Healthcare Disparities: An Improvement in Equity Starts With Us

By: Rachel Kimball

Introduction:

After going to the emergency room, did insurance cover your bills? Have you had access to vaccines? Access to affordable prescribed medications? Have you been eligible to participate in clinical trials? Have you had access to affordable, safe housing and non-polluted air? Have you had access to nutritious food and clean water? Have you had a doctor listen to your symptoms thoroughly to provide an accurate diagnosis?

Unfortunately, these are questions that many Americans cannot say yes to. Having access to quality healthcare should be the norm, but why isn’t it? 

Now, it’s possible this isn’t a problem that you personally face. However, you can play a role in combating it. The issues regarding healthcare disparities are the result of lack of compassion  and a lack of education around these issues. Healthcare is vital for our survival, crucial for our existence. Yet, many of those who have access to it don’t care about the fact that others don’t! Ending this problem begins with acknowledging it, so let’s learn a little about healthcare inequity, so we can better educate ourselves and our peers.

Healthcare Disparities Overview: 

The definition of healthcare disparities is “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion ” (2020 Healthy People). 

It is important to note that healthcare disparities are not something that happen by chance, and as mentioned in this definition, healthcare disparities statistically affect marginalized groups of people more than others. Joan Quinlan, Vice President of Community Health at Massachusetts General Hospital states that “80% of one’s health status is attributable to a set of social and economic issues” (MGH Charged).

Examples of these attributable issues include a lack of the following: high-quality education, nutritious food, decent and safe housing, reliable public transportation, culturally sensitive healthcare providers, health insurance, clean water, and non-polluted air. 

Preventing the factors that cause healthcare disparities is a start to ending the inequity surrounding healthcare. Although they may not seem related, things such as improving quality of education or providing affordable housing can greatly improve the healthcare of many. 

Lack of trust in healthcare: 

Harriet Washington, a medical ethicist and author of Medical Apartheid, states, “It is important for those of us in the medical community to gain awareness of the history because it provides a richer cultural context when engaging the African American community and our patients.” Although many of us are not professionals in the medical community, we are part of a community in which healthcare is crucial, and some of us may one day become healthcare professionals.

Unfortunately, the US has a long and complex history of medical experimentation on marginalized groups, and as Washington states, it is important to understand it, as it has led to a lack of trust in healthcare for many. Throughout history, medical schools disproportionately used African Americans in clinical trials and live surgical demonstrations. Additionally, for 40 years, from 1932 to 1972, the US Public Health Service (PHS) conducted an experiment on African American men who suffered from syphilis that led to slow and painful deaths. 

This unfortunate history of prejudice and discrimination in clinical trials has led to a significant lack of trust. This is seen today in vaccine hesitation and a desire to seek medical treatment. Rebuilding this trust may be difficult, but it is important, as it has led to tremendous inequity in healthcare if some feel as though they are unable to trust the medical systems in place. 

Implicit Bias in Medicine:

Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control.

Subtle biases towards patients of color may be expressed in several ways. This can include approaching patients with a dominant and condescending tone, failing to provide interpreters when needed, doing less thorough diagnostic work, recommending different treatment options, and allowing some families to visit patients after hours while limiting visitation for other families. 

It is very dangerous for healthcare providers to have implicit bias, and due to the fact that it is implicit, it is often difficult to dismantle. Implicit bias is often learned from a young age, and the environments in which kids are brought up can greatly influence their opinions. Calling out bias and prejudice when you hear it, even among your adolescent peers, can make a difference, as many of them will one day be healthcare professionals. Likewise, if you hear those who are already healthcare professionals (your friends, family, or pediatricians) express bias, don’t be afraid to kindly call it out. 

Lack of Representation in Clinical Trials:

First, socioeconomic status plays a significant role in eligibility of participating in clinical trials. In order to participate in a clinical trial, one must know that the trial is occuring in the first place. Those living in rural areas or those who don’t have access to internet are much less likely to know that the trials are occurring.

Second, due to the complex history of medical experimentation, many black Americans are rightfully hesitant to participate in these trials. 

Third, due to underlying medical conditions and/or lack of education, many people are excluded from trials. For example, over 75% of black women have hypertension, compared to 40% of white women, and in most clinical trials, participants must have no underlying health conditions, such as hypertension. Furthermore, prior to participating in the trials, cognitive screening is performed. A lack of education or lack of English proficiency would cause potential participants to not reach the benchmark to participate. All of these factors result in a significant lack of representation in clinical trials.

It is important to note that clinical trials test potential treatments for the general public, and they often lead to incredible scientific discoveries. Every approved treatment and cure in medicine today once started with a clinical trial. However, when only a select demographic is included in the trials, it is unknown how the treatment would affect the actual population, a significant issue in healthcare today.

The Results of Inequity in Neurology & Psychiatry:

As mentioned in our Alzheimer’s Instagram/Blog posts, Alzheimer’s is a progressive disease. The later AD is diagnosed, the worse it is, and least likely it is to be reversed. Furthermore, AD isn’t the only progressive neurological disease, and most neurological diseases get worse with time, especially those left untreated. 

Because people of color are unfortunately, less likely to seek care early on due to medical bias and the history of medical experimentation, it means that diagnoses are made further on in disease progression.

Conclusion: 

Acknowledging that healthcare disparities are a problem is the first, but not only step needed to move forward. The NIH has stated that “Virtually absent in literature is evidence-based information on how to reduce an individual health care provider’s bias.” Therefore, it is critical that we point it out when we see it. We highly recommend listening to Joan Quinlan’s episode on MGH Charged to learn more!

Sources:

Hall, William J, et al. “Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.”

American Journal of Public Health, American Public Health Association, Dec. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/. “National Healthcare Quality & Disparities Reports.” AHRQ,

www.ahrq.gov/research/findings/nhqrdr/index.html. “Scholar Speaks About History of Medical Experimentation on African Americans.” Scholar Speaks About History of Medical Experimentation on African Americans | UC San Francisco, www.ucsf.edu/news/2007/12/7682/scholar-speaks-about-history-medical-experimentation-african-american.

Siegel, Sari, et al. “Assessing the Nation’s Progress toward Elimination of Disparities in Health Care.” Journal of General Internal Medicine, Blackwell Science Inc, Feb. 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC1492147/.

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