Perception of Racial Barriers to Health Care Persists in Rural South

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Healthcare and Race

The perception that racial barriers to health care exist in the rural South is prevalent, especially among African-Americans but also among whites, according to a new study.

Overall, 36 percent of participants said that there were racial barriers to health care in their community, with 54 percent of African-Americans and 23 percent of whites reporting this perception in the study in the February issue of the Journal of Health Care for the Poor and Underserved.

This perception may breed mistrust and dissatisfaction in those who receive health care in the area, according to researchers led by Angela Fowler-Brown, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School.

The researchers looked at survey data from 3,694 respondents in Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina and Texas. The survey took place in counties with higher poverty and unemployment rates, and higher minority populations than the national average.

Randomly selected participants answered questions about demographic characteristics, health-care use, use of preventive services (such as routine check-ups and tests), satisfaction with health care received, whether they felt accepted in the clinic where they received care and their level of confidence in their physicians.

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African-Americans who were middle-aged or older, male, or who reported being in good- to-excellent health were more likely to perceive racial barriers. Those who perceived barriers reported lower satisfaction with care and quality of care, with concern shown them in the medical setting and with getting their health questions answered, and less confidence in their physicians. This group, however, did not have lower use of preventive services than those who did not perceive barriers.

Among whites, those who were relatively younger, less educated, uninsured and reported poorer health were more likely to perceive racial barriers. The only factor influenced by this perception of racial barriers was less satisfaction with concern shown them in the medical setting.

According to Fowler-Brown, the higher number of African-Americans reporting racial barriers is not surprising. "The root of this problem is the institutionalized discrimination that was pervasive in American society, including the medical community, for many years," she said. "Most people would agree that there is now much less overt racism in the medical community, but the scars remain."

Thomas A. LaVeist, Ph.D., director of the Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health, said, "I think racism flairs up overtly from time to time; other times it is more subtle."

"Cultures generally change slowly, but they do change," LaVeist said. "I am hopeful that the cycle will be broken; the best way to instill trust is through trustworthiness."

"Realistically, it will likely take more time for African-Americans to feel valued by the medical community and U.S. society," Fowler-Brown said. "In the meantime, the medical community should work hard to create and maintain an inclusive and welcoming environment for people of all cultures."

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