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Health-care gap: Miners shine light on national access problem

Thousands of coal miners have died from exposure to toxic mine dust in recent years, according to a recent report from NPR, in collaboration with PBS Frontline. Even more troubling than the staggering numbers of death and disability was the revelation that government regulators had not only underreported the cases of advanced black lung disease, but they also had known about the excessive level of toxic mine dust for decades and did nothing.

According to the NPR report, in an interview, Danny Smith, a coal miner, stops mowing his lawn to expectorate a piece of dead lung tissue. Certainly this is a distressing image, but the poignant words of Ron Carson, director of the Black Lung clinics, are haunting: “These men paid a price for the greed of others.”

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Some say the greed driving the industry of coal mining has squashed the economic development of these regions. Many coal-mining counties are in the most economically distressed counties in the United States, yet coal mining companies are experiencing record  profits.

The miners who are taking the risks are not walking away with these large earnings or profits. It is the companies that are profiting from the dangerous and sometimes fatal work of the miners.

This narrative of the miners resonates because I experience a similar scenario of lack of access and treatment of disease unfold in healthcare as it relates to socioeconomic status and geography.

As a registered nurse, I have seen those who have little face worse health consequences while those who have the most escape the horrors of disease, disability and even death.

A 2017 study published in the Journal of the American Medical Association, demonstrates that life expectancy can vary by up to 20 years based on where you live. More affluent areas tend to have high life expectancies, while lower income areas, have lower life expectancies.

Even within cities, being born in the right place — or the area with higher incomes-- predicts a longer life. For example, in Atlanta, Georgia, residents in Buckhead have a life expectancy of 84 years. In northwest Atlanta, less prosperous than Buckhead, the life expectancy is 72 years.

The coal-miners afflicted with complicated black lung disease, faced a government that ignored the predictors, failed to regulate what could have been prevention and also a healthcare system that failed to screen and treat this considerable disability.

This is also true for those who are economically disadvantaged everywhere in this country. These individuals are less likely to receive screening services to maintain health and are more likely to encounter the health system once their disease is advanced.

In a 2012 report from the Centers for Disease Control and Prevention, in adults ages 50 to 75, 19.5 percent of those with annual household incomes of $75,000 or more reported not being screened for colon cancer. However, for individuals with incomes below $15,000, 42.5 percent reported not being screened for colon cancer.

The link between poverty and late diagnosis is seen in a 2012 study, where researchers found that women living in impoverished areas are more likely to get a cancer diagnosis at a later stage. Survival rates are lower at a later stage of cancer.

Perhaps the most stunning similarity between the miners and the economically disadvantaged in the health care system, is the failure of government to provide action when necessary. In the case of the coal miners, regulatory bodies had reports and data of concerning growth of complicated black lung disease and increased toxic dust exposures for decades. Despite this knowledge, no action was taken on the behalf of the coal-miners.

Likewise, Congress has received annual reports from the Agency for Healthcare Research and Quality on the healthcare quality and disparities in the U.S for the last 15 years. Despite the increasing reports and awareness surrounding healthcare disparity, the U.S. has one of the most inequitable health systems in the world.

Every American regardless of employment, income or geography has the right to unbiased healthcare treatment and a government that regulates obvious causes of health risks.

Colleen Chierici is a BSN, RN is a telemetry RN and president of the nursing staff at Rush Oak Park Hospital. She is a 2018 Illinois Nurse Leader Fellow, a member of the Illinois Kidney Advocacy Council and a Public Voices fellow through The OpEd Project.