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Risa Lavizzo-Mourey, M.D.

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Better Health for All Americans: Bending the Arc Toward Justice

Posted: 10/23/11 12:50 AM ET

As thousands of people gathered in Washington this past weekend to dedicate the Martin Luther King, Jr. National Memorial, I found myself reflecting once again on a statement Dr. King uttered two years before his assassination: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

These 16 powerful words have motivated much of my career. As a physician, I have worked to reduce the health care disparities that exist in our society -- that deny many Americans the access and quality of care that would help them lead healthy lives. No question, we have made progress during the past half-century. But I remain extremely troubled by how much distance we have not covered.

Equity in health and health care are singular human rights. The code word for the lack thereof is disparities. We seldom say out loud that it really means what happens when you're not white. And disparities remain because the majority of America too often fails, even today, to regard the vast numbers of our poorest, oldest, sickest non-white people as equal members of our society.

For African Americans, the ramifications are seen in statistic after statistic. They extend from the moment of birth all the way through old age.

  • African-American babies are almost four times as likely to die of causes related to low birth weight compared to white babies.
  • African Americans are twice as likely to be diagnosed with diabetes compared to whites -- and after that diagnosis, they are more likely to go blind, have feet and legs amputated and suffer end-stage renal failure.
  • African Americans are twice as likely to have a stroke compared to whites, and they're more likely to become disabled or die.
  • African Americans still live on average about five years less than whites.


None of this should be a revelation to any American and certainly not to any of this nation's leaders. Ten years ago, I co-led the committee that produced the Institute of Medicine's landmark report on disparities in health care. "Unequal Treatment," we called it, and we identified vast differences among racial and ethnic groups in their access to health care and health insurance. But far more disturbing was our finding that minority patients received lesser quality of care even when insurance status, age, income and other factors were comparable.

Since then, little has changed. This past spring, the federal Department of Health and Human Services announced a plan to reduce health disparities. It acknowledged that African Americans and other racial and ethnic groups still face more barriers in getting preventive care to stay healthy or acute treatment when they fall ill. They also get poorer care in managing chronic disease.

Communities of color continue to be hit harder than their white counterparts in almost every category that contributes to health security -- not only health care but education, employment, income and housing. The impact is persistent and pernicious, and it spans generations.

This is not a natural disparity. This is a national disgrace. And unless we truly narrow the gap, this will become a national disaster. The Census Bureau reports that more than half the nation's working age population will be people of color by 2039. We must make significant strides forward, or the future U.S. workforce will be less healthy and less productive as a consequence.

So how do we turn the tide of health care inequality?

America cannot reconcile the differences that divide us without reconciling the issues embedded so deeply in the health and health care of our people. As Dr. King taught us, "Whatever affects one directly, affects all indirectly."

This, then, is the task before us. Let us draw inspiration from the man we honored this past weekend, who also said, in a speech several months before he was killed, "The arc of the moral universe is long, but it bends toward justice."

Let us transform disparities into equity -- and bend the arc of America's good health toward justice.