In 1926 Carter G. Woodson created what we know now as Black History Month to preserve the history and successes of Black Americans in the United States. As we celebrate the contributions of the many black pioneers in healthcare, we also are taking a moment to reflect on the ways our industry can better serve black populations.
The Office for Minority Health states, “Despite our nation’s advances in science, public health and health care, the health status of the African American community continues to lag behind the general population.”
Here are a few key concepts to learn from to help providers think about how they can help to operationalize equity for black patients in their communities.
Acknowledge Disparity to Provide Equity
A knee-jerk reaction may be: “Why treat patients of any race differently?” While this color blindness may be rooted in good intentions, it illustrates a pitfall of how we approach the intersection of race and medicine. Treating each patient equally ignores the unique aspects of their lives that greatly contribute to their mental and physical health. Instead of seeking to provide equality, providers should seek to provide equity. Equality seeks to treat everyone the same, while equity distributes resources according to need. This is true of all patient interactions; you wouldn’t care for a diabetic patient the same way as a non-diabetic patient. The goal of this work is not to stereotype, but to individuate.
Issues of race permeate all parts of our society, and healthcare is no exception. A 2018 report from the U.S. News and World Report found that, of the 700 U.S. communities that have a larger black population, only 26 rank among the 500 healthiest communities. This report also found that the some of the strongest predictors of a community’s “health” were also the areas in which large black populations generally struggle, including homicide rates, low birth weight and, in particular, access to healthy and affordable food.
Your zip code is a greater predictor of your health than your genetics. What does that tell us? It isn’t that someone of a particular race has a different genetic predisposition, but rather societal and communal influences.
How Issues of Race Affect Black Mothers
While socioeconomic issues are significant indicators of one’s health, status and education do not always protect against disparities. One trend that has raised concerns among many healthcare organizations and providers is the maternal morbidity rate for black mothers. Maternal morbidity is three times higher for black mothers than white mothers and neither education level nor socioeconomic status affects these risks. In 2016 the New York City Department of Health and Mental Hygiene Bureau of Maternal, Infant and Reproductive Health published a report based on five years of data that found that black, college-educated mothers were more likely to suffer severe complications during pregnancy or childbirth than white women who never graduated from high school.
This issue received national attention when tennis superstar Serena Williams shared her own post-pregnancy scare in a January 2018 Vogue magazine cover story. Williams informed a nurse that she believed she was suffering from a pulmonary embolism given her history with blood clots. The nurse thought Williams was confused from pain medicine, but after much insistence from Williams with her doctor, they did in fact discover that blood clots had settled in her lungs.
How does one of the world’s most prominent athletes experience this kind of neglect? Recent studies find that Black Americans are systematically undertreated in regards to pain management. A 2016 report from the Proceedings of the National Academy of Sciences of the United States of America polled a group of white laypersons and white medical students and found that some of the respondents believed that blacks’ skin is thicker than whites’. Fifty-eight percent of the laypersons believed this to be true, along with 40 percent of first-year medical students, 42 percent of second-year students, 22 percent of third-year students, and 25 percent of residents. Participants who endorsed these beliefs were also more likely to underrate a black patient’s pain.
What Can You Do?
Tackling problems and issues specific to race is not easy, but independent providers are uniquely positioned to be an active participant in the pursuit of equity in healthcare.
First, it is important to address the role implicit bias can play in verbal and nonverbal communication between patients and healthcare providers and staff. A recent study shows that verbal communication between physicians and patients did not differ by race, but nonverbal communication scores were significantly lower with black patients. Like in many other workplaces, creating a space to discuss diversity and inclusion encourages conversation, acknowledgment, and reflection on ways to improve. Hold diversity lectures and engagements at your practice to give employees an opportunity to engage in talks, listen to other perspectives, and acknowledge implicit biases in a safe, nonjudgmental environment.
Practice leadership can also integrate health equity as a core value of their business through measures like ensuring the makeup of their providers and staff are reflective of their patient population and clearly discussing performance against this value in staff evaluations. Even changes to the look and feel of your office can make for a more inclusive environment. Last year, Brigham and Women’s Hospital removed 31 portraits of the hospital’s all-male chairs, most of whom were white, to show greater diversity in their space. Assess your waiting room to see if the posters, pictures, and magazines reflect the diversity of your patients.
Providers can also use technology and practice resources to uniquely address the needs of their patients. If you leverage your patient portal’s potential, you can segment patient populations to highlight gaps in care such as missed annual wellness visits, location (see the point about the zip codes), family history of diabetes, and other factors. After identifying these patients, leverage community resources to help to connect patients with organizations that can supplement the support they receive from their doctor.
Make the Fight for Equity Yearlong
While we shine a light on these issues during Black History Month, it is important to keep this information top of mind throughout the year. Monique Tello, MD, captured this sentiment in a blog post for Harvard Medical School: “To fight racism and discrimination, we all need to recognize, name, and understand these attitudes and actions.“ Providers are uniquely positioned to create not only a healthier society, but a more just one, too.