Work needed to address health care disparities

ORLANDO, Florida (CNN) -- Pointing to numerous studies that show disparities in the medical treatment of women and minorities -- especially for heart disease -- a team of medical researchers said Tuesday that more needs to be done to address the problem.

The researchers looked at numerous studies examining which patients receive the best cardiac care, and found that women and minorities are less likely to receive the most advanced treatments, or even standard procedures such as cardiac catheterization, which is used to diagnose coronary artery disease.

For example, Dr. George Mensah, a cardiologist with the Centers for Disease Control and Prevention, said studies previously released have shown that only two-thirds of African-Americans who need a cardiac catheterization referral actually get one when compared to the white population.

The American College of Cardiology is meeting here to discuss such studies and what can be done to improve health care among the female and minority populations.

The researchers said the disparities may stem from communication problems and urged doctors to develop a better rapport with their patients.

The research committee included representatives from five prominent medical organizations: the CDC, the National Heart Lung and Blood Institute, the American College of Cardiology, the American Heart Association and the Association of Black Cardiologists.

Mensah, who is a member of the ABC, said two of the 18 recommendations presented at the symposium stand out, including one on health insurance.

"Every American deserves to have the right to basic health insurance; that is, we find, a major factor that impacts access to care, and it disproportionately impacts women and ethnic minorities," Mensah said.

Mensah said universal health coverage would not only help close the gap between minority and non-minority Americans, but it would help all Americans.

Universal health care has proved to be a thorny political issue with lawmakers in Washington disagreeing on how involved the federal government should be in guaranteeing medical care for all Americans.

Mensah said another recommendation merits emphasis: "Equal care for equal indications, regardless of race, ethnicity or gender."

"Our approaches to treatment must be based on the best clinical science. That's it," he said. "Not just where the person is from, their income level, whether they're black or white or whether they are a man or woman."

He said it's not certain why there are such large differences between various segments of the population.

"What we don't have are appropriately designed studies that look into the mechanisms why these disparities persist," Mensah said. "If we knew better what the most important mechanisms were, then we can really target our approaches to eliminate them."

He believes a part of the problem is communication. Doctors of one ethnic background may have a hard time communicating with patients of a different background. This may also be true when the doctor and patient are of different genders.

Doctors, the researchers said, need to be sensitive to how patients communicate, and they need to be aware of how patients of different cultural backgrounds may describe their symptoms. Mensah said he is concerned that while many doctors have heard these messages, some doctors still miss important cues from patients.

He also said the responsibility of good communication also rests with the patient. Studies have shown that patients of one cultural background are less trusting of doctors from a different cultural background. This means they may not be as open in discussing their problems with that doctor, which makes proper diagnosis more difficult. Experts say a thorough questioning of a patient can overcome this barrier, but some health professionals neglect to do this.

The research committee's 18 recommendations, which touch on health insurance, rural health care and patient trust, are expected to be published later this year after they have undergone extensive peer review.

Heart attacks treated differently for men, women
July 6, 2000
Hypertension a greater risk for black women
November 1, 1999

Centers for Disease Control and Prevention
National Heart, Lung, and Blood Institute (NHLBI)
American Heart Association National Center
American College of Cardiology
Association of Black Cardiologists, Inc.

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