City to track health disparities

Mayor Thomas M. Menino of Boston will unveil a comprehensive initiative this morning designed to address what public health authorities regard as the city's most pressing medical issue: the intractable differences in health status between the races.

As part of the $1 million effort, the city will help pay for hospitals to begin detailed tracking of racial and ethnic differences in the care patients receive, and it will underwrite training designed to make physicians more culturally sensitive.

Menino's announcement follows the release of the city's most detailed analysis of healthcare disparities in Boston.

In stark detail, that study demonstrates the human burden of healthcare disparities: Black men in Boston die on average five years sooner than white men; blacks are twice as likely to die from diabetes and four times more likely to succumb to HIV; and not even higher income or college degrees confer protection against the health disparities.

The report also shows that blacks in the city are four times more likely than whites to believe that they have been discriminated against while seeking healthcare.

Hispanics and Asians also tend to have poorer health than whites, although not to the same extent as blacks, according to the report.

In many respects, the study's findings affirm earlier federal studies detailing racial disparities in health nationally.

Health policy specialists hailed the city's study and initiative, but cautioned that disparities in treatment and health status stem from a web of medical, social, and economic factors. Closing the gap, they said, will require complex solutions.

''The way to walk 100 miles is one step at a time, and this is an important step in the right direction," said Arnold Epstein, chairman of the Department of Health Policy and Management at the Harvard School of Public Health. ''But there's likely to be no single pressure point where we can say, 'Bam, we've made this go away.' "

The city's campaign is multifaceted, calling on hospitals to diversify work forces, to improve the cultural awareness of medical workers through training, and to collaborate with religious groups and community coalitions that work in black, Hispanic, and Asian communities.

The costs will be underwritten partially by $1 million in grants that Menino will announce today. That money comes from foundations, healthcare providers, and the city.

Dr. Gary Gottlieb, president of Brigham and Women's Hospital, was one of the leaders of a mayoral task force that developed the plan during the last year and a half.

As the outline of the problem in Boston became clearer, Gottlieb was struck by ''the severity of disparities in so many areas," he said.

Menino, who is in the midst of a reelection campaign, said he formed the task force because of what he encountered on visits across the city.

''We live in a city that is literally the medical center of the world," Menino said. ''There's no reason why blacks and Latinos in this city should have worse health than our white citizens. I look at the data, and I'm shocked by the differences."

Poverty and lack of medical insurance play a significant role in those differences, health policy specialists said.

But the study being released today suggests that socioeconomic standing can't fully explain the gap.

For instance, the report shows that even infants born to black women with college degrees are substantially more likely to die before their first birthdays than babies born to white women with comparable levels of education.

National studies have shown that white patients suffering from early-stage lung cancer are much more likely to receive life-saving surgery than black patients with the same diagnosis.

Other research has demonstrated that black patients on dialysis are less likely to get kidney transplants than their white counterparts.

''I don't think we fully understand what's going on," said Dr. Selwyn Rogers Jr., a surgeon at Brigham and Women's.

''But we can't hide from the fact that there's still racism in America, and if that racism affects you going into a store, when you're black and you're followed by the security guard, that racism has to impact upon your healthcare, too."

To better understand the consequences of discrimination and other factors contributing to healthcare disparity, Rogers is presiding over an initiative at Brigham and Women's that aims to track the kind of care surgical patients receive and how those patients fare.

The Center for Surgery and Public Health started in March, and doctors at the hospital are developing ways to collect detailed data on patients and to discern the factors that contribute to their care.

''In a justice sort of way, it's time for us to move beyond documenting these disparities, and saying, 'Oh, isn't this awful,' but to design creative solutions to address and repair these disparities," Rogers said.

Doing that, said Dr. Lauren Smith of Boston Medical Center, will require physicians to examine their own biases.

''And the concept of invoking racism is a very toxic concept for some people," said Smith, medical director of the hospital's Family Advocacy Program, which endeavors to assure that the basic health needs of children are met.

But solutions to health disparities will also require the involvement of policy makers outside hospitals, Smith said.

That means figuring out how to address high levels of lead paint in homes in predominantly African-American neighborhoods, for example, and it means addressing the abundance of tobacco and alcohol advertising in poorer communities.

For April Inniss, discrimination has been evident in her own care, and she has heard older black women tell how they don their work uniforms or job badges for a doctor visit, hoping it will ensure respect.

Just last Sunday, a woman at church offered her own account of discrimination, Inniss recalled. ''She said she went to the emergency room, and they treated her like a crack head," said Inniss, 22, who lives in Mattapan.

''They spoke to her in a demeaning and dehumanizing tone," Inniss said. ''She came back to the ER later, and she had her police uniform on, and they started to treat her differently. They were more respectful. The sad part is that she isn't alone in that way."

Stephen Smith can be reached at stsmith@globe.com.