Is Healthcare Really a ‘Black and White’ Issue?

Disparities clearly exist, and it is our responsibility to figure out why and how to address them, for the good of everyone.

As we close in on the 2020 presidential election, key issues have become inseparably connected. Two of these are healthcare and race.

In a previous blog post, we addressed racial disparities related to COVID-19 risks, which show a disproportionate impact on Black and Latino people across the United States. Inequities in social determinants of health appear to be a factor not only in coronavirus outcomes but also in overall health.

Researchers with Michigan Medicine have been studying racial disparities in the healthcare system for years. In addition to COVID-19 inequities, they have confronted an array of other health gaps:

• Prostate cancer mortality is higher in Black men.
• Minority patients benefit from having minority doctors, but this often isn’t possible.
• Racial and ethnic disparities in insurance access impact maternal-infant health.
• Young African Americans with colon cancer have worse outcomes at every stage of the disease.
• End-of-life care is more expensive for Black and Hispanic people than for white people.
• Black people are likelier than white people to develop dementia later in life, possibly as a result of high blood pressure.
• Technology for people with low vision is less accessible to Black people than to white people.
• Despite ACA efforts to make health insurance access more equal, Black and Hispanic Americans are still less likely than whites to have coverage—and more likely to have gone without some type of care because of cost.
• Food insecurity disparities by age, health status, race, ethnicity and education existed before COVID-19 and may have been worsened by the pandemic.

We have previously acknowledged that many questions about these gaps have yet to be conclusively answered. Researchers are working diligently to explore and address root causes. Data suggest that, depending on the issue, these root causes span a wide range including structural inequity, economics, societal factors, genetics, a lack of trust, implicit bias, Medicaid discontinuity, lack of access to care, and items not covered by Medicare.

In the oft-quoted words of Benjamin Franklin, “an ounce of prevention is worth a pound of cure.” Although he was referring specifically to fire prevention, Franklin’s advice is clearly applicable to healthcare. The more we can address problems before they worsen or even develop in the first place, the better things are for us all.

As healthcare leaders and as human beings, we have a public health, financial, social and moral imperative to bring about a better reality. This means achieving advances in multiple arenas, including: recognizing, confronting and changing systems that discriminate, whether consciously or unconsciously; expanding coverage to at-risk groups; continuing research into various medical conditions and demographic differences; and educating individuals and groups about behavioral modifications that will help them live a healthier life. What it does not mean is accepting the broken status quo.

Jane Sarasohn-Kahn, MA, MHSA, in a recent Medecision blog post, discussed the need for all of us—inside and outside the healthcare industry—to claim, and act on, our collective health citizenship. As the pandemic has abundantly demonstrated, our health is linked to, and increasingly reliant on, that of our fellow citizens: family members, neighbors, coworkers, those who process and prepare and serve our food, those with whom we do business and socialize and worship.

Historically, physicians have sworn oaths expressing principles of ideal conduct. The best known of these, the Hippocratic Oath, has been modified and modernized over the years, while others have also taken root. The Declaration of Geneva (also known as the Modern Hippocratic Oath), adopted by the General Assembly of the World Medical Association in 1948 and amended several times since, is perhaps the most explicitly inclusive, stating: “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.”

Diana Salinas, a student in the Michigan State University College of Human Medicine, reflected on that oath in her 2013 essay “The Color of Medicine.” “(A)s physicians we should treat and care for each patient equally and in an unbiased manner, but at the same time understand that a universal treatment plan will not apply to all patients,” she wrote. “This requires us as physicians to develop cultural competency and be aware of patient diversity.”

As Medecision’s Olivia Peterson discusses in her blog post, organizations need to respond to racial injustice and improve their diversity, equity and inclusion efforts in an authentic and sustainable way. That we were all created equal does not mean we are all the same. Each of us is a unique being with unique needs and challenges. The better we as a society can meet the healthcare needs of all, especially the underserved, the better we will be as a human race.