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12 September 2000

Coping With Chronic Disease

It is nearly impossible to separate the way we finance and deliver health care in this country from health disparities that continue to plague us. Here again, the heated debates about managed care, the uninsured, and government-financed care tend to be emotional and politicized, not always informed by objective reality. CHC faculty members are in the reality-check business.

Anthropologist Gay Becker, for example, has written extensively about the way health care crises affect people's lives and how individuals cope with those crises. In her recent work, Becker conducted a series of interviews with members of ethnic minorities who had chronic illnesses, such as asthma, diabetes or congestive heart failure. The interviews lend a human face to what it means to have one of these diseases without insurance.

"There is no question that the uninsured found their illnesses more harrowing and more bewildering," says Becker. In her work, African-Americans and Latinos were uninsured in much larger percentages than other groups interviewed-a finding that echoes earlier studies.

The lack of insurance often has a devastating and mushrooming effect on individual health. Becker's interviews confirmed that the uninsured are more likely to delay seeking medical care, unlikely to seek it except in a medical emergency, and often go long periods of time unmedicated or undermedicated for their chronic condition. Usually, by the time they do seek care in emergency rooms or free clinics, the problem is advanced or acute. To make the disparity worse, the uninsured have considerably less knowledge about their illness than those who were insured, have more trouble controlling the illness because they do not follow basic self-care procedures, and take more risks.

Becker's paper also argues that community and low-income clinics play a critical role in the health of the uninsured, and so must take it upon themselves to educate their patients about managing chronic disease.

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