Assets, Access and Attitudes

As an economist, Dr. Julianne Malveaux sees the country's health care disparities through economic statistics and finds many of them troubling.

Dr. Malveaux is an educator, author, and commentator who's writing has appeared in USA Today, Black Issues in Higher Education, Ms. magazine, Essence magazine, and The Progressive.  For over a decade, her columns appeared in numerous newspapers, and, more recently, she is the immediate past-president at Bennett College for Women in Greensboro, North Carolina.

Speaking March 20 at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College as part of their "National Scholars' Current Issues in Health Policy Seminar Series," Malveaux said she chose the subject of  "Assets, Access and Attitudes" because "how much money you have determines what you get," she said.

Malveaux cited a wealth of statistics to point out economic disparities, and said that even though we've all experienced the recent recession, African Americans and Caucasians have experienced it differently.

"The average white household has an income of $51,000 a year--last year it went down by a thousand dollars. The average African American household [earns] $31,000 a year--it also went down by a thousand dollars. What's the difference? A thousand dollars to someone who earns $50,000 is a lot different from a thousand dollars to someone who earns $30,000.

"The whole issue of assets puts African American people, from a medical perspective, at a disadvantage."

Regarding access to health care, Malveaux cited the trend in many large cities of closing inner city hospitals, reducing access for urban residents, many of whom are African American. "If people don't have hospital services, obviously they ignore aspects of their health." According to Malveaux, the object of closing the urban facilities is to direct patients to the suburban hospitals.

But this, she said, brings up issues of transportation services—mass transit in most places is designed to move suburban workers into the city, not to shuttle inner city dwellers where they may need to go. And, she said, according to one survey, while 91 percent of whites own automobiles, only 75 percent of blacks own a car.

Inner city shopping, she said, doesn't provide best access to proper nutrition. Malveaux calls the inner city "supermarket deserts" for the lack of quality food shopping. The issue of food access, she said, is part of access to health.

And then, she said, there are the attitudes. "The treatment of African American people is a function of the way people see [them] in larger life."

Among the many issues she ascribed to attitudes, Malveaux cited many negative stereotypes that exist about blacks. But she said instead of assuming the stereotype, questions should be asked.

Some of those perceptions, she said, affect medical treatment and drug administration for pain. "All medical schools need to have courses in cultural sensitivity," Malveaux said. "That people understand that there is a diversity in the African American community...that everyone is not poor, but even poor people have ethics.  People are not going to the emergency room to get drugs to play with, they're going to the emergency room because they're really sick."

Once again, Malveaux, said, it's about understanding and learning."When you look at the ways that we approach medicine and the way medicine approaches us, there are huge issues."

To hear Dr. Malveaux's complete lecture, click here.