I have been practicing Pediatric Hematology in Minnesota for 20 years. For the bulk of that time I’ve had the distinct honor and privilege of caring for children with sickle cell disease. Sickle cell disease is one the most common inherited genetic disorders, and is the most common abnormality detected on nationwide Newborn Screening tests. There are 100,000 Americans living with sickle cell disease. It is a disease that affects the red blood cell and has multiple complications including severe pain, stroke, lung disease, infections, and early death (http://scinfo.org/). Although sickle cell disease is a global issue that affects people of all races, in the United States patients are predominantly black.
As a white man, trained by mostly white faculty and white mentors, I never really gave this much thought. Physicians strive to provide quality health care to all of our patients and families and race shouldn’t be an issue, right? Well, then I stumbled into a workshop on White Privilege given by Heather Hackman at the Rainbow Families Conference in 2008. Only then did I begin to consider how my identity as a white male physician might affect the health care delivery to my patients of color. This consideration was long overdue and since that moment, I have been on a journey to better understand racial health care disparities and, with Heather, develop an action plan to address this inequity.
While many factors affect health care equity, disparities based on race that target communities of color are consistently reported in the management of many diseases. For example, blacks receive a lower standard of care than whites when being treated for breast cancer, orthopedic problems, cardiovascular disease, pain, and end-of-life care. According to the 2009 National Healthcare Disparities Report produced by the Agency for Healthcare Research and Quality, many of these discrepancies are not decreasing. Blacks receive worse care than whites for half of the core measures studied, and only about 20 percent of measures of disparities in quality of care improved over the study period of 2000–2007. Being uninsured was the single strongest predictor of quality of care. However, when correcting for uninsurance and socio-economic status, blacks still eceive worse care than whites (www.ahrq.gov/qual/qrdr09.htm). At the local level, a recent Wilder Foundation study reported similar results. Blacks and Native Americans in the Twin Cities have a significantly shorter life expectancy than whites, even after correcting for socio-economic status. (“The unequal distribution of health in the Twin Cities: a study commissioned by the Blue Cross and Blue Shield of Minnesota Foundation,” October 2010 available at www.bcbsmnfoundation.org/objects/Publications/F9790_web%20-%20Wilder%20full%20report.pdf)
Barriers to racial health care equity include the health care system (insurance, funding, white-domination in provision of care), the patient (poor health literacy, fear, mistrust), the community (awareness, advocacy), and we the providers (bias, attitudes, stereotypes, expectations). The combined magnitude of these factors can seem overwhelming, and yet there are points of entry for each of these major variables. As providers, I believe we have the greatest potential for changing racial disparities by working on our own biases. There is much published evidence that our behavior contributes to race/ethnicity disparities in care and that patients and providers perceive race as an issue in health care delivery. Heather and I recently published some of our work in this area (http://www.hackmanconsultinggroup.org/hcg/wp-content/uploads/Race-Matters.pdf). So, what can we do about provider attitudes and biases?
Stay tuned…..Heather and I have developed a training module for health care providers to address race, racism and whiteness and how these affect health care delivery. We hope to present data from our initial pilot training at the 7th Annual Sickle Cell Disease Research and Educational Symposium & Annual National Sickle Cell Disease Scientific Meeting April 14-17 in Miami (http://fscdr.org/).
Similar to Heather’s blog from January 13 Racial Justice Work: A Spiritual Imperative, I strongly believe that racial justice work is also a Health Care Imperative. In the words of Martin Luther King, Jr: “Of all forms of inequity, injustice in healthcare is the most shocking and inhumane.” National Convention of the Medical Committee for Human Rights, Chicago- 1966 (http://www.standupforhealthcare.org/blog/martin-luther-king-jr-a-civil-rights-icon-s-thoughts-on-health-care).
© 2013 Hackman Consulting Group – Do not reproduce part or all without permission.