Focus on Minority Health and Gaps in Care
April 14, 2022
The COVID-19 pandemic has brought to light the health disparities minorities face. Inequality in care leads to increases in poor health outcomes and higher rates of chronic conditions in underserved communities.
The top three areas of concern for minority health are cardiovascular disease, diabetes and cancer. These conditions can result in other severe health issues, such as stroke, blindness, kidney failure, limb amputation and death, says Dr. Lena Bretous, an associate medical director for BlueCross BlueShield of South Carolina.
“Disparities in minority health are not OK. Good health care for one should be good health care for all. Good health care should be inclusive,” she says.
Minorities face problems in seeking preventive care. They often have limited access to health care, insurance, or healthy and affordable food. Low-paying jobs, low-quality education and unsafe environments can all be factors.
Dr. Lena Bretous, associate medical director
Minorities are less likely to seek care through a primary care physician (PCP) or other health care provider.
“There is a lot of distrust amongst underserved minorities toward the medical community. And if you don’t have a lot of money, you are unlikely to use some of your monthly income on primary health care,” Bretous says. “Both low income and distrust increase the disparities.”
Minorities often have transportation and low-income barriers that make it difficult to access a PCP. Working more than one job or doing shift work makes it difficult to see a PCP during office hours.
“More people need to understand the emergency department is not primary care. Urgent care is not primary care. Everyone should have a regular doctor they trust and can see for non-urgent needs,” Bretous says.
Minorities also might be more likely to see a doctor who looks like them. In South Carolina, people of color make up 36 percent of the state’s population but only 25 percent of its health care professionals.
“The distrust in health care is already there. And if you find a doctor you trust, you can’t afford all of the care. For example, paying for prescriptions can be expensive. Then you have recent incidents between groups of people that fuel the existing distrust. You want someone who understands and sees you. You want someone who listens. It can be isolating to be surrounded by people who don’t understand,” she says. “It is very important to be seen and acknowledged as a person.”
In South Carolina, many of these issues are heightened in rural areas. There are health care deserts and food deserts where there are few health care options and limited access to healthy, affordable food.
Cancer is a concern in minority communities because the population doesn’t get screened as often as other groups. Getting a cancer screening, such as a mammogram or a colonoscopy, is vital in catching the disease early for treatment. Find more about the importance of cancer screenings on our blog.
Black women have higher rates of breast cancer. Black Americans are about 20 percent more likely to have colon cancer and about 40 percent more likely to die from it, according to the American Cancer Society*. Actor and South Carolinian Chadwick Boseman’s death in 2020 from colon cancer was a wake-up call for many minorities, Bretous says.
“Having someone highly visible in the minority community die of that disease put it on the map,” she says.
Black Americans have the highest death rate and the shortest survival rate for cancer of any ethnic group in the country. Black men suffer a higher burden of cancer than any other racial group in the country, with the highest death rates from prostate, lung and colorectal cancers, according to the South Carolina Institute of Medicine and Public Health*.
The COVID-19 pandemic affected racial and ethnic minorities more than other groups. Black and Hispanic Americans have been vaccinated at lower rates than white Americans. This has led to an increase in hospital stays and deaths from the disease in these groups.
The vaccine is the best way to prevent serious illness and death from COVID-19. These vaccines are effective and safe. The Centers for Disease Control and Prevention* and the South Carolina Department of Health and Environmental Control* recommend vaccination and booster shots for adults and vaccination for children over the age of 5. Find where to get a vaccine or booster near you. Read more of our COVID-19 coverage on our blog.
The pandemic has sparked a change in the way many Americans think about and talk about behavioral health issues. Racial minorities overall have similar mental disorders to white Americans. However, minorities have poor mental health outcomes* because of the same factors that influence poor physical health outcomes: limited access to care, financial concerns and distrust in medical industry.
There is also cultural stigma and lack of awareness around mental health in minority populations. The pandemic has shifted some of the cultural perceptions, Bretous says.
“Typically, in the Black community, mental health is not something people believe in. Some people will not seek help because of the fear that you will be judged. But the sheer numbers of people suffering with anxiety, depression and post-traumatic stress triggered by the pandemic has changed how mental health care is perceived in the community. It is a little more accepted,” she says.
The access to care has greatly improved telehealth or virtual care options. This makes it easier for minorities to get mental health care across the state.
Responding to disparities
As the only South Carolina-based insurer, BlueCross has played an important role in addressing health disparities in the state. When many insurers dropped out of the Affordable Care Act Marketplace, BlueCross did not. For several years, BlueCross was the only provider of Exchange plans in the state. This provided health care coverage for about 200,000 South Carolinians who wouldn’t have had access otherwise.
To address some of the issues that disproportionately affect Black South Carolinians, BlueCross’ Diabetes Free SC (DFSC) initiative has focused on prevention programs. DFSC is a long-term commitment to reduce health care gaps and improve the health status of all South Carolinians affected by diabetes. The program has developed maternity programs to improve pregnancy outcomes for women who have diabetes. It has also focused on reducing the risk of diabetes in children.
Black South Carolinians are more likely to have diabetes than white South Carolinians. More than 16 percent of Black residents are affected by the disease compared to about 11 percent of white residents. Not only is diabetes more prevalent in Black communities in South Carolina, but it is also more deadly.
DFSC has made huge strides on the path to health equality for people of color who have diabetes in South Carolina. But there is still work to be done to tackle the systemic issues at the root of higher rates of diabetes and other inequalities that affect the lives and health of many South Carolinians. Find more about DFSC programs on our blog.
To support the pipeline of minority health care providers in the state, the BlueCross BlueShield of South Carolina Foundation created a 10-year grant to help train and retain minority students pursuing careers in medicine. The grant provides scholarships to underrepresented students at the University of South Carolina School of Medicine in Greenville.
Student awardees will receive full-tuition scholarships for four years and agree to practice medicine within South Carolina for at least four years after graduating. It is the longest grant awarded in the Foundation’s history.
*The American Cancer Society, the South Carolina Institute of Medicine and Public Health, the Centers for Disease Control and Prevention, the South Carolina Department of Health and Environmental Control, and the American Psychiatric Association are independent organizations that provide health information you might find helpful.
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