New Orleans’ access to health care has improved over the last decade, but there remain significant gaps in coverage and racial disparities in the city’s health care system that have led to disproportionately higher rates of illness, disease and death among black residents.
A report released by The Data Center this week, in conjunction with its tricentennial series, reveals a stunning history of health care in New Orleans, from the foundation of a Charity Hospital in the 18th century to health epidemics and their cost to enslaved people, and how institutionalized racism in public health agencies through the late 1800s through the 20th century, and the failure to integrate hospitals well into the ‘60s and ‘70s, drove poor health outcomes.
“The historical and perpetuated oppression of black Americans, from the time of the city’s founding to present day policies and practices, has resulted in inextricable ties between race, socioeconomic conditions and population health,” the report says. “Bolstered by centuries of stereotypes and false myths about human differences and group behaviors, racial stratification in societal treatment, and access to power, resources and opportunities remains.”
The report found disproportionately higher rates of several health issues among non-white residents, including a nearly 20-point difference in the rates of hypertension and high blood pressure. The report notes that there’s a 25-year difference in the life expectancy of residents in the predominantly white 70124 ZIP code and predominantly black 70112 ZIP code, despite being within five miles of one another.
In 2015, overall infant mortality rates among babies born to New Orleans women declined to a rate of 6.5 deaths per 1,000 births — but the infant mortality rate among black women remained at least two times higher than the rate among white women. The report notes there were “an additional seven black infant deaths per 1,000 live births for every one white infant death.”
From 2008 to 2010, black residents were eight times more likely to die of homicide, and at least two times more likely to die from HIV, kidney disease and diabetes.
The report also argues that “little priority” was given to address mental health needs following Hurricane Katrina; though a growing and “decentralized community-based healthcare system” followed with increased access to care, there remained a 39 percent decrease in adult psychiatric beds, a 25 percent decrease in child and adolescent psychiatric beds, and a 31 percent reduction in detox beds within the years following Katrina and the federal floods, resulting in residents using hospital emergency rooms to treat mental health crises more frequently, according to a report from the New Orleans Health Department.
The result, the Data Center says, “is a system with limited capacity to serve the city’s population — one disproportionately exposed to traumatic events.”
New Orleanians reported higher poor mental health days (4.4 days a month in 2015) than state and national averages (at 4.3 days and 3.6 days, respectively).
Gov. John Bel Edwards’ adoption of the Medicaid expansion closed a significant gap in health care coverage among the so-called “working poor,” with the rate of uninsured residents dropping double digits from 22 percent in 2013 to 13 percent in 2016.
The report says that coverage and continued enrollment holds “promise for filling service gaps experienced by low-income residents,” but it will be a test of the health system and local and federal leadership to continue sustained funding — through both federal and private sources — to continue care, the report says.
The report also warns of ongoing and implicit “provider bias” among health care providers in care of people of color, “evidence of persisting systemic racism in the [health care] system.”
The report recommends more collaboration among government agencies and university and community organizations “to promote a health lens on housing, criminal justice, trauma-informed care and social-emotional development training.”
“Health disparities are reduced or eliminated not by worsening the health of those who are better off, but by improving the health of excluded or marginalized groups,” it concludes. “Without acknowledgement of how health is shaped by both advantage and disadvantage, unfair, unjust and avoidable race-based differences in population health will endure. Health equity will be reached when we can no longer predict health outcomes based on race, ethnicity, class or any other characteristic.”