Tools for overcoming health disparities

March 15, 2024
Irby B. Hunter Jr., Medical Director Oncology Independent Education, Inc & Executive Publisher Oncology Disparities www.oncologydisparities.com

Despite expanding interest in understanding certain social factors that drive poor health outcomes, many academics, policy makers, scientists, elected officials, journalists, and other responsible for defining and responding to the public discourse are reluctant to identify racism as a root cause of health inequities. ⁽⁸⁾ Racism is a system consisting of structures, policies, practices, and norms that assign value and determines opportunity based on the way people look or the color of their skin. It is widely accepted that centuries of racism in the US have had a profound and negative impact on communities of color; social determinants of health are key drivers of health inequities within communities of color, placing US citizens within these populations at greater risk for poor health outcomes. Modern data demonstrates that racial and ethnic minority groups in the US experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, heart disease, and certain cancers.

As of November 2021, American Indian and Alaska Native, Black, and Latino people all had suffered from higher rates of hospitalizations and deaths related to COVID-19 compared with White people. ⁽¹⁾ These inequities result from racial and ethnic minority populations inequitable access to health care, which persists because of structural racism in health care policy. ⁽²⁾ The US health care system is structured to advantage the White population-the racial group in power-and disadvantage racial and ethnic minority populations. ⁽³⁾ Structural racism operates through laws and policies that allocate resources in ways that disempower and devaluate members of racial and ethnic minority groups, resulting in inequitable access to high-quality care. ⁽³⁾ Affordable Care Act (ACA) was expected to help reduce these inequities, yet they persist in the areas of health care coverage, financing, and quality. ⁽³⁾ Black and Latino people are approximately 1.5 and 2.5 more likely, respectively, to be uninsured than White people. ⁽⁴⁾ Data shows that the uninsurance rate for Black and Latino people in Medicaid expansion states has decreased. ⁽⁵⁾

Structural racism in access, coverage, and finance has created a two-tier system of racially segregated care in which minority people receive poorer-quality care; evidence suggests that Black and Latino people receive lower-quality care compared with White people, even after insurance coverage and income are adjusted.⁽⁶⁾ Data shows that ethnic minority patients are less likely to receive evidence-based cardiovascular care, kidney transplants when indicated, age-appropriate diagnostic screening for breast and colon cancer, and timely treatment related to cancer and stroke. ⁽⁷⁾

The most commonly identified form or structural racism, residential segregation affirms the powerful connection between place, opportunity, and outcomes. ⁽⁹⁾ People of color are more likely to live in care deserts and are less likely to have access to transportation to care outside of their neighborhoods. ⁽¹⁰⁾ Residential segregation indirectly influences health through its adverse effects on the quality of education, housing, and physical environment in communities of color. ⁽¹¹⁾ Occupational segregation is a second common identified form of structural racism. People of color are more likely to be employed in low-wage jobs with poor benefits like leave and scheduling flexibility, to be less able to afford and access health care. ⁽¹²⁾ Due to the underrepresentation of people of color in medicine, people of color are less likely to see providers of the same race and ethnicity. ⁽¹³⁾

Evidence reveals that community partnerships, equitable policy interventions, and training are effective means to make an impact on health disparities caused by structural racism. ^{(8, 14,15)} The Save 100 Babies initiative in Atlanta, Georgia is an example of effective community partnership. The program was implemented to fight infant mortality in the Black community; more than 100 community members participated in discussion personal experiences, followed by actionable steps against infant mortality. ⁽¹⁶⁾ The Family Smoking Prevention and Tobacco Control Act is an example of how policy interventions may positively impact persons of color. ⁽¹⁷⁾ As a result of the legislation passed in 2009, public health experts were able to identify how lower-income and minority communities were more likely to have stores that were noncompliant and thus encouraging tobacco use in specifically younger minority citizens and increasing health disparities in these communities. ⁽¹⁷⁾ Training medical professionals to avoid the biases present within the medical field is pertinent in attacking structural racism. Medical curricula that underline the importance of the relationship between public health and medicine has been proven to highlight how structural racism can impact patients and one’s responsibility to work toward health equity. ⁽¹⁷⁾

It is a high time to eradicate the structural racism in health care policy that perpetuates inequitable access to high-quality health care. If not the racial and ethnic inequities will not only devastate minority communities but harm the entire country. ⁽²⁾ Resolving structural racism provides a concrete, feasible, and promising approach towards advancing health equity and improving population health. ⁽⁸⁾ Health care practitioners have opportunity to make tangible strides forward towards partnering with community members thereby directly advocating for all patient populations. The editors of www.oncodisparities.com will continue push forward best practices to strengthen the equitable use of resources and access to quality care.

References:

• Centers for Disease Control and Prevention. Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. Atlanta CD 2021 Jul 16. Cited March 10, 2024. Available from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethncity.html
• Yearby, R., Clark, B., Figueroa, F. Structural Racism in Historical and Modern US Health Care Policy. 2022. Health Affairs Volume 41, Issue 2: Racism & Health February 2022 Pages 157-313
• Yearby R. Structural racism and health disparities: reconfiguring the social determinants of health framework to include the root cause. Journal Law Medical Ethics. 2020, 48(3)518-26
• Hill, A., Damico, O., Health coverage by race and ethnicity, 2010-2019. San Francisco (CA): Henry J. Kaiser Family Foundation: 2021 Jul 16 Cited March 10, 2024. Available from https:www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/
• Cross-Call J. Medicaid expansion has helped narrow racial disparities in health coverage and access to care Washington (DC): Center on Budget and Policy Priorities; 2020 Oct 21. Cited March 10, 2024. Available from: https://www.cbpp.org/research/health/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage
• Ndugga, N. Artiga, S. Disparities in health and health care: 5 key questions and answers. San Francisco (CA). Henry J. Kaiser Family Foundation; 2021 May 11. Cited on March 10, 2024. Available from: https://www.kff/org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers
• Agency for Healthcare Research and Quality. 2019 national healthcare quality and disparities report. Rockville (MD): AHRQ; 2020 Dec. Cited on March 10, 2024. Available from: https://www.ahrq.gov/research/findings/nhqdr19/index.html
• Bailey, ZD., Krieger, N., Agenor, M. Graves, J., Bassett, MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 April 8;389: 1453-1463.
• Furtado, K., Verdeflor, A., Waidmann, T. A Conceptual Map of Structural Racism in Health Care. Urban Insitute. October 2023. Cited on March 10, 2024. Available from: A Conceptual Map of Structural Racism in Health Care | Urban Institute
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