How to Combat Racial and Ethnic Health Disparities
In the historic and tumultuous year of 2020, one resounding theme was heard loud and clear. People of color – black, Indigenous, LatinX and others – continue to experience persistent, pervasive structural racism and the tragic, regrettable, and preventable consequences that come with it.
The impact of racism on both individual and population health is disturbing, with the COVID-19 pandemic illuminating the macrocosm of inequities still present across our health care system. Even today, a half a century after the civil rights movement began, racial and ethnic minorities are less likely to receive preventive health care, often receive lower quality care, and have worse health outcomes for many medical conditions (Klein and Hostetter 2018).
These are not new issues, nor is this the first time that medical literature is filled with such discussion. But where and when will change finally come? And finally, how can we help?
The following are just a sample of recommendations, best practices, and advice from throughout the medical community.
- Acknowledge that structural racism and health disparities exist.
To solve a problem, we must be able to acknowledge and define it. Health care professionals need only glance at the latest headlines to know that health disparities unequally claimed twice as many black and brown lives during COVID-19 than white lives. To gain a broader understanding of the extent of systemic racism and health disparities, education is key. We recommend checking out an extensive bibliography compiled by the family medicine scholar community, available here.
- Own your part – even when it’s uncomfortable.
Health care providers, family practitioners, hospital systems, and specialists are encouraged to recognize their own preconceived perceptions when dealing with patients, such as implicit bias. The American Medical Association says that bias, whether explicit or unconscious, “perpetuates structural inequalities” and can “determine whether a patient gets proper testing and treatment” (AMA, July 2020). Consider whether disadvantaged populations have access to your services, seek treatment when sick, receive high quality care, follow your medical advice, and feel they are listened to and heard by you. Taking an honest self-assessment is likely to present opportunities for transformative change.
- Find common language.
Key to dismantling racism in health care is sharing the same understanding of terms that will be used to express issues, ideas, and goals. For example, health equity is not the same as health equality. Here’s why: offering the same resources to those who are already privileged as those who are disadvantaged maintains the status quo. “Those with the greatest needs and least resources require more, not equal, effort and resources to equalize opportunities” (Braveman et al., 2018, pg 3). Similarly, health disparities are distinct from health differences. According to the Department of Health and Human Services, health disparities are closely linked with social, economic, and environmental disadvantage – making them avoidable differences. (Kaiser Family Foundation, March 2020).
- Shift the focus from individual racism to structural racism.
It is widely known that poor health outcomes in communities of color are closely connected to Social Determinants of Health (SdoH), newly updated in its definition as “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks” (Office of Disease Prevention and Health Promotion). In Healthy People 2030, SDoH are grouped into 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. By looking at these conditions from a community perspective rather than at the individual level, resources can be directed at improving broader areas of need. In the case of COVID-19, assuring the distribution of culturally and linguistically appropriate prevention materials and equitable testing resources could have led to “early identification, quarantine, and distribution of resources to reduce community spread of disease” (Van Beusekom, Sept 25, 2020).
- Understand the Impact
Health and health care disparities cost the country billions of dollars per year. A 2018 report from the W.K. Kellogg Foundation and Altarum concluded that advancing racial equity in health would boost the economy by $135 billion by eliminating $93 billion in excess medical care costs and $42 billion in lost productivity (Turner, 2018). Addressing racism, inequity, and disparities in health and health care is important not only from an equity standpoint, but also for improving overall quality of care and population health.
- Rebuild trust with racial and ethnic minority populations
Healthcare delivery systems can take immediate steps to reverse discriminatory and inequitable practices. For instance, the Centers for Disease Control recommend ensuring that preventive and chronic disease management programs are accessible and that patients are supported with self-care information and appointment reminders. Another way to provide equitable, culturally appropriate, and accessible care is to partner with “trusted community and faith-based organizations and institutions” (CDC July 24, 2020). Many community health clinics and organizations suffered huge setbacks during COVID-19 due to chronic underfunding. Yet nearly one in five Medicaid patients get their care from a community health center (Health Affairs, July 20, 2020). Finding cost-effective ways to fund and sustain these community safety nets should be a top policy priority.
- Establish best practices and share them with others
In a recent policy paper, the American College of Physicians created an evidence-based “policy framework” in which to understand and address disparities and discrimination in health and health care. First, the ACP acknowledged the need to “recognize and confront” the multiple, interconnected factors for poor health outcomes among racial and ethnic minorities. They also emphasized the intersection between health policies and other contributing policy areas, including education, criminal justice, and housing, and how each area must undergo deep, substantial, and equity-focused change to have a positive impact on health.
The overarching goal in all of this is equity - to end racial and health disparities. It will take effort and energy that is stronger than the forces fighting against it. It will require “collaboration, commitment, education, and transformative conversations around racism, health inequity, and advocacy” (Sexton et. al. Oct 2020), but in the end, our patients and our communities are worth it.
- A Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care: A Policy Paper from the American College of Physicians. Annals of Internal Medicine, ACP Journals, 12 January 2021. Retrieved from https://www.acpjournals.org/doi/10.7326/M20-7219
- Addressing Racial Health Disparities in the COVID-19 Pandemic: Immediate and Long-Term Policy Solutions. Health Affairs, July 20, 2020. Retrieved from: https://www.healthaffairs.org/do/10.1377/hblog20200716.620294/full/
- Disparities in Health and Health Care: Five Key Questions and Answers. Artiga S, Orgera K, Pham O., Kaiser Family Foundation, March 4, 2020. Retrieved from:
- Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States. July 26, 2010. Retrieved from:
- In Focus: Reducing Racial Disparities in Health Care by Confronting Racism. Klein S., Hostetter, M. Commonwealth Fund, Sept 27, 2018. Retrieved from: https://www.commonwealthfund.org/publications/2018/sep/focus-reducing-racial-disparities-health-care-confronting-racism.
- Studies spotlight COVID racial health disparities, similarities. Van Beusekom, M. CIDRAP News, Sept 25, 2020. Retrieved from: https://www.cidrap.umn.edu/news-perspective/2020/09/studies-spotlight-covid-racial-health-disparities-similarities
- Systemic Racism and Health Disparities: A Statement from Editors of Family Medicine Journals. Sexton S., Richardson C., Schrager S., et. al. Oct 15, 2020. Retrieved from: https://www.aafp.org/journals/fpm/content/Racism_statement.html
- The Business Case for Racial Equity, A Strategy for Growth. Turner A., W.K. Kellogg Foundation and Altarum, April 2018. Retrieved from: https://altarum.org/publications/the-business-case-for-racial-equity-a-strategy-for-growth.
- Social Determinant of Health. Office of Disease Prevention and Health Promotion, Healthy People 2020. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
- COVID-19 FAQs: Health equity in a pandemic. American Medical Association, July 28, 2020. Retrieved from: https://www.ama-assn.org/delivering-care/health-equity/covid-19-faqs-health-equity-pandemic
- What We Can Do. Health Equity Considerations and Racial and Ethnic Minority Groups, Centers for Disease Control, July 24, 2020. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
- Systemic Racism and Health Disparities: A Statement from Editors of Family Medicine Journals. American Family Physician. October 15, 2020. Retrieved from: https://www.aafp.org/journals/afp/content/Racism_statement.html