Health disparities refer to variation in health based on social, economic, and environmental circumstances resulting in worse health or healthcare outcomes among disadvantaged populations along racial or ethnic, social and economic status. Health disparities are not only linked to social and economic difficulties based on race or ethnicity but also to challenges such as discrimination based on religion, geographical location such as urban versus rural, gender, disabilities, education and income inequality, sexual orientation, and other discriminatory factors (Braveman, 2014). Even though the term “health disparities” was coined about three decades ago, it is not a new concept and has been a prevalent problem in our society for a very long time.

Health disparities result to devastating health and healthcare outcomes among affected people such as limited healthcare access and high rates of health issues, and mortality. How to reduce health disparities in the U.S. healthcare entails understanding and addressing a complex combination of systemic healthcare quality and access problems as well as the socio-economic factors that contribute to health disparities. To reduce health disparities, historically underrepresented and disadvantaged populations must be engaged and their trust in the system restored. We should also come up with strategies to mitigate the historical and current unequal distribution of social, political, economic, and environmental resources.

The Essential Big Picture on Reducing Health Disparities

The first critical step on how to reduce health disparities is to not only clearly understand the factors that contribute to their existence but also their complexity. It would not be possible to come up with effective strategic approaches to reduce health disparities unless we go back to their roots. The current health disparities in our society are rooted in our country’s history of social inequality, racism, oppression and economic injustice dating back to the time of slavery. Overtime our society made essential progresses by abolishing slavery, Jim Crow and passing regulations to end discrimination and provide civils rights to all citizens but the legacy of the past injustices still haunts the people and communities that were affected.

While our country has made these important legislative progresses, the situation for communities that were hurt by past injustices has not changed much as they continued being left behind because of structural and systemic challenges that impede their prosperity. For example, our society overtime has evolved a grotesque income inequality where the rich continue to get richer and the poor get poorer every year. The historical inequalities and injustices that have persisted in our society based on different social and economic factors should continually be studied and addressed to reduce health disparities. Here is a reflection on the top 5 best ways to reduce health disparities.

1. Racial and Ethnic Justice and Equity in Healthcare to Reduce Health Disparities

Racial justice and equity in healthcare helps reduce health disparities
A team of healthcare professionals image from DLPNG.com

It is imperative that in our healthcare system every patient is given the opportunity to achieve their full health potential regardless of their race or ethnicity. Health disparities have been prevalent in racial and ethnic minority communities as they face many obstacles to access quality healthcare. In a recent study on ovarian cancer mortality, non-Hispanic black women had an increased risk of overall mortality when compared to non-Hispanic white women and had higher risk of not receiving surgical interventions when compared to non-Hispanic white women (Stenzel et al., 2019). The same trend holds true for many other health conditions and mortality rates whether it is about different types of cancers such as prostate cancer for racial minorities males, cardiovascular diseases, diabetes, and the list goes on.

To achieve our goals in reducing health disparities and ensuring health equity, we must eliminate obstacles such as racism and various forms of discrimination not only in our society but also in our healthcare system. Another crucial aspect in reducing health disparities is the promotion of racial and ethnic justice in our healthcare system through implementing policies, practices, attitudes and other measures that result to equal access to treatment, opportunities, and desired healthcare outcomes for all our people regardless of their race or ethnicity.

2. Reducing Health Disparities Require Addressing Socio-economic Issues

The role of social and economic factors in contributing to health disparities cannot be overstated. Poverty is debilitating and directly linked to many social problems such as lack of access to education, domestic violence, broken families, homelessness, increased crimes rates etc. According to CDC, health disparities are linked to educational inequities because issues such as dropping out of school is associated to multiple social and health problems.

Based on the CDC report, individuals with less education are more likely to have health issues such as obesity, diabetes, and cardiovascular diseases compared to individuals with more education. On the other hand, higher levels of education are linked with healthy lifestyles, longer life and an increased likelihood of getting and understanding fundamental health information and services needed to make appropriate health decisions. (CDC, 2020).

COVID-19 Has Exposed the Relationship Between Health Disparities and Socio-economic Issues

Coronavirus pandemic exposed relationship between socio-economic issues and health disparities
Microscopic view of Coronavirus from Harvard Health Resource Center.

The devasting impact of lack of educational and economic opportunities on health disparities has been exposed by the current public health crisis we face as COVID-19 pandemic have ravaged poor and racial minority neighborhoods. For example, here in Erie County the zip code with the highest confirmed cases of COVID-19 is an inner city historically African American neighborhood on the East Side of Buffalo. It was just a week ago that the U.S. Surgeon General warned that COVID-19 was severely impacting racial minorities and poor communities and urged them to start doing what was necessary to reduce the impact.

The important question to try to understand is why is this the case? From my experience on the East Side of Buffalo, I have seen myths and misconceptions about COVID-19 spread like wildfire in the community because of lack of access to reliable health information which then cause people to disregard the public health recommendations. I also know that most people on the East Side work low paying jobs such as in food stores and live paycheck to paycheck and it is not practical for them to stay inside their houses during the public lock down. Working in these low paying jobs such as food stores that has been classified as essential, put the workers at greater risk of COVID-19 exposure which can in turn spread in the community, and this is part of what has happen on the East Side of Buffalo and other racial minorities and poor neighborhoods.

Necessary Socio-economic Measures to Reduce Health Disparities

 As we strive to reduce health disparities, we must uplift racial and ethnic minorities and economically disadvantaged communities out of poverty and lack of access to opportunities through providing access to good paying jobs, quality and affordable housing and education, and safe environments. In fact, I strongly believe that addressing socioeconomic factors is the ultimate game changer in reducing health disparities and we must act quickly to achieve the outcomes that we desire.

3. The Crucial Role of Patient-Centered and Quality Care in Reducing Health Disparities

Patient-centered healthcare reduce health disparities
A patient receiving healthcare photo from webcomicms.net

While the term “patient-centered” or quality care may sound new to some people, the concept was introduced in U.S. healthcare system in the 1980s and it has not only evolved significantly but also brought about essential changes in our healthcare that cannot be taken for granted. Patient-centered or quality care is a very crucial weapon to fight health disparities because it places the patient at the center of the healthcare process and entails empowering the patient as he/she and his/her family are involved in the decision-making process of medical treatments or health plan. 

Patient-Centered and Quality Care Restore Disadvantaged Population’s Trust and Confidence in Healthcare

Patient-centered care has great potentials to reduce health disparities because it promotes dignity and respect, social support, communication, privacy/confidentiality, patient’s autonomy, and trust which are paramount to disadvantaged populations. Some members of our disadvantaged populations lack trust and confidence in our healthcare system because of past injustices such as the Tuskegee Syphilis Experiment that was conducted on a large group of African American men for decades without their knowledge or consent.

It is not surprising that even today many members of the African American community are less likely to go to the doctor or participate in medical studies. The patient-centered care approach is the way to not only restore trust but also encourage members from disadvantaged populations to increasingly participate in our healthcare system. Increased participation and engagement in our healthcare system by people from disadvantaged populations is essential in reducing health disparities because it creates opportunities for our healthcare professionals to learn and listen to their issues and work with them to find ways forward.

The other crucial aspect of patient-centered care is that healthcare provider become involved even in some social aspects of the patient which is important for reducing health disparities. For instance, a patient-centered care provider might connect a patient without a job to social services/job opportunities or provide health documentations to ensure that a patient with disability receive the benefits that he/she deserves.

The fact that patient-centered care engages the patient’s family in decision making or coming up with a health plan is important to note.  Imagine some elderly diabetic patients with limited literacy skills, engaging their families such as their educated children could play a very important role in their health plan by ensuring that they take their medication as intended and adhere to healthy lifestyles such as exercising or diabetic diet. The idea is that patient-centered or quality care has promising potentials that should be harnessed as more healthcare providers adopt this approach to reduce health disparities.

4. The Importance of Understanding Cultural Context in Healthcare to Reduce Health Disparities

Understanding cultural context in healthcare is paramount in reducing health disparities in several ways. Culture is a very important aspect of life and significantly influence one’s way of life, behaviors, and actions in different situations. Cultural context should be carefully approached in healthcare because of the diversity that can exist even within people from the same cultural group. It is important to remember that various factors such as religion, age, socio-economic class, upbringing, education, sexual orientation, and gender influence culture.

As someone who have provided interpretation service to different refugees/immigrant families in healthcare, I know firsthand that culture impact patients’ perceptions of their health, diseases and their causes, where and how to seek help, their preferred type of treatment, and how to deal with misfortunes such as death. In this context, it should not be difficult to see how cultural context might be linked to health disparities. To reduce health disparities, healthcare providers should be culturally competent and be able to discuss cultural differences or ask patient about different cultural factors that might influence their health or their preferred treatment. Cultural awareness can improve physician-patient relationship, trust, and lead to better overall healthcare outcomes that could reduce health disparities.

5. The Role of Health Professions Diversity and Inclusion in Reducing Health Disparities

Diversity and inclusion help reduce health disparities
A diverse healthcare team photo from webcomicms.net

Diversity and inclusion are a must in healthcare and health professions if we must reduce health disparities. Diversity is a very broad term and can mean a lot of different things in different context but here I’m specifically talking about increasing the physical representation of disadvantaged communities in healthcare through including their members in healthcare workforce. Our healthcare system serves a very diverse population, yet we often don’t see that much demographics-based diversity when it comes to health professionals.

Based on 2018 United States Census Bureau data, African Americans and Hispanics were 13.4 percent and 18 percent of the total U.S. population respectively (U.S. Census Bureau, 2018). However, based on 2018 AAMC healthcare workforce data, African American and Hispanic physicians were 5 percent and 5.8 percent of all practicing physicians in the U.S. respectively (AAMC, 2020). In other words, the percentage representation of African Americans and Hispanics in healthcare based on the number of physicians from their communities is way less than half their percentage composition of the U.S. population.

This under-representation in healthcare trend hold true for other disadvantaged populations such as the LGBTQ community and we must improve their representation in order to reduce health disparities. Proportionately increasing representation of disadvantaged populations in healthcare is critical because health professionals from those communities not only best understand their challenges but also their inclusion would boost trust and cooperation.

To reduce health disparities, a diversity and inclusion strategic approach must be implemented by our health profession institutions that recruit students from disadvantaged populations to health professions education programs and ensure that they have enough support to succeed. Students recruitment and mentor-ship should start as early as middle school or high school to help steer students in this direction. Our healthcare organizations should also make sure that they hire proportionately employees from disadvantaged populations and provide them with career development opportunities and the resources or support they need to help reduce health disparities facing their communities.

References:

AAMC. Diversity in Medicine: Facts and Figures (2019). https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018

Braveman P. (2014). What are health disparities and health equity? We need to be clear. Public health reports (Washington, D.C. : 1974)129 Suppl 2(Suppl 2), 5–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863701/

CDC. Health Disparities (2020). https://www.cdc.gov/healthyyouth/disparities/index.htm

Stenzel, Ashley E., Matthew F. Buas, and Kirsten B. Moysich. “Survival disparities among racial/ethnic groups of women with ovarian cancer: An update on data from the Surveillance, Epidemiology and End Results (SEER) registry.” Cancer epidemiology 62 (2019): 101580. https://www.sciencedirect.com/science/article/abs/pii/S1877782119300918

U.S. Census Bureau. United States Quick Facts (2018). https://www.census.gov/quickfacts/fact/table/US/PST045218