Racially Rationed Health

Whether health care in the U.S. is an organized system or a haphazard numbers game, there is no doubt whatever that it is racially biased. For most whites, medical attention is only a phone call or a car ride away. By contrast, says the nation's top health officer, Dr. Roger O. Egeberg, Assistant Secretary for Health and Scientific Affairs in the Department of Health, Education and Welfare, "it is the black Americans and other minorities for whom the 'system' works least well." Among blacks, the poor are a majority, and for them inadequate health care--or none--is a womb-to-tomb reality. They suffer a hugely disproportionate share of disease and premature mortality.

Deliberate racial discrimination is one cause. A classic case was that of Singer Bessie Smith, who was in an auto accident while driving north from singing engagements in Mississippi. After her black Samaritan driver had been turned away from white hospitals, she at last reached a hospital that was willing to admit her. Too late. In the grisly abbreviation of the hospital industry, she was DOA--dead on arrival.

Ultimately the cause of more disability and deaths is simple neglect compounded by the inadequacy of health education classes in many public schools. A six-year-old black girl in the South dies of diphtheria because no one ever told her mother that she should have her baby inoculated against the disease--or bothered to make sure that she did it. In fact, says Egeberg, more than 20% of nonwhite children have failed to get the standard shots against diphtheria, tetanus and whooping cough (a combination "DTP" vaccine), while 91.4% of all white children have had them. A boy is deaf in one ear because his mother could not take him to the clinic for a second treatment of a common ear infection; to make the first visit, she had to take her five children on two different buses to a distant clinic, where she waited all day for a doctor to see the boy. A woman who lives in a rat-infested slum says that rats are no problem: she means that she has seen no more rats than usual that day.

Survival First. Health services are rationed according to purchasing power rather than need, and so are least available to those who need them most. Says Egeberg: "The poor suffer a great deal more infectious disease, go to the hospital more often, and stay there longer"--if they can afford to get to a hospital. As Permon Johnson, a student at Nashville's predominantly black Meharry Medical College, puts it: "The average poor black adult places survival ahead of medical attention. He comes to the hospital only when he's on his last legs. He doesn't know anything about his medical needs or his right to medical attention."

To redress the imbalance in health services between blacks and whites, a more efficient system must be devised for delivering care to all Americans, ultimately perhaps through one of the many proposals for national health insurance now being discussed. A more immediately practicable solution is to increase the number of well-trained physicians not merely willing but also eager to serve the black population. Most of these will be black. There are only 7,000 black doctors, little more than 2% of the U.S. total. There is a white doctor for every 700 whites, but only one black doctor for every 4,000 of his people; in Mississippi, one black doctor for every 20,000.

Until recently, blacks applying to all but two of the nation's 99 medical schools encountered naked race prejudice. Today that bias is reversed: to expiate a century's accumulation of guilt, the most highly regarded predominantly white schools are taking black students who are less qualified than most white applicants. Even so, blacks make up less than 1% of the current med-school enrollment, with the notable exceptions of Meharry and Howard University College of Medicine in Washington, both predominantly black schools.

Tycoons. Of these two schools, Howard has the more modern physical plant; it receives more than 50% of its funds from the Government through HEW. It has 400 students enrolled, 85% of them black, 15 to 20 women in each class. Given a little more money, says Dr. Carlton P. Alexis, Howard '57, and vice president for health affairs, the school could immediately increase its enrollment by 10%. Its students come from North and South in proportions reflecting the distribution of the black population. While most of them expect to practice in city and suburban areas, Alexis is confident that increasing numbers will join health-care projects in the rural South, largely as a result of Howard's programs in the Washington area and Mississippi.

Meharry, founded 94 years ago and largely supported by private funds, was on the verge of closing five years ago. A small group of black faculty members succeeded not only in keeping it open. They put it on a new course--preparing physicians for community health care. George Russell, vice chairman of General Motors, heads its tycoon-studded national fund committee, and Meharry is embarked on a campaign to raise $88 million ($33 million is expected from federal funds, the rest from private donations) and become a major medical school.

Reversed Pattern. With a rundown physical plant in a drab section of Nashville, Meharry has 298 medical students enrolled (it also has schools for dentists, nurses and medical technicians); 43 are women and about 10% are nonblack. The majority come from the South. Many are the sons or daughters of ministers or schoolteachers. Some have chosen to become doctors because they have seen the suffering that comes from the lack of medical care. Says Permon Johnson of his childhood in Eustis, Fla.: "The only thing I can remember about doctors then is that there weren't any. No black doctor within 25 miles of my home. And the nearest white doctors had segregated waiting rooms."

Others have elected a career in medicine for two reasons that have been prevalent in other ethnic groups but were uncommon until recently among blacks. One is the prideful "my son the doctor" ambition. The other is the blacks' growing satisfaction in their own people's professional success, and their increasing sense of security visiting a black rather than a white doctor. This is a complete reversal of the older pattern: blacks used to take their minor ills to a black doctor, but seek a supposedly superior white practitioner for major medical matters because there were few black specialists.

Team Spirit. Howard and Meharry have something in common more important than skin color: the service that their soon-to-be-graduates expect to give. Whereas virtually all black doctors used to go into solo practice and isolate themselves from community affairs, more of today's students plan to go into group practice. They know that whether they choose to practice in groups or alone, their offices will have to serve as neighborhood health centers. Increasing numbers of them are certain to emerge as community leaders, and set up healthcare teams, including social workers, medical aides and legal counsel.

Says Meharry President Lloyd C. Elam, a psychiatrist: "If you send a patient home after treating him in the hospital for pneumonia, and his home is badly heated, he'll be back with pneumonia again. So you have to do something about heating his home. Or if you've treated a patient for an infection from a rat bite, it's no use sending him home to be bitten again. You have to do something about the rats. That's where the community medical approach comes in."

It is ironic, says HEW's Egeberg, that some of the most venerable medical schools in the country have not yet recognized the need for this new medicine: "They will have to follow the lead that Meharry is helping to chart, in the way that they train their students and in their approach to meeting the long-neglected health needs of the poor."

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