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June 02, 2018 12:00 AM

Editorial: Lessons on healthcare from news of racism, inequality and budget cuts

Merrill Goozner
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    Merrill Goozner

    In the wake of the news:

    Roseanne Barr loses show after racist tweet.

    She should be thankful she didn't lose a decade off her life expectancy.

    Her penance should include reading The Death Gap: How Inequality Kills by Dr. David Ansell, the senior vice president for community health equity at Rush University Medical Center in Chicago. A self-described social epidemiologist, Ansell catalogs how life expectancy in the all-black, impoverished Lawndale neighborhood is just 72, a full 13 years below that in the nearby Loop, where gleaming high-rises are filled with empty nesters, wealthy business executives and well-to-do young families.

    This death gap has little to do with Chicago gun violence, which routinely makes the national news. "Over half of the premature deaths in Chicago are from premature heart disease and cancer, diseases for which prevention, early detection, and treatment methods exist," Ansell writes.

    The same gaps between poor black and wealthier neighborhoods can be found in cities without Chicago's high murder rate. In recent years, it has also emerged in rural areas where poor whites are suffering from the same social pathologies that have long ravaged inner cities.

    Barr's tweet refueled a national discussion about the stress induced by the daily indignities inflicted on African-Americans. It's long been known that prolonged stress harms health and reduces longevity. When coupled with entrenched poverty, whether white or black, and growing income inequality, it has left America as the only country in the developed world whose life expectancy has declined two years in a row.

    California Chick-fil-A raises minimum wage to $17 an hour

    Speaking of inequality, a quick tour through the data on the Bureau of Labor Statistics website shows healthcare organizations have a long way to go before they provide a living wage for all their workers. The rest of the country may not be as well-off or as pricey as California, but surely the economy's largest sector can do better than fast food.

    The problem isn't among the 7 million highly skilled doctors, nurses and technicians, whose median salary (half earn more; half less) was $58,448 in 2017. Rather, it is among the 2.5 million people in so-called "support occupations" like housekeeping and food service, where the median salary was $28,184, or about $14 an hour.

    The median hourly wage for nursing, psychiatric and home health aides was even lower—$12.50 an hour. Their frustration is growing. After threatening to strike, 2,500 home health aides in Connecticut in May month won an hourly wage hike to $14.75, their first increase in over a decade.

    In Illinois, a state court judge last fall ordered the governor to raise wages for caregivers of the disabled by a measly 48 cents an hour after years without increases. The median hourly wage for those workers in 2015 was $10.59, or $12,600 annually, which left 40% of the workers dependent on some form of public assistance despite holding full-time jobs, according to the law firm that sued the state.

    Budget cuts force AHRQ to end Guideline Clearinghouse

    The Agency for Healthcare Research and Quality this July will stop posting and cataloging the hundreds of clinical-practice guidelines published each year by medical journals and professional societies.

    This blow to transparency will make the jobs of chief medical officers much more difficult. Its website, guideline.gov, which averages about 200,000 visits a month, has been an invaluable tool for organizations wishing to analyze and then adopt best-practice guidelines for their clinicians.

    Budget cuts forced the closure, according to Friends of AHRQ, which is housed at Academy Health and lobbies for more funding for the agency. The agency's current budget of $334 million is $120 million below its inflation-adjusted 2010 budget.

    AHRQ's programs that seek to improve hospital safety and chronic-disease management are also facing cuts. Penny-wise, pound-foolish seems to be the order of the day in Washington.

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