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Excerpted From: Dania Palanker, Enslaved by Pain: How the U.S. Public Health System Adds to Disparities in Pain Treatment for African Americans, 15 Georgetown Journal on Poverty Law and Policy 847 (Fall, 2008) (264 Footnotes) (Full Document)


DaniaPalankerRace-based health disparities have garnered significant attention from researchers and policymakers. African Americans have poorer access to care, receive lower-quality healthcare treatment, and have poorer health outcomes than whites. In recent years, it has become clear that African Americans also receive poorer pain treatment. The problem of disparities in pain is worsened by current and past policies within the United States public health system. This paper examines how the U.S. public health system has worsened disparities related to pain treatment for African Americans.

Section II provides an overview of African American health disparities, including a review of the literature showing health disparities in general, disparities in pain treatment, and the negative impact of under-treating pain.

Section III analyzes how the history of discrimination in medical research and the provision of health care have created mistrust among the African American community. This section begins by discussing the role the Tuskegee Syphilis Experiment played in increasing distrust among African Americans, the history of medical experimentation on African Americans dating back to slavery, and the more recent history of segregation in the health care system.

Section IV discusses the role that socioeconomic status (SES) plays in health and pain treatment disparities, including the impact SES has on access and treatment, variance in pain coping strategies depending on SES, and a discussion of how attempts to take focus away from the impact of SES on health disparities actually perpetuates the racial disparities.

Section V reviews research showing African Americans receive less pain treatment in publicly funded health programs, the impact of managed care on pain treatment and why institutions serving primarily minority populations provide less aggressive pain treatment.

Section VI discusses the war on drugs and how drug policies may be reducing access to necessary pain medications for African Americans. These policies create prejudices about African Americans as drug abusers that unconsciously impact physician decisions. Physicians are scared to prescribe adequate pain medication because of a fear of criminal investigation, and state regulations result in pharmacies in minority neighborhoods carrying inadequate supplies of opioid medications. Opioids refer to the class of medications that possess some properties of opiate narcotics, including analgesics, however, opioids are not derived from opium.

Section VII provides criticism of research for failing to adequately address the issue of pain treatment disparities and the lack of political will to truly reduce pain treatment disparities.

Section VIII concludes the paper by providing policy options to reduce disparities in pain treatment for African Americans.

[. . .]

There is no one reason for the disparities that exist in pain treatment and there is, therefore, no one solution. The disparities exist because of a combination of issues relating to racism, American history, socioeconomic factors, the war on drugs, and an inequitable health care system. More research is needed to better understand the disparities in pain treatment and how these disparities might need more targeted solutions than other health care disparities. In the meantime, it is possible to take steps to reduce the disparities and increase African American's access to adequate pain treatment.

M.P.P., John F. Kennedy School of Government and Harvard University; J.D., Georgetown University Law Center.

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