2020 has been a devastating year, and it has also provided a long-overdue wake-up call. The plight of African Americans and Hispanic/Latino Americans — who are dying of COVID-19 at much higher rates than white patients — brought the topic of racial health disparities to our living rooms and dinner tables. Weeks later, the tragic death of George Floyd highlighted the insidious systemic racism that permeates our culture and institutions.
As an African American healthcare CEO and emergency physician in an underserved rural community, social justice — and especially healthcare justice — is close to my heart. I am a firm believer that we are only as safe as the most vulnerable among us. As the pandemic has shown us, this applies doubly to public health.
I am hopeful that suffering collectively through these shared tragedies will lead us to a more just world where no person or family suffers due to a preventable health condition. In this article, I share some personal thoughts on what healthcare justice means and what it will take to achieve it.
Healthcare Discrimination has Many Faces
Why are black children six times more likely to die from asthma than white children? Why are American Indians/Alaskan Natives 2.4 times more likely to die of liver disease than their white counterparts? And why is the HIV infection rate among trans women over 20% versus less than 1% for the general population?
The causes of these and other disparities are complex and vary geographically. (I encounter different inequities in central California than do my colleagues in Chicago, for example). But they have some common denominators, including:
- Geographic disparities in access
As an emergency physician in California’s Central Valley, which includes broad swaths of “medical desert,” I know firsthand that healthcare access depends on where you live. Patients in communities of color, poor urban areas, and rural areas must often travel long distances and/or endure long wait times for doctor appointments. For many, the emergency department (ED) represents the only option for timely care.
- Distrust of the healthcare system
Unfortunately, doctors, hospitals, and medical researchers have sometimes violated the human rights of vulnerable people. The Tuskegee Syphilis Study was one of many cases in which black people were subjected to unethical medical research without informed consent. Medicine has also been used to pathologize people fighting for equality (for example, branding black civil rights activists as dangerous paranoid schizophrenics in the 1960s).
I’d like to believe that we’re past all that and that things are different today. But then I see undocumented patients in my rural ED who have delayed life-saving care for fear that their status will be discovered and reported to immigration authorities.
- Lack of clinical competence
Many providers are misinformed (or underinformed) about appropriate clinical care for minority patients. One survey found that 40% of white medical students believe that black people have higher pain tolerances. (I sometimes shudder to imagine what this could mean for myself or my loved ones if we experienced a painful illness or injury.)
Also, too few patients with substance use disorder receive highly effective medications for addiction treatment (MAT), because some providers still believe these therapies “trade one addiction for another.” And about a third of transgender people report forgoing medical care because they can’t find doctors who respect and understand their health needs. In fact, a significant number had been refused care.
Economic Solutions: No Magic Bullet
Some people hope that universal or expanded coverage will immediately usher in healthcare justice. While many people (including those at risk for disparities) would no doubt benefit, it’s important that we don’t stop there.
It’s a persistent myth that health inequity affects only the poor. While money may confer some privilege, it does not insulate one completely from systemic racism. Wealthy and middle-class black men are still more likely than white men to experience heart disease, diabetes, and premature death. And almost every black physician, healthcare leader, medical student, and academic I know (myself included) has experienced discrimination if not outright violence.
Having immigrated to the United States from Canada, I am often asked if universal coverage solves health disparities. The answer is complex. Although Canada’s system has largely eliminated socioeconomic inequality, health disparities persist for many other groups. So, while coverage expansion has helped many Canadians, it hasn’t been a magic bullet.
Justice Starts with Each of Us
What else needs to happen to eliminate health disparities? Fundamentally, I believe that healthcare justice must start in the heart of each provider. We must each commit to treating each patient as a blank slate by recognizing our biases and programming — and leaving them at the door.
As healthcare leaders, we must “walk the walk” to promote this level of inclusiveness across our organizations. On a personal level, this means modeling honesty, humility, openness, and willingness to learn. It also means factoring inclusion into every decision by routinely seeking input from diverse stakeholders.
Here are a few key steps that healthcare administrators, clinical leaders, and providers can take to help usher in change.
1. Talk about disparities
Often the most powerful action we can take is to start a conversation and keep it going. There are likely people within your hospital, health system, or physician group who consider health disparities “not that serious” or “someone else’s problem.” These attitudes may also extend to the workplace, creating unsafe spaces for minority providers. Through our collective example, we can send the message that discrimination hurts everyone and that we all have a responsibility to correct it.
Vituity is committed to amplifying the voices of diverse providers for the benefits of our patients. An early example was Vituity Women in Medicine, an advocacy group that focused on improving recruiting, retention, and career development opportunities for women professionals.
The model has since evolved into six Enterprise Resource Groups representing Women, Black/African American, Hispanic/Latinx, Asian/Pacific Islander, LGBTQ+, and Parent/Family professionals.
Read more about Esther Choo, MD champion for equity and diversity in medicine and recipient of the Dr. Wes Curry Emergency Medicine Diversity Leadership award at Vituity’s 2019 Executive Leadership Diversity Summit.
2. Create opportunities for diverse leaders
Research suggests that when it comes to diversifying our C-suites, boardrooms, and clinical leadership, standard leadership training is not enough. To overcome systemic discrimination, we must actively create pathways for promising candidates.
Consider how mentorship, pipeline programs, and personal relationships can help to diversify all levels of your organizations. (Case in point: I am the second African American CEO of Vituity, and I would not be here if my predecessor had not taken a personal interest in my career and encouraged my career development.)
Learn more about how healthcare organizations can attract and nurture diverse leaders from Savoy Brummer, MD.
3. Make culturally competent care the standard
Culturally competent providers who understand the communities they serve can make a massive difference in the health and well-being of their patients.
One of the most fundamental ways we can ensure this competence is by recruiting locally. When Vituity moved into new cities like Baltimore and Washington D.C., we invested heavily in outreach to local physicians, teaching hospitals, and medical schools. As a result, we quickly recruited providers who understood the culture, needs, and strengths of these communities.
It’s not necessary to look like a patient to relate to them and provide excellent care. However, it is important to understand your own biases and how they impact the provider-patient relationship. Through our partnership with the National Diversity Council, Vituity provides first-rate cultural competence training to help providers better serve diverse patients.
Healthcare Justice at Vituity
As CEO of Vituity, I’m proud to be part of organization that advocates for healthcare justice while leading by example. Our physicians are actively advocating for policies that protect our most vulnerable patients and developing care delivery models that expand access to vulnerable populations. Examples include the California Bridge Program aimed at promoting MAT access in the ED and our groundbreaking approaches to acute behavioral healthcare. I further believe that to change the world, we must address inequities beyond the physical walls of our Vituity hospitals and clinics. To this end, we launched the Vituity Cares Foundation in summer 2020, with goals to build representation in the provider workforce, provide care to vulnerable communities, and develop solutions that address social determinants of health. I am incredibly excited about the impact this foundation will have on expanding access to patient care and fostering diversity in healthcare.
As a physician-owned and -led organization, Vituity is in a unique position to make lasting change in healthcare delivery across the country.