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Commentary: Race and Health Care Reform

By Dr. Edward Rincon

Dallas, TX –

INTRO: In the local and national debate about health care reform, commentator Edward Rincon believes one subject has been absent. Dr. Rincon's research firm conducts a periodic study of the health-related experiences of Dallas-Fort Worth residents that includes a broad cross-racial sample of adults interviewed in five languages. Rincon shares some results to explain why he believes race and ethnicity should be part of the dialogue in this debate.

COMMENTARY: 46 percent of the Dallas-Ft. Worth area now consists of African-Americans, Hispanics and Asians. That's 2.9 million persons. These residents have language abilities, values and cultural traditions that vary sharply from white residents. Several findings from our Health Watch study remind us health care providers are falling short in several areas as multicultural residents become a larger part of the patients they serve.

For example, Asians and Hispanics had the most difficulty understanding medical forms, explanations given about their illnesses, and the instructions on prescription medicine. Communication issues can complicate diagnoses and compliance with medical advice. Although we all have some difficulty understanding medical terminology, comprehension is more challenging for patients like Hispanics and Asians, many who are foreign-born and less proficient in English.

In regards to health-related attitudes, we discovered some race-ethnic differences that can influence important health outcomes. African-Americans, for example, were the least likely to plan an organ donation, an unfortunate barrier for the many African-Americans waiting for an organ transplant. African-Americans and Hispanics felt more nervous about donating blood, and believed a doctor's advice should never be questioned. Attitudes, however, can change and it's especially important we try to change them when the supply of organs and blood is at stake.

For some patients, experiences with their personal physicians were less satisfactory. For example, Asians reported their personal physicians were less likely to allow them to ask questions or to take the time to explain things clearly to them. And Hispanics were more likely than other race-ethnic groups to feel that their personal physicians kept them waiting for long periods of time. Are physicians less comfortable in treating multicultural patients? If so, perhaps medical educators should consider updating the training that physicians currently receive.

Not all of the study findings related to shortcomings in our health care delivery system. Despite record levels of obesity, nearly half of all adults in D-FW did not exercise at all. African-Americans and Hispanics - who have some of the highest levels of obesity and diabetes -- were the least likely to exercise. The lack of exercise, coupled with unhealthy lifestyles, may partially explain why a greater proportion of the persons waiting for an organ donation are African-American and Hispanic.

And lastly, I agree with Dr. Andrew Weil that the marketing practices of the pharmaceutical industry are creating more dependency on medication as a long-term solution. In his new book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future, Dr. Weil points out drug companies spend unprecedented amounts on advertising directly to consumers using the familiar tagline "Just ask your doctor" - a tactic that has been highly profitable in sales related to new medications. However, aside from the drugs being ineffective or showing serious side effects, Dr. Weil warns the ads for the drugs "circumvent better sources of health information." African-Americans and Hispanics, who depend more on television for health-related information, are especially susceptible to the message that these ads deliver: that medication is the solution to healthy living.

The message seems clear. Healthcare providers need to take more responsibility for improving their communications and relationship with patients from all backgrounds. As individuals, we also need to focus more attention on health alternatives like exercise and healthy eating that provide more affordable, long-lasting benefit than the many medications that are promoted regularly on television.

Dr. Edward Rincon is President of the research firm, Rincon and Associates, based in Dallas and a faculty member at The University of North Texas.

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