Health Inequity in Philadelphia: A Tale of Two Cities

“It was the best of times, it was the worst of times”
-Charles Dickens-

The promise of millions of newly insured Americans, which includes countless people of color, has yet to show indications that it is impacting health disparities. Even the recent slowdown in spending on health care costs in this country, happened mainly because Americans lost health insurance and incomes during the recent “Great Recession” and in the sluggish recovery that followed.

As we approach the continued implementation of the Affordable Care Act (Obamacare), at no time in history has the state of health disparities, particularly in communities of color, been more dismal than today.
Health disparities are differences in health outcomes between groups that reflect social inequalities. Since the 1980s, our nation has made substantial progress in improving residents’ health, and reducing health disparities, but the ongoing racial/ethnic, economic, and other social disparities in health are both unacceptable and correctable.
Here in Philadelphia, health disparities play out in a most visible, and poignant way…A true tale of two cities.
• 5 medical schools, 2 schools of osteopathic medicine
• Schools of dentistry, optometry and 3 pharmacy schools
• Five NCI-designated cancer centers
• 120 hospitals
• 414 hospital beds per 100,000
• Top children’s U.S. hospital
• 373.7 physicians per 100,000

Greater Philadelphia ranks as one of the nation’s hubs for higher education with over 100 degree-granting institutions enrolling just under 400,000 full and part-time students, as of the fall of 2010.
Yet, unfortunately in Philadelphia, each year, in Philadelphia, approximately 4 in 10 Philadelphia students leave school without obtaining a diploma. Further, only about half of Philadelphia’s students graduate high school within 4 years of entrance and, of this group, many graduate reading and writing far below the twelfth-grade level. Only 1 in 7 Philadelphians has a college degree, ranking the city 92nd out of the 100 largest municipalities in the country in educational attainment.
Among the most frequent health issues affecting the Black community in Philadelphia are: heart disease (or cardiovascular disease), diabetes, obesity (or overweight and obesity), hypertension (or high blood pressure), and HIV/AIDS.
In fact, the 15 Key Factors Contributing to Minority Health Conditions (Racial and Ethnic Health Disparities) in Philadelphia, Pennsylvania
1. Low priority of preventive care (generally) in many Philadelphia residents because of:
2. Lack of health insurance, or underinsurance (for many)
3. Inadequate number of multicultural health professionals
4. Key reasons for health disparities in minority populations
5. Decreased overall awareness of lifestyles and health practices that increase the risk of health disparities
Denial of early warning signals and delays in seeking care
7. Decreased access to high quality care
8. Greater distrust of the health or medical establishment (The Tuskegee Study effect, and other studies and experiences that have a long-lasting effect).

According to Drexel University’s School of Public Health, “Many of the major challenges facing the City of Philadelphia disproportionately affect low-income and minority communities. The poverty rate in Philadelphia is nearly twice that of the nation (24% vs 13%) and over four times higher among African Americans (30%) than Whites (7%). Insufficient access to quality groceries is also a barrier to healthy living in Philadelphia that disproportionately affects low-income communities (36% vs 21%).
These and many other social conditions have contributed to health disparities between Philadelphia and the nation and within the City’s population… Low-income individuals are more likely to have a chronic condition for which regular care is needed than those who are financially stable (37% vs 25%) as are women compared to men (30% vs 24%).”

Despite landmark historical contributions to the field of medicine by Blacks, such as performing the first cardiac surgery, advancements in pharmaceuticals, and developing the method to process and store blood plasma, vital to the American military in Europe during World War II, Blacks are still disproportionally underrepresented in the medical community. In 2010, Blacks made up 13 percent of the U.S. population, but only 3.2% of U.S. doctors and less than 1% of dentists. Bear in mind that these figures represent Blacks who are African Americans, Africans, and Carribean/West Indians. Whites represent 47.8% of all physicians. Black doctors only make up 2.3%, and Hispanics about 3.2 %. The largest minority percentage is Asians, at 8.3% of all doctors.
Blacks in Philadelphia have the highest mortality rates for all causes of death when compared to other racial groups, in addition to the highest mortality rates from the three leading causes of death of Pennsylvanians (heart disease, cancer and stroke), as well as from HIV/AIDS, homicide, diabetes, and renal failure. They have the highest infant mortality rates and significantly higher rates of death for most causes of infant death.
So, how is this possible in a city which boasts it’s reputation of “EDs and Meds?
Let’s take a little journey through the Philadelphia Region, and see what we find, as we…”Follow the money”.
• Home to 15 leading pharmaceutical firms
• 11 pharmaceutical world headquarters are located here
• $20.2 billion in annual earnings
• 15 percent of all the economic activity in the Region
• 5 medical schools, 2 schools of osteopathic medicine
• Schools of dentistry, optometry and 3 pharmacy schools
• Five National Cancer Institute-designated cancer centers
• 120 hospitals
• One of the Top children’s U.S. hospital

As you can see, Philadelphia is home to some of the top, and most respective medical centers and hospitals in the world. It would almost seem to have to be by design that in a city approaching 50% Black population, that such disparities in health exist.
In 1906, W.E.B. Du Bois published The Health and Physique of the Negro American to document the poor health status of African Americans and to analyze the underlying causes. Du Bois agreed that black people had higher rates than white people for some diseases, including tuberculosis, pneumonia, and infant mortality. However, he contended these disparities reflected social conditions, not racial susceptibilities. “The high infant mortality of Philadelphia today,” Du Bois wrote, “is not a Negro affair, but an index of social condition.”
Philadelphia is characterized by racial inequality, not only in health, but in economic life reflected in broad disparities in income, employment, business ownership and other measures of economic well-being.

Until, and unless, all stakeholders, public and private, make a committed, concerted effort to acknowledge and address this issue, we will continue to see “ A Tale of Two Cities” in Philadelphia health staus of Blacks.