Research: Proposal 2 could have ‘adverse health effects’ on state’s minorities

October 18, 2006
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ANN ARBOR—A ballot proposal to restrict affirmative action being considered by voters this fall could have “adverse health effects” on minorities, according to a report by a University of Michigan School of Public Health professor.

Proposal 2 would amend Michigan’s Constitution to make it illegal for public bodies, including public universities, to discriminate against or give preferential treatment to any individual or group on the basis of race, gender, color, ethnicity, or national origin for public employment, education, or contracting. The proposal is modeled after similar initiatives approved in California and Washington in the 1990s.

Richard Lichtenstein, a U-M associate professor of health management and policy, predicts in a 12-page review of research that that the Michigan Civil Rights Initiative would likely reduce minority enrollments at medical schools.

He warned that cutting minority enrollments “could have disastrous effects on the health of minority patients, particularly those who live in medically underserved areas like Detroit, Saginaw and Benton Harbor and on those who prefer to see physicians who are from the same racial and ethnic group as themselves.”

All Michigan residents, regardless of incomes, should care about these inequalities, he said. He noted the Institute of Medicine has documented that when one part of the population has poor access to health care, lacks preventative care and experiences more serious illness, it tends to increase the cost and availability of health care for all residents, including the most affluent.

Prior to the 1960s, minorities made up about 3 percent of medical school enrollments. That ratio grew during the affirmative action efforts of the 1960s and 70s but dropped again after the 1978 Bakke Supreme Court case. Minorities today make up 12 percent of enrollment at medical schools with the only declines coming in California and Washington state, which passed ballot initiatives barring affirmative action.

“Minority populations in the United States suffer disproportionately from poor health status and members of minority groups are more likely to die early from a broad range of diseases,” Lichtenstein said, noting that the average Caucasian woman lives four years longer than the average African American woman while the average Caucasian male lives six years longer than the average African American male.

African Americans have higher mortality rates than Caucasians for many ailments including heart disease, stroke, diabetes, prostate cancer, breast cancer and AIDS, he noted, adding that the infant mortality rate is two times higher for African Americans than whites nationally and three times higher in Michigan.

Part of the reason for the disparity may be the problems minority patients encounter when seeing non-minority physicians. Research has found that these physicians tend to lack cultural sensitivity when dealing with minority patients and, thus, communication suffers. Some minority patients don’t trust the healthcare system and, therefore, don’t use necessary care, research showed.

Minority physicians have been found to be more likely than whites to choose to enter primary care over a sub-specialty, to locate their practices in communities that are underserved by healthcare practitioners and to care for more minorities (including those receiving Medicaid). Although minority populations may be better served by minority physicians, the number of minority physicians is too small to meet these populations’ needs.

He cited 2005 research showing 51 percent of new African American physicians, 41 percent of Native Americans and 33 percent of Hispanics were planning to set up practice in underserved areas compared to only 18.4 percent of whites.

Without the ability to consider race as a factor in medical school admissions, Dr. Jordan Cohen, former president of the Association of American Medical Schools, projects that the number of African Americans, Hispanics and Native Americans could drop nationally from 1,868 (the total number in 2001) to 526, a 72 percent drop.

“With the growth of the minority population in the U.S. and in Michigan, there is also a growing need for more minority physicians,” Lichtenstein said. ” In the future, minorities will likely continue to experience limited access to healthcare, face cultural and linguistic barriers to obtaining healthcare, and receive lower quality care if affirmative action programs are banned and no other means for increasing diversity is operating in its place.”

 

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