“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” – Dr. Martin Luther King Jr.
Health care disparities are associated with all aspects of care, including preventive medicine and primary care, maternal care, pediatrics, pain management, cardiology, surgery, dermatology, and oral health. People from racial/ethnic minority populations, and other socially marginalized groups, disproportionately experience inequities in health care access, treatment, and outcomes. Disparities in health care have been attributed to institutional factors (e.g. structural racism) and interpersonal bias (e.g., discrimination, implicit bias).
Structural racism directly impacts vulnerable populations; it also drives many of the social determinants of health (SDOH) that affect care, including health insurance access, housing and food insecurity, and pharmacy proximity. A neighborhood without a pharmacy restricts or limits access to medications. As Monica Peek, MD, primary care physician and health disparities researcher at the University of Chicago, noted:
“Think about how infrastructure was initially created and policies were established. Even policies as recently as the past few years, such as those around immigration and how they impact health. Many were done with the intention of marginalizing some communities while benefitting others. In order to create equity today, we have to go back and undo those policies and that infrastructure.”
Even when patients have health care access, health care professionals’ biases, both explicit and implicit, obstruct equitable care and contribute to medical mistrust among vulnerable populations. Working together to mitigate health disparities is urgent and incumbent. In a timely and pivotal forum, “Addressing Unconscious Bias and Disparities in Health Care”, health care professionals from a range of disciplines voiced a call to action against health disparities and their deeply rooted sources in historical, structural, and modern racism. In this landmark two-day conversation, participants discovered how structural racism and the impact of interpersonal biases are prolific and pervasive, regardless of specialty or health care setting.
While race is a sociopolitical construct, not biological, myths regarding inherent racial and ethnic differences persist throughout society, medical education, and in health care practices. Transforming health care begins with educating current and future health care professionals on structural and health systems inequities, including provider bias. Existing medical training reinforces disparate care through a lack of diversity along the trainee pipeline, and a de-emphasis on empathy and compassionate communication, especially among marginalized patient populations.
Historically, the medical profession’s mistreatment of minority populations created mistrust and produced racist policies that undermine health care today. A recent report, Examining the American Medical Association’s racist history and its overdue reckoning (pbs.org), outlined the AMA’s role in current inequities. Uncovering injustices and tracing their emergence is not enough; actionable solutions are needed at every level – individual, interpersonal, and structural. The esteemed panel acknowledged that while larger structural solutions are necessary to generate real and long-lasting change, interpersonal racism can be addressed by health care professionals at the institution level. The goal: rebuild the health care systems with patients in mind and reimagine how health care meets the needs of all people.
The onus is on health care professionals to learn how historical and structural inequities became entrenched in health disparities today, and commit to changing these injustices. What actions can be taken, right now, to address patients’ needs and reduce health care disparities? Begin by unlearning the past – examine what was incorrectly taught and believed. Each of us has implicit biases – the implicit association test (IAT) illuminates these. But this is only the first step. Emphasizing cultural humility and compassionate communications is also necessary, as is working to ultimately eradicate racism from health care.
“Systems need to be realigned and fixed at their very roots.” – Dr. Peek
By unraveling what we think we know to be true, we begin to see the impact of racism and racist policies on minority populations. The oppressive structural, institutional, and interpersonal inequities of health care become alarmingly clear.
Ready to move forward? Start by visiting the Diversity and Inclusion Hub, which offers all activities for the initiative – including CME Outfitters’ Diversity & Inclusion digital badge credentials – in one central location.
Unlearning is just the first step. Check back weekly for more updates, education, and discussion on these important topics. Please send us your feedback and questions to: questions@cmeoutfitters.com and you can follow us @cmeoutfitters on Instagram, Facebook, Twitter, LinkedIn, and YouTube.