Kidney disease is a common malady across populations. There are many causes of this disease and there seems to be a socio-economic component. In the US kidney disease tends to have a less favorable outcome among those of a lower income. This population tends to be made up of racial and ethnic minorities who are disproportionately represented in this US population with kidney disease.
A common problem when trying to address the issue of the prevalence of disease among economically disenfranchised elements of the US population, that is if the problem is determined by socio-economic status or is it the result of racism as well as racism that has been institutionalized. This problem is especially difficult to decide when one considers the history of racism and its impact on present day institutionalized racism.
Finding a link between racism and kidney disease is necessary to address the problem. While socio-economic status may seem to be the prime mover behind the disparity between better outcomes for those that are economically better off than those at the bottom of the economic scale, the determinacy of racism must be ascertained in order to address the problem of kidney disease successfully.
Ordinarily one might wonder if higher rates of kidney disease are the result of racism or the result of socio-economic factors caused by racism which results in less favorable outcomes. In order to address the problem of kidney disease in racial and ethnic minorities this issue must be resolved. Is the solution to address socio-economic conditions, institutionalized racism or face to face discrimination?
If it were socioeconomic factors that determine kidney disease then these determinants would have to be addressed. To address this problem more money would need to be put into health care and a program of preventive care would need to be instituted. Access to health care would need to be improved by those lower on the economic ladder so that health outcomes could be improved. Oftentimes though if programs are in place that provide access to services and these services do not improve health outcomes then there is the impulse to blame the victim.
But perhaps further evidence of racism among those of lower socio-economic status and a lower education level is shown by the fact that even with equitable insurance coverage and access as well as similar health insurance within the same system of care in the same managed care plan, the result is still for poorer outcomes among minorities (Bierman, 2002). Yet there are other factors that can lead to a less successful outcome in those of minorities. Those of lower socio-economic class find themselves more subject to arrest (Brooks, 2008). Also this group is more likely to be victims of crime, more likely to have housing problems, and to be families with single mothers more likely to have child care issues. All these factors can result in less adherence to a treatment regimen and must be controlled in any study.
More likely though is the other alternative. Most probably racism is the cause because minorities are the victims of a history of racism and face institutionalized racism as well as personal racism. Racism being largely unconscious and entitlement that is assumed by those higher on the economic ladder, especially whites, can make the health care provider blind to the causes of the poorer health outcomes of racial and ethnic minorities when basing their opinion strictly on socio-economic factors especially in the case of kidney disease.
It is clear that those of lower social and economic stature have a higher rate of kidney disease and are at a greater risk of death. Illegal drug use in the inner city causes higher rates of hypertension, acute and chronic kidney disease. Socio-economic factors are determinants of a higher rate of asthma, diabetes mellitus, hypertension, tuberculosis and chronic kidney disease. Cocaine use is thought to be a cause of the progression of kidney disease.
There is a greater likelihood of increased mortality and lower placement on kidney transplant waiting lists. Strictly socio-economic factors are often looked at when health insurance limits the ability of patients to pay for drugs used for the maintenance of immunosuppression in transplant patients which is limited to three years. (Nzerue, 2002)
The claim is made that racial bias is difficult to determine in surveys of physicians and other health care providers by looking at physician behavior or medical records although subtle biases are suspected which may influence physician’s therapeutic decisions. There are documented difficulties in communication between those of a lower socio-economic class and physicians who harbor negative personal perceptions of the less affluent and lower educated (Nzerue, 2002).
There are documented instances of a disproportionate less favorable outcomes among those of lower socio-economic classes among African Americans and Mexican American communities of microalbuminuria and macroalbuminuria (Tareen, 2005). But it is difficult to determine the exact factors that result in this outcome.
“Education directed toward patients and physicians is important for overcoming the many cultural differences in health beliefs and behaviors that contribute to both the risk and progression of Chronic Kidney Disease (CKD)… Adherence to referral and treatment for CKD may be improved when patients feel they receive health recommendations in a respectful and culturally considerate manner. Increasing the number of minority physicians practicing within their own communities may further help to reduce some cultural barriers” (Norris, 2005).
One study makes a strong claim of racial and ethnic disparity in low socio-economic groups. Referral and initiation of dialysis, adequacy of dialysis and anemia management-with non-white patients are usually at a disadvantage. For example Whites and Asian Americans are more likely to be placed on peritoneal dialysis compared with African American and Native Americans. “Factors in treatment for kidney disease are not completely explained through socio-economic determinants. Factors such as cultural bias, … physician bias and communication barriers all contribute to lower peritoneal dialysis among certain minority groups” (Gadegbeku, 2002).
Another issue that comes out in this study is that there is what is termed “Transplantation Reluctance.” It seems clear that while there are socio-economic factors that lead to a higher incidence of kidney disease and less favorable outcomes, it seems clear that racially specific differences can be eliminated [and identified] when a multi-faceted approach is adopted (Gadegbeku, 2002).
Much remains to be done to eliminate socio-economic, racial and ethnic biases that permeate the health care establishment. By separating the socio-economic factors from the racial factors one can institute strategies which address these shortcomings that are the direct result of racism.
Only through determining the racial and ethical component in this equation can disparities that deprive African Americans, Latino American and Native Americans access to affordable, effective and fair health care provision. Only in order for society to be just and enabling minorities to be effectively brought into the health care establishment will discrepancies between minorities and whites be addressed.
References:
Bierman, A.S., Lurie, N., Collins, K.S., & Eisenberg, J.M. (2002). Addressing racial and ethnic barriers to effective health care: The need for better data. Health Affairs, 21(3), 91.
Brooks, D., Charleston, J., Dowie, D., Gabriel, A. I., Hall, Y. B., Hiremath, L., Lightfoot, T., Sika, M., Smith, W. C., Wang, X. (2008). Predictors of Participant Adherence and Retention in the African American Study Of Kidney Disease and Hypertension. Nephrology Nursing Journal, 35(2), 133-42. Retrieved July 16, 2008, from ProQuest Medical Library database. (Document ID: 1470818171). http://proquest.umi.com/pqdweb?did=1470818171&sid=2&Fmt=3&clientId=29440&RQT=309&VName=PQD
Gadegbeku, C., Freeman, M., Agodoa, L. (2002). Racial disparities in renal replacement therapy. Journal of the National Medical Association: Racial Disparities in Kidney Disease, 94(8), 45S-54S. Retrieved July 16, 2008, from ProQuest Medical Library database. (Document ID: 160201271). http://proquest.umi.com/pqdweb?did=160201271&sid=2&Fmt=4&clientId=29440&RQT=309&VName=PQD
Norris, K. C., et al., (2005). Unraveling the racial disparities associated with kidney disease1. Kidney International, 68(3), 914-24. Retrieved July 16, 2008, from ProQuest Medical Library database. (Document ID: 1014509361). http://proquest.umi.com/pqdweb?did=1014509361&sid=2&Fmt=6&clientId=29440&RQT=309&VName=PQD
Nzerue, C.M., Demissachew, H., & Tucker, J.K. (2002). Race and kidney disease: Role of social and environmental factors. Journal of the National Medical Association, 94(8), S28-S39.
Tareen, N., Zadshir, A., Martins, D., Pan, D., Nicholas, S., & Norris, K. (2005). Chronic kidney disease in African American and Mexican American populations. Kidney International, 68(S97), S137-S140.