Alabama has consistently been ranked one of the least healthy states, being 46th as compared to the rest of the nation. Alabama is 37th in health care access, 39th in health care quality, and 47th in public health. Not only is the overall health of Alabamians poor compared to that of other states, but health disparities between African Americans and Whites are also considerable. African Americans comprise nearly 82.75% of the minority population in Alabama. These health disparities exist in both access to care and the delivery of care to minorities in the state. African Americans in Alabama had higher rates of all chronic diseases, injury, premature death, and disability. The consequences of these disparities include shorter life expectancy, diminished quality of life, loss of economic opportunities, and socioeconomic inequality.
Despite the presence of nationally recognized medical institutions like the UAB School of Medicine and University Hospital and revolutionary advancements in healthcare, African Americans continue to experience poorer health outcomes resulting in more significant morbidity and mortality. Disparities in access to care are aggravated by the availability of physicians and lack of health insurance.
Factors Affecting Access to Care in Rural Alabama:
8 rural Alabama counties do not have hospitals.
35 of 55 rural Alabama counties do not provide labor and delivery services.
Emergency response time in rural counties is over 27% greater than in urban areas.
Hospitals in rural Alabama counties have 25.1 general beds/10,000 residents compared to 45 general beds/10,000 residents in urban counties.
In 2006 the patient-to-primary care physician ratio was 2160 per PCP compared to 1250 per PCP in urban counties (these numbers were much worse in 2021).
There is a strong relationship between the level of education and overall health status. According to the 2000 census data, nearly one-third, or 30.3%, of all rural Alabama residents age 25 years or older had less than a high school education. The Covid-19 pandemic has exposed the fissures of racial inequity in the healthcare system of Alabama. The mandates and other activities put in place to mitigate the spread of Covid-19 and decrease deaths have also had grave economic, social and secondary health consequences.
Significant racial disparities exist in cardiovascular disease, diabetes, obesity, kidney disease, cancer, infant mortality, chronic lung diseases, stroke, and complications (and severity) of the Covid-19 infection. It is a moral imperative that we actively seek to increase the number of physician healthcare providers in the state of Alabama and ensure that there is an appropriate representation of African American physicians. Studies have shown that black patients are more likely to feel comfortable with physicians of their culture and more likely to adhere to preventative medical recommendations offered by black physicians. Cultural competency is the key to improving patient compliance and trust. The Covid-19 vaccine rollout has confirmed that the black community continues to distrust majority health institutions reverting to old fears of the “Tuskegee Experiment” and physicians like James Marion Sims (the “father of modern gynecology”) who performed unethical surgical procedures on black women.
Recommendations:
For these reasons, we must provide an early introduction to STEMM (science, technology, engineering, mathematics, and medicine) education, mentor, prepare and recruit more African American students into medicine. The presence of diversity in medicine enhances African American cultural competency by increasing empathy and cultural sensitivity in the entire medical community.