Healthcare Disparities – How Can We Shrink the Gap?

Inequities in healthcare — such as lack of health insurance, unaffordable medical expenses, and structural racism in healthcare — create disparities in care and make the system more costly and less effective. One study estimates that eliminating racial/ethnic health disparities would reduce healthcare costs by $230 billion and indirect costs of excess disease and mortality by more than $1 trillion over four years.1 Despite the best efforts of physicians and other healthcare professionals, health trends are moving in the wrong direction. Every day, health administrators face multiple real-world examples of health disparities, recently heightened by the COVID-19 pandemic. Healthcare providers and healthcare systems must play a major role in advancing health equity to prevent needless suffering, premature deaths, and avoidable costs.

Our nation, considered the most prosperous in the world, has rising rates of obesity, diabetes, and hypertension. In fact, a study published by the New England Journal of Medicine predicts that by 2030, several states will have obesity prevalence close to 60 percent, while the lowest states will be approaching 40 percent. The researchers predicted that nationally, severe obesity will likely be the most common BMI category for women, non-Hispanic black adults, and those with annual incomes below $50,000 per year.2 The COVID-19 pandemic has only added more dismal statistics. According to new federal data, in the first six months of 2020, the U.S. life expectancy dropped by a full year. What’s even more alarming is that the life expectancy of an African American dropped by three years during the same time frame.3

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Leading the change to confront the public health crisis

We are fortunate to have physicians and other healthcare professionals who are passionate about improving the health of their patients and communities, and who are dedicated to achieving greater equity for those who experience worse health outcomes because of inequities.

Physicians are ideally positioned to not just talk about these issues, but to act upon them. Many people talk about doing what’s right for healthcare. Physicians can make an immediate impact by utilizing tools that can remove barriers that interfere with patient care and drive the future of medicine through improved technology, physician training, and education.

Removing barriers by advocating for patients

Through advocacy and by influencing public policy, physicians can fight to ensure that patients have access to needed health coverage. Too many Americans are uninsured and underinsured and can be one medical bill away from draining their family’s savings. Medical organizations at the state or national level — such as the American Medical Association (AMA), the National Medical Association, and American Medical Women's Association — can also help physicians engage in healthcare advocacy efforts. The American Academy of Family Physicians published the EveryONE Project
(www.aafp.org/family-physician/patient-care/the-everyone-project.html) that offers strategies for use in your practice to help improve patient care and outcomes. The toolkit can be used as a guide to help physicians become involved in health policy by addressing key drivers of health outcomes and health inequities for state and local governments.

Through advocacy, physicians with the Behavioral Health Integration Collaborative have called on policymakers to enforce mental health parity laws to allow fellow physicians to better care for patients diagnosed with a substance use disorder. Although reported estimates of certain mental disorders, substance use, or substance use disorders are not generally higher among racial and ethnic minority groups, persons in these groups are often less likely to receive treatment services.⁴

Improve physician training and education

There are many organizations that have focused their efforts on improving healthcare disparities. The AMA policy on reducing disparities in healthcare aims to increase awareness of racial and ethnic disparities in healthcare among the general public. The AMA provides a toolkit entitled, “Working Together to End Racial and Ethnic Disparities: One Physician at a Time” (www.ama-assn.org/print/pdf/node/44501), that offers physicians information on topics such as culture competence and literacy.

The Health Resources and Services Administration (HRSA) provides extensive resources for healthcare professionals on cultural competency, health literacy, and limited English proficiency. The following are two links for free online training and a library of cultural competency resources.

Unified Health Communication: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency.
https://www.migrationpolicy.org/sites/default/files/language_portal/HRSA_0.pdf

Cultural, Language, and Health Literacy Resources for Health Care Providers
https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/culture-language-and-health-literacy

Summary

Today, more than ever, we need healthcare professionals and collaborators to pave the way to make our health system more accessible, more affordable, and more effective, with improved outcomes for all. We need to band together to truly improve the health of our nation.   

 

Monica Ludwick is a Senior Risk Management and Patient Safety Specialist for CAP. Questions or comments related to this article should be directed to MLudwick@CAPphysicians.com.

1LaVeist TA, Gaskin D, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41(2):231-238.

2Ward, Zachary et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity.  New England Journal of Medicine, December 19, 2019.

3Santhanam, Laura. “COVID-19 has already cut U.S. life expectancy by a year. For Black Americans, it’s worse.” PBS, February 2021, https://www.pbs.org. Accessed August 28, 2021.

⁴McKnight-Eily LR, Okoro CA, Strine TW, et al. Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental Health Conditions, and Increased Substance Use Among Adults During the COVID-19 Pandemic — United States, April and May 2020. MMWR Morb Mortal Wkly Rep 2021;70:162–166.