Seattle's Child

Your guide to a kid-friendly city

Time for a Check-Up: Unequal Health Care in King County

By many measures, we live in a healthy place for kids. King County has the lowest infant mortality rate of any county in the state. Washington ranks fourth in the nation for its relatively small percentage of low-birth weight babies, and 11th overall in the 2010 Kids Count Data Book, a state-by-state study on the well-being of America’s children.

But take a trip to the Northwest African American Museum and a more complicated picture emerges. On exhibit through June 5, “Checking Our Pulse” looks at health care in the local African-American community, with a section devoted to infant and maternal health. Through stories, short films and interactive displays, the museum – in partnership with Swedish Medical Center – offers a compelling lens on the intersections of race and health care in Seattle and the U.S., both historically and today.

Among the exhibit’s most startling messages: African-American mothers with

post-graduate college degrees – women who are lawyers, doctors and other professionals – have a higher risk of losing their babies in the first year of life than Caucasian mothers who didn’t finish high school.

In other words, socio-economics and education don’t account for everything. Nor do genetics. “When you explain away everything else but skin color and you still have health differences, it puts a pretty bright light on racial experience,” says Dr. Benjamin Danielson, medical director and pediatrician at Odessa Brown Children’s Clinic in Seattle’s Central District.

Indeed, a growing body of research shows a correlation between racism-induced stress and adverse health outcomes. Among pregnant African-American women, for example, levels of the hormone cortisol (“the stress hormone”) stay higher, peak higher and don’t go down as low as their Caucasian counterparts. This is true for African-American children, too, Danielson says.

“The high blood pressure reading, the severe asthma, the overweight, are all worse because of stress,” Danielson says. “Cortisol – that arbiter of fight or flight – is so harmful when it trickles corrosively and unendingly through the body on a daily basis.”

Danielson’s young patients at Odessa Brown reflect these findings. They have chronic diseases and levels of severity at three times the rate of children in more affluent Seattle neighborhoods. Among the more common: asthma, obesity and the consequences of obesity such as Type 2 diabetes, and mental and behavioral health issues.

Even more troubling, he says, are the rates of hypertension among the children he sees. Calling it “pretty faintingly rare among Caucasian kids,” Danielson says he never expected to be managing hypertension as a pediatrician.

For many African-American kids, Danielson says, their health outcomes are like those many white kids might have experienced 20 years ago. “It’s not just about access to care. It’s as if they’re not getting the same quality of care, not benefiting as much from the new technologies and practices as white children are,” he says. “King County tends toward better health care for the more well-off, and worse health care for the less well-off.”

A recent King County Public Health study backs this up: King County was found to be one of the worst in the U.S. for the depth of disparities between socio-economics and racial and ethnic groups. According to Dr. David Fleming, director and health officer for Public Health – Seattle & King County, South King County has health demographics comparable with those in certain developing countries.

Depending on where you live in King County, rates of infant mortality and childhood illnesses can double or triple. In Southeast Seattle, the infant mortality rate is more than three times the rate in East and Northeast Seattle.

“It’s too easy to blame the victim for the problem,” said Dr. Maxine Hayes during a panel discussion about health issues in the black community. Hayes is health officer for the Washington State Department of Health. She continued: “Not all neighborhoods are created equal. Some have convenience stores and fast-food restaurants on every corner. Some neighborhoods aren’t safe to go out and exercise in. Studies show that it costs more to eat wholesome foods and those on food stamps can’t easily afford to do so.”

For Dr. Jim Stout, whose primary focus is on asthma health care delivery, the poor/non-poor divide in Seattle is consistent and pronounced. As a pediatrician at Odessa Brown and a professor of pediatrics at the University of Washington, he has worked to improve the care and prevention of asthma for more than 30 years.

For asthma, “the difference is driven largely by the indoor environment,” he says. “Who among us would choose to live in a small, run-down rental place that harbors mold, isn’t well-ventilated, pumps unfiltered forced air for heat, and has no filters anywhere, if you had the means to do otherwise? That’s where low-income families live, to say nothing of the challenges faced with lack of safe neighborhoods, good outdoor air quality, and available healthy food once they leave their home.”

Children in low-income rental apartments can face all kinds of allergy-causing residue, Stout says, from structural problems such as leaky roofs, leaky windowsills and damp ground-floor apartments that can’t be fixed by surface cleaning. As a result, while asthma prevalence is not that different across socio-economic groups, there’s a striking difference in how sick children get, Stout says.

Such issues highlight the limits of the health care provider, Stout says. “You can do good, careful assessments, give the proper medication, but that’s in response to the air our children are breathing. You usually can’t fix their living conditions.”

In most cases, the families who come to Odessa Brown don’t feel they can fix their living conditions either. Structural repairs at home would require negotiations with landlords, which require language skills, a sense of self-efficacy, and/or confidence that families in poverty don’t have. Additionally, often they don’t want to bring legal attention to themselves.

In response, Odessa Brown has started a medical-legal partnership with the Northwest Justice Project. (“The attorney that works with us likes to call himself a social worker with legal stationary,” Stout says.) Unlike a tenant, a lawyer can write a letter to a landlord to get a problem addressed because of health reasons and get a response. A legal team can also offer families legal assistance they’re entitled to, but may not know how to access. As Danielson puts it, such a partnership “breaks down our own silos of work but also breaks down some fundamental inequities our patients face both racially and socio-economically.”

Danielson is heartened by the number of different organizations and partnerships in Seattle working to address the effects of racial and socio-economic inequities in access to and delivery of high-quality health care. He points to the Seattle Children’s Center for Diversity and Health Equity, Equal Start, and Swedish Medical Center’s partnership with the Northwest African American Museum, among others.

Still, what all these health inequities say to Danielson is that “our health care system is designed poorly even though some of its technical attributes are unmatched. It says that we have decided that we want a system that is at least two-tiered if not many-tiered in the way that it offers and affords health care. And it says that we have a shortsighted view of how we see people around us, both as contributors to society and the workforce and also as human beings.”


About the Author

Laura Hirschfield