Black men might not have the lowest life expectancy in America if there were more black doctors in the workforce, a new economic study declares.
African American men have higher rates of early death – largely from cancer and cardiovascular disease – than any other demographic group in the US.
Despite years of efforts to close the racial gap there has been little impact.
Now a groundbreaking experiment suggests efforts to boost diversity in the physician workforce could be a game changer.
Researchers found African American men were far more likely to agree to services – and more invasive ones – if their doctor was of the same racial background, than if they were treated by a white person.
Other literature suggest the same is true for all races and genders: that they trust a doctor that appears to have the same background.
But the finding is particularly pertinent to African American men: the study, published by NBER, found that boosting the number of black doctors could reduce the rate of cardiovascular mortality by 16 deaths per 100,000 per year — closing the racial gap in heart attack deaths between white and black men by 19 percent.
A Stanford-Berkeley study shows the race of a man’s doctor could play a role in closing the racial gap (file image)
According to the latest data from the CDC, Hispanic American women still have the highest life expectancy of any racial group in the US – living to an average of 84 years old. Non-Hispanic white women in the US are expected to live to 81.1 years old, while both Hispanic and non-Hispanic white males live to 79 years old, on average. African American women have a life expectancy of 78 years old.
Meanwhile, African American men live to 75.6 years old.
There are many factors that pad out this gap. Among them: black men are less likely to have health insurance coverage, are more likely to live in a disadvantaged community, and are more often subjected to discrimination.
That increases stress and makes it harder to eat a healthy diet – among other things – which drives up the risk of diabetes, hypertension and various cancers. Often, those warning signs are not caught early enough to make a difference.
For many, that might be because they do not have health insurance, so doctor visits are few, if at all. But that’s not the whole picture.
Studies show trust is a factor that cannot be understated in this vicious cycle.
Public health experts broadly agree that the ‘Tuskegee Study of Untreated Syphilis in the Negro Male’ had a direct impact on the health of African American men.
The experiment was a 40-year study on 600 black men in Tuskegee, Alabama, who all had syphilis. From 1932 to 1972, syphilis-infected men would flock to the center, run by the Public Health Service, for blood tests and treatments.
But it turned out, it was a dud: researchers were not disclosing their true diagnoses, and plying them with a placebo. They had never planned to treat the men; they planned to watch how syphilis progressed in black men.
In 2016, a study by Marcella Alsan, associate professor of medicine at the Stanford School of Medicine, and Marianne Wanamaker, of the University of Tennessee, showed the life expectancy of African American men had dropped an entire year by 1980 – something, they found, could be directly attributed to Tuskegee.
According to Dr Alsan, that was what drove her to carry out this new one, in collaboration with Owen Garrick, of Bridge Clinical Research, and Grant C. Graziani, of University of California, Berkeley.
‘That study really weighed on me. The more disclosures we dug into, of the archival abuse, the more disgraceful it was,’ Dr Alsan told DailyMail.com.
‘So I started reading about various interventions that are being suggested to improve the health of African American men, especially as African American men have the lowest life expectancy of any demographic group.
‘Many have put forward this platform of trying to increase diversity in the physician work force, since African Americans are vastly underrepresented in the physician work force. That struck me as something we could test.’
The group decided to investigate how a black man’s health differed depending on the race of his doctor.
They could not find a clinic with a balanced-enough ratio of white and black doctors that would agree to partner on a study, so they created their own in Oakland, California, with 14 doctors (six black, eight of other races), and invited more than 1,300 black men to take part.
The doctors and the patients new that they were part of a study looking to improve the take-up of care in African American men, but nothing more.
First, the patients were offered $25 to fill out a survey about medical mistrust and sociodemographics in healthcare.
Next, they were offered $50, and a free ride, to go to the clinic for a check-up, to be screened for blood pressure, cholesterol, and diabetes, and to get their BMI measured. They were given a list of the things they might be offered – including drawing blood – and a bio, with a picture, of their doctor.
Finally, they met their doctor, who was told to try to persuade their patient to get all five of the preventative treatments on offer.
The results were stark.
Before meeting their doctor, there no notable difference in how many treatments patients agreed to – whether their doctor was African American or not.
However, after speaking with their doctor, there was a clear divide: African American patients were far more likely to agree to everything if their doctor was black, too.
The only patients that agreed to invasive treatments (i.e., drawing blood) were ones that saw a black doctor. They were also 47 percent more likely to be screened for diabetes, and 72 percent more likely to get their cholesterol levels checked, if they saw a black doctor.
Dr Alsan said her team see the findings as a clear indication of the sense of trust and understanding the patients felt based on their doctor being of the same race.
‘The [theory] that seems to fit most neatly with our results was that communication and trust was really important,’ Dr Alsan told DailyMail.com.
‘Some things require more trust, like drawing blood. There, we saw really big differences.’
To get a sense from a broader cross-section of the population, from both white and black men, they carried out a secondary study – this time, a survey – to see whether race might matter in general.
From the outset (pre-appointment) it didn’t, but after meeting their doctor, it did.
‘When it came to questions like “which doctors do you think will understand your concerns?”, and “which do you feel most comfortable speaking with?”, there was a preference for a doctor with their own racial background,’ Dr Alsan explained.
Why is not exactly clear. Communication is so nuanced that it would take far more studies to dig into the way doctors of different races connect with their patients in person.
But for now it is a clear indication that in-person conversations could be crucial for tackling health disparities in America, home to the most costly healthcare system, and some of the biggest gaps in citizens’ health.
‘It’s a very concerning, inequitable fact of our health statistics that African American men have fewer years to live on this planet than any other demographic group,’ Dr Alsan said.
‘This was the first time we could see that there might be a real economic effect of having diversity in the physician work force.’