2003-09-15 -- PROPOSITION 54'S EFFECTS ON HEALTH CARE

The following information concentrates on Prop 54's effects on
structural racism in health and health care, but it could equally
apply to housing, education, employment, incarceration, police
profiling, or many other aspects of life.

RACIST HEALTH DISPARITIES:

Of all industrialized nations, the US has the worst infant mortality,
highest percentage of low-birth weight babies, shortest male
life-span, second-shortest female life-span, and second-lowest
visits-to-doctors-per-person.   11 US residents die per hour from lack
of healthcare.

Although these abysmal statistics affect everyone, racial "minorities"
(soon to become the majority in Calif) are particularly affected.

In 2002, the Institute of Medicine, wrote

"Minorities are less likely than whites to receive needed services,
including clinically necessary procedures. These disparities exist in
a number of disease areas, including cancer, cardiovascular disease,
HIV/AIDS, diabetes, and mental illness, and are found across a range
of procedures, including routine treatments for common health
problems."

"Standardized data collection is also critically important in efforts
to understand and eliminate racial and ethnic disparities in health
care. Data on patient and provider race and ethnicity would allow
researchers to better disentangle factors that are associated with
health care disparities, help health plans to monitor performance,
ensure accountability to enrolled members and payers, improve patient
choice, allow for evaluation of intervention programs, and help
identify discriminatory practices."

Some examples:

In the San Francisco Bay Area:

Residents of mostly black areas of south and west Berkeley have a
20-year shorter life expectancy than white residents of Berkeley hills
or Claremont areas.

Blacks are 20% of Berkeley's population, yet have 1/3 of AIDS cases
and over half of hepatitis-C cases.

In San Francisco, black men now have a life expectancy of 60 years,
the lowest since 1970.

Alameda County black children and women in their reproductive years
have twice the mortality rate of their white counterparts.  Poverty
alone was not an explanation.

Cancer:

Breast and cervical cancer rates for Bayview-Hunters Point women under
50 are twice those of San Francisco as a whole, from lack of gyn care
and pap smears.  Breast and cervical cancers are the leading causes of
death among black women 15 to 50 years old, mainly for want of early
detection, particularly in poor areas.

Black women have lower breast cancer rates than white, but they
develop it earlier, are screened less, are diagnosed later, and a
higher percentage of cases die. Only 22% of women diagnosed with
breast cancer at NY's Harlem Hospital live five years, compared with
76% of white women and 64% of all black women.

Elderly blacks are less screened than whites for cervical, breast, and
colon cancer, despite being more likely to live in areas polluted by
carcinogens and other toxins.  Bayview Hunters Point houses 1/3 of San
Francisco's hazardous waste sites.

Vietnamese women have the highest cervical cancer incidence rates of
all women.

Diabetes:

Diabetes is the seventh-leading cause of death, the leading causes of
blindness for ages 20-74, in kidney failure, and non-trauma-related
leg and foot amputations.  Diabetics are 2 to 4 times more likely to
have strokes and death from heart disease.

Blacks are 1.7 times as likely to have adult diabetes; 25% of blacks
ages of 65 to 74 have it.  Among all diabetics, blacks are twice as
likely to become blind, 1.5 to 2.5 times more likely to have leg or
foot amputations, and 2.6 to 5.6 times more likely to have kidney
disease.

Latins are almost twice as likely to have adult diabetes;
approximately 24% of Mexican Americans ages 45-74 have it.  Among all
diabetics, Mexican Americans are 4.5 to 6.6 times more likely to
suffer from kidney failure.  32-40% of Mexican Americans have
diabetes-related eye damage.

Tuberculosis

TB is a disease of poverty and overcrowding. Drug-resistant TB, fatal
in 50 to 70% of cases, is on the rise.

Compared with the white population of the US:

New York City Latinos are 299 times more at risk,

New York City Asian/Pacific Islanders are 421 times more at risk; and

New York City blacks are 701 times more at risk.

Glaucoma:

Blacks have glaucoma at four times the rate of whites, but are half as
likely to get surgery for treatment, though it's the leading cause of
blindness among blacks.

Cardiovascular Disease:

28 percent of African Americans and 22 percent of Latinos suffer from
high blood pressure, as compared to 15 percent of whites and Asians. A
history of high blood pressure is a powerful predictor of stroke, no
matter where a person's blood pressure now stands. Stroke is the
third-leading cause of death.  Blacks ages 35 to 54 have four times
the risk of dieing of a stroke than their white counterparts.
Middle-aged Hispanics, Asians, American Indians and Alaska natives
also are at greater risk.  Blacks' strokes are more severe as well as
more common.

An analysis of 45 million hospital discharge records found that blacks
who suffered from heart disease and several types of cancer were less
likely than whites to receive an "attempted cure," even when nearly
two dozen other factors influencing medical care were taken into
consideration.

Blacks were "much less likely" to receive lifesaving and costly
treatment following a heart attack, such as angioplasty or bypass
surgery.

Black heart attack victims received less high-tech diagnostic
procedures than whites, even from black doctors.

Black heart attack victims are less likely to get proven therapies
dissolve clots or prevent recurrence, such as beta-blockers or
aspirin.

Elderly blacks were less likely to receive "life improving"
procedures, such as hip replacements, compared to whites.

Health Care Access:

1/3 of US Latinos under 65 lack health insurance.

Nearly half of all Native American/Alaskan Native women do not receive
prenatal care until late in their pregnancies

Even matching people of similar income, occupation, and education, or
even matching people of similar cardiac risk factors, people living in
"disadvantaged" neighborhoods have a higher rate of cardiac disease,
reflecting low neighborhood access to primary care.

A 1969 phone survey of seniors getting flu shots showed 69% for
whites, 59% for Hispanics, and 48% for blacks.

In 1980, admissions through Emergency Rooms that could be avoided
given proper access to primary care were 75 percent more common among
blacks than whites; and 1998 it was 131 percent more common among
blacks.

HIV

A Centers for Disease Control and Prevention study found that among
gays, 3 percent of Asians, 7 percent of whites, 15 percent of
Hispanics and 30 percent of blacks are infected with HIV, a figure
comparable to Africa.   The percentage of all men infected with HIV is
5 times higher for blacks than whites.



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MEDICAL EFFECTS OF PROP 54

As the American College of Epidemiology says,

"(We) strongly oppose Proposition 54 because epidemiologists have an
ethical obligation and a professional responsibility to address areas
of health disparity. In order to address disparities, we need to know
where the disparities lie, and this requires the collection of
specific types of data, including data on race, ethnicity, color, and
national origin."

Data on race, ethnicity, color, or national origin is needed to know
where to target healthcare, education, housing, job programs, etc.
Health officials need this information to track where and when disease
or risk occurs.

Data on race, ethnicity, color, or national origin is needed to know
to create effective prevention campaigns or informational material
using appropriate language and culture.

Studying disease and health risks where they actually occur offers the
best opportunity to study the diseases and risks themselves, and
potentially benefit people of all races.

Some examples:

Statistics regarding infant mortality, child abuse, teen smoking,
suicide, obesity, asthma, and teen pregnancy could no longer be
collected to develop targeted programs to help the children most
affected. The ban would also apply to birth and death certificates and
affect such vital statistics as infant mortality rates, asthma,
immunization rates.

Public health information on SARS, AIDS, heart disease, prostrate
cancer, etc. providing race-based health risks could no longer be
collected if Prop 54 is approved.

It would hamper the efforts of national cancer registries to identify
and monitor trends in cancer incidence and mortality if data from the
state of California were incomplete.

In Santa Clara County, culture-specific targeted outreach to the
Indian, Vietnamese, Filipino, and Mexican immigrant communities
lowered the incidence of tuberculosis, a communicable disease
affecting everyone.

In Santa Clara County, Vietnamese women are five times more likely
than white women to contract cervical cancer. Culture-specific media
messages can be tailored to inform these women. Outreach, education,
and prevention programs are most effective when targeted to specific
populations with unique health needs.

The California Primary Care Association (CPCA) reports that community
clinics and health centers (CCHCs) could lose up to $26.2 million in
funding if it cannot compete by providing population studies on health
disparities in such areas as infant mortality rates, diabetes, and
hypertension.



San Francisco Gray Panthers Health Care Committee
1182 Market Street, Room 203
San Francisco, CA   94100
415-552-8800
e-mail: graypanther-sf@sbcglobal.net