Disparities in Healthcare

September 27, 2018  Martha Hostetter and Sarah Klein

Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. They also have worse health outcomes for certain conditions. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. This issue of Transforming Care offers examples of health systems that are making efforts to identify implicit bias and structural racism in their organizations, and developing customized approaches to engaging and supporting patients to ameliorate their effects.

It’s been 15 years since the publication of the Institute of Medicine’s Unequal Treatment report, which synthesized a wide body of research demonstrating that U.S. racial and ethnic minorities are less likely to receive preventive medical treatments than whites and often receive lower-quality care. Most startling, the analysis found that even after taking into account income, neighborhood, comorbid illnesses, and health insurance type — factors typically invoked to explain racial disparities — health outcomes among blacks, in particular, were still worse than whites.

This research prompted the Institute of Medicine to add equity to a list of aims for the U.S. health care system, but efforts to ensure all Americans have equal opportunity to live long and healthy lives have been given less attention than have efforts to improve health care quality or reduce costs. A recent Institute for Healthcare Improvement white paper called equity “the forgotten aim,” noting as did the 2010 Institute of Medicine report, How Far Have We Come in Reducing Health Disparities?, how little progress has been made.

To reduce racial and ethnic health disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. Less directed efforts to improve health outcomes, ones for instance that fail to consider the particular factors that may lead to worse outcomes for blacks, Hispanics, or other patients of color, may not lead to equal gains across groups — and in some cases may exacerbate racial health disparities.

Addressing social factors like unstable housing that can lead to poor health is important, but it’s also necessary to acknowledge past and present policies — redlining, eviction procedures, and disinvestment in low-income communities for example — that fuel housing instability. “As health care organizations, payers, and others focus on social determinants and population health, we have a responsibility to ask: To what degree are our approaches grounded in a framework that addresses structural racism and equity?” says Rishi Manchanda, M.D., president and CEO of Health Begins, a nonprofit that helps health care and community organizations address social determinants of health.1 “If we can’t answer that question with rigor and candor, even our most innovative solutions might perpetuate inequity and illness, not prevent it.”

In this issue of Transforming Care, we consider the roles of implicit bias and structural racismin creating and perpetuating racial health disparities. Implicit bias refers to learned stereotypes and prejudices that operate automatically and unconsciously, while structural racism takes into account the many ways societies foster racial discrimination through housing, education, employment, media, health care, criminal justice, and other systems. We focus on these factors more than interpersonal racism, or negative feelings or prejudices that play out between individuals, because while the latter is important the former are more likely to be undetected or unacknowledged factors. We offer examples of health systems that are making deliberate efforts to identify how implicit bias and structural racism play a role in their work, and developing customized approaches to engaging and supporting patients to ameliorate their effects. Many are taking part in the Institute for Healthcare Improvement’s Pursuing Equity Initiative or have been recognized by the American Hospital Association’s Equity of Care Awards. Most of our examples relate to health disparities among black patients; we’ll delve into health disparities among Hispanics in a future issue.

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Greensboro, N.C., is remembered as the site of one of the first “sit-ins” of the Civil Rights movement. In 1960, a group of black college students refused to leave a whites-only Woolworth’s lunch counter, coming back day after day. The incident garnered widespread attention and prompted similar protests across the South. The city’s role in desegregating health care is less well known. In 1962, George Simkins, Jr., a Greensboro dentist, and other black dentists, physicians, and patients filed a lawsuit claiming that…

This article was sourced from CommonWealthFund.org.

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