A. The Health Care System Itself
The current state of medical practice, medical education, medical research, and medical leadership in the United States creates its own obstacles for minority women. These four areas of medicine have traditionally ignored the health of both women and minorities.
1) Medical practice. Obstacles for minority women include inadequate numbers of primary care physicians, the tendency of physicians not to practice in either rural or urban low income areas in which many minority women live, the absence of nearby health care facilities, and the communication barriers presented by physicians who do not speak or understand the native language of their patients.
Minority women who live in poverty face additional problems. Most receive care in community health centers, hospital outpatient clinics, or other facilities that have high-volume practices. Consequently, physicians in these settings spend less time with patients and provide less preventive care counseling than is common in other medical practices.2) Medical education. Medical education offers little training in cultural competence. Ultimately, cultural competence-more than gender, race, or ethnicity-fosters an environment in which patients of diverse backgrounds will be understood, appropriately diagnosed, and appropriately treated. Only recently has medical education promoted community-based training and increased its focus on primary care, which is desperately needed by minority women in underserved communities.
3) Medical research. Few minority women participate in research studies, which results in inadequate or inaccurate data on these populations. Many research studies and data collection efforts misreport the race and ethnicity of minority women. Moreover, data are typically gathered from a limited number of subgroups, and then the conclusions are erroneously applied to the entire minority group.
4) Medical leadership. In addition, too few women and minorities serve as physicians, administrators, researchers, medical faculty, nurses, dentists, or other health care providers. Many health care professionals and facilities are, consequently, insensitive to the needs and preferences of minority women. Inadequate communication between patients and health care providers commonly occurs, often as a result of stereotyping, language barriers, and health care materials that are written at inappropriate literacy levels. Health care services that are relevant to the social concerns, cultural attitudes, health needs, and health practices of minority women do not typically exist.
B. Economic Barriers
1) Income levels. While minority women are found in all socioeconomic levels, they are more likely to have lower incomes and to live in poverty than are White women. Despite more than 30 years of progress in this society, minority women continue to have less formal education than White women. Even minority women who have similar levels of education as their White counterparts earn less money and have fewer assets. Minority women also hold a disproportionate share of low-wage jobs, and they experience higher unemployment rates.
Low income, in particular, is strongly associated with the decreased use of health services and poor health outcomes. The tendency of economically disadvantaged women to delay seeking treatment-often until the advanced stages of disease-points to the need for early prevention efforts.2) Health insurance. More minority women than White women are uninsured or rely on public, rather than private, health insurance15. Since 1965, the federal government's Medicare and Medicaid programs have helped increase minority women's access to health care. Program benefits are limited, however, and frequently do not meet all of these women's health care needs. Unfortunately, the gaps in socioeconomic status and health insurance coverage between White and minority women appear to be growing.
3) Social and cultural barriers. Several other factors limit the access of minority women to the U.S. health care system. They include social disadvantages, cultural values, discrimination, lack of culturally appropriate services, inadequate childcare, and transportation, among many others.
Substantial numbers of minority women
distrust the health care system, which is perceived by many to be hostile and insensitive;
are single parents;
have cultural values about health that lead to seeking traditional, ancestral, or spiritual healing first and seeking Western medicine only when other interventions fail;
experience racial, ethnic, gender, and other forms of discrimination, which can interfere with appropriate diagnosis and treatment;
are dissatisfied with their health care plans and service providers; and
experience language barriers and religious differences when being treated by healthcare providers.
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July, 2003