The most compelling evidence of apartheid can be found in the records of medical institutions which reveal the characteristics of patients that they admit and discharge.

The records show that there is a clear public-private divide when it comes to care: private hospitals have a solid record of exacerbating the racial inequities through their refusal to treat under-insured and uninsured patients, while public hospitals shoulder the lion’s share of minority—not to mention poor—patients.

Consider:

• Almost all of the NYC hospitals in the top quartile of those caring for uninsured patients are public hospitals.
• Pairs of public and private hospitals in the immediate vicinity of each other show remarkably different patterns in patient care. As BHR notes, “67 percent of discharges from the public Bellevue Hospital are for uninsured or publicly insured patients, compared to less than nine percent at New York University Hospital which is one block away.” And there are more examples:
  • The public Jacobi hospital is almost twenty times more likely to discharge the uninsured, and more than twice as likely to discharge patients on Medicaid, than is the private Montefiore Weiler hospital two blocks away.
  • At the public North Central Bronx Hospital, 15 percent of discharges are uninsured and 61 percent are on Medicaid; at Montefiore Moses, a private hospital contiguous with North Central, these numbers are 2 percent and 29 percent respectively.

And this is just a taste. The brutal truth is that the racial components of health coverage translate into segregated care—which in turn has serious health implications. Here are some startling national figures regarding racial health disparities in the US:

• In 2004 average life expectancy of a black baby was 73.1 years—or, as BHR puts it, “the same life expectancy that a white baby had in 1970, a lag time of over 30 years.”
• The current lag time in infant mortality rates is a whopping 40 years, meaning that the odds of a black mother losing her newborn are as good today as they were for a white woman in the 1960s. As some noted earlier this year, “non-Hispanic black women had the highest infant mortality rate in the United States in 2004 — 13.60 per 1,000 live births, compared to 5.66 per 1,000 births among non-Hispanic white women.”
• Since the 1970s, the death rate from heart disease for whites has fallen much faster than it has for black: today, the survival rate for blacks equals survival rates for whites eight years ago.
• The death rate for blacks from HIV/AIDS is nearly 7 times higher than it is for whites.

While it’s unreasonable to pin differential health outcomes entirely on deficient care and ignore the effects of poverty, environment, and behavior (see Maggie’s post on “Class and Health”), the segregated delivery of medical care is beyond a doubt a critical factor.

Worse, the disturbing patterns BHR chronicles in New York City are likely repeated a thousand times over across the nation: race and health care coverage are correlated at the national level as well. According to the Census Bureau, 10.8 percent of non-Hispanic white Americans did not have health insurance in 2006, compared with 20.5 percent of blacks; 9.0 of non-Hispanic whites are on Medicaid, versus 22.8 percent of blacks.

Tomorrow: More facts about the many faces of medical apartheid outside of NYC—and how it is chipping away at the health of the nation.