Perry lecturer calls for ‘true studies’ of racial health disparities

Thomas A. LaVeist’s interest in health equity began as he procrastinated one day during the writing of his dissertation. Wasting time at a bookstore, he browsed a volume on the Titanic disaster. The statistics about female Titanic survivors, he discovered, showed that death rates correlated to the class of ticket the traveler held: Women in first-class cabins got onto lifeboats at much higher rates than women in steerage.

His interest more than piqued, LaVeist embarked on a career-long investigation of how health policies, regulation, economic status and more affect the quality of health care and, indeed, health itself, focusing on disparities experienced by Black people.

Today, LaVeist is dean and Weatherhead Presidential Chair in Health Equity at the Tulane University School of Public Health and Tropical Medicine, and a noted expert on equity and health issues. He offered his insights on the topic on Nov. 13 during the 32nd Annual J. Warren Perry Lecture, sponsored by UB’s School of Public Health and Health Professions.

“Why do African Americans have the highest mortality rates?” LaVeist asked, and approached the topic by debunking three popular myths about health disparities:

• Equal access to health care will solve the problem. LaVeist conducted a study of men who needed a referral to diagnose possible heart disease. Even when Black men had the same physicians and health insurance, they got referrals at lower rates than white men  
• Biological or genetic differences cause disparities. LaVeist said this myth has a “long history” and creeps into our thinking “in subtle ways.” He discussed a situation in which combining two drugs saw good results in reducing heart disease in men, and at slightly greater rates in Black men. The drugs’ manufacturer received FDA approval for their use in Black men. However, the initial study also showed the drug was effective in white men and, LaVeist argued, is effective in any man, whether Black, white or another race.
• Race differences in socioeconomic status or poverty cause race disparities. “Even if this were true,” LaVeist said, “what difference does it make? The point is that people are having inequitable outcomes.” He cited National Health Interview surveys showing income, poverty and race all affected disparities. But analyzing those same surveys’ results further shows that race, income and other factors, like problems with completing daily physical activities, combine in various ways to affect health.

What, then, does drive disparities? “While we live in a country together, we experience that country in very different ways,” LaVeist said. He displayed an infographic of the subway system in Washington, D.C., that showed that the particular subway lines people took effectively predicted their life expectancy because they correlate to “where people live.” He also cited a study of Baltimore that tallied corner stores selling not much more than cigarettes and bottles of 40-oz. malt liquors, which LaVeist called “elixirs for the ills of poverty.” Such stores existed almost exclusively in highly segregated, predominantly Black, low-income communities.

The reason? “Racial segregation creates an infrastructure where communities can be targeted for harmful products like malt liquor and exposed to other health risks,” he explained.

A big issue in attempts to study the problem of health disparities based on race is that studies often do not “account for the fact that the country is dramatically racially segregated and that people are living in extremely different risk environments and have different experiences that might account for the race differences.” The remedy, LaVeist suggested, is to conduct true studies of race by finding “communities where people are living together with the same risk profile and socioeconomic status, and then we can say we have a true apples-to-apples comparison, and we can say something about the disparities.”

LaVeist and his colleagues have done just that, by first identifying 426 communities that meet the criteria he outlined. His EHDIC study (Exploring Health Disparities in Integrated Communities) looks at data from several of those areas and compares them with national data sets to see how the results compare related to disparities.

“When people live under similar conditions, we find their health outcomes are much more similar,” LaVeist said.

Ultimately, he added, the four “great race disparities” are health, education, wealth and criminal justice. Unless society acknowledges that they form a “causal web” that all influence one another, “We won’t make any progress.”

LaVeist revisited a question he posed at the beginning of his talk asking what a society without racial disparities would look like. He closed with the follow-up question — a challenge, in fact — "What would we have to do to make that possible?”

The J. Warren Perry Distinguished Lectureship honors the late J. Warren Perry, founding dean of the School of Health Related Professions, precursor to the School of Public Health and Health Professions. A pioneer of the field of allied health, Perry was a prolific and accomplished scholar, administrator, author and lecturer.

View LaVeist’s full lecture here.