Moving Forward Together: Addressing Health Equity

By Matt Fisher, General Counsel, Carium
Twitter: @matt_r_fisher
Twitter: @cariumcares
Host of Healthcare de Jure#HCdeJure

Inequalities and disparities exist throughout society and industries, an issue that has become ever more apparent and spotlighted throughout the COVID-19 pandemic. Focusing on healthcare, the inequities are impacting non-white patient populations and with each report found to exist across what appears to be every aspect of healthcare.

Examples of Health Inequities

Recently, reports of new disparities in healthcare are coming out on an almost daily basis. The issues arise in a variety of circumstances and tie together across race, ethnicity, socioeconomic position, and similar social determinants of health factors. As each report comes out, an opportunity is presented to learn from those concerns and develop ways to improve the healthcare system.

1. COVID-19 Vaccination Rates

An unfortunately common theme through COVID-19 has been the determination that Black communities and other non-white communities faced higher risks of exposure and infection due to positions of employment or other societal roles. After the higher risk of infection, there have now been widely covered disparities in access to the vaccine to address those risks.

The initial rollout of the COVID Vaccine showed fairly widespread access issues. Vaccines were not necessarily distributed to areas where non-white individuals could access the vaccine nor was support provided such as time off from employment, child care, or even the ability to schedule an appointment. While some of the challenges are being resolved, vaccination rates are still not equal for all populations.

The still lagging rates mean that non-white populations will keep bearing the brunt of COVID-19 impacts. Improving vaccination rates call for changing tactics and paying clearer attention to how to appropriately engage different populations. Taking varying approaches will means listening to those different populations and tailoring approaches in a way that will be impactful.

2. Diagnosing Heart Disease

Heart disease presents another example of Black patients facing worse outcomes. Recent reports indicate that black patients are not presented with the same treatment options as white patients. In one specific example involving symptomatic severe aortic stenosis, 24.4% of white patients received transcatheter aortic valve replacement treatment whereas only 14.4% of Black patients received the same treatment. Additionally, clinical trials of the treatment modality underrepresent Black patients, which means less opportunity to assess the efficacy.

Failing Black patients on heart disease treatment can increase mortality among those patients, which means more earlier, preventable deaths or long-term health complications. Placing such a burden on Black patients reinforces

3. Impact of Stroke

Treatment of stroke and prevention of death varies greatly based upon location, race, and ethnicity per new research results. Even though overall stroke mortality was reportedly pretty much stable from 1999 to 2018, the stability hides that large variability based on location. The study determined that areas with higher numbers of Black and Asian residents showed more care occurring outside of dedicated stroke units. Not being able to access a stroke unit is impactful because stroke care can very much depend upon timing and knowledge. Inability to access specialization means a much higher risk of adverse outcomes.

Additional social determinant factors were also associated with less favorable outcomes. Some of the other factors that correlated with higher mortality rates were counties with higher percentages of rural, female, uninsured, Black, and Asian populations. The clear picture from the data is that non-white populations and non-urban populations are suffering.

4. Disparities Despite Increased Education

Typically, as education levels rise so does overall health and outcomes, However, more education is not producing the same benefit in Black communities. Differences in study designs reportedly make it harder to exactly compare outcomes for Black men versus white men, but strong evidence does exist for gaps in the impact of education. One statistic cited suggests that Black mean experience a life expectancy increase of 9.7 years compare to Black men with the least education where as the increase for white men is 12.9 years.

Additional factors theorized to fuel the disparities are diseases and environmental factors. As stated by Derek Novacek in the KHN article: “No matter how far you go in school, no matter what you accomplish, you’re still a Black man.” The statement is extremely telling in that no amount of actual and/or perceived work can address the underlying barriers and forces that prevent health from really improving.

Focusing on Health Equity

If change is to occur, then health equity must become a serious action point. What is health equity though? Health equity is defined by the American Public Health Association to mean “everyone has the same opportunity to attain their highest level of health.” If everyone has the chance to get to the same place, then no factor, whether race, ethnicity, gender, or anything else should be in the way of getting to one’s best possible outcomes.

How can equity be achieved? It is likely that no single or readily identifiable answer exists at this point in time. Instead, the first step is recognizing, identifying, and calling out the differences. Without acknowledgement that a problem exists, no attention or effort will be given to making any sort of difference.

After the recognition, the next step will be pursuing and implementing changes to the healthcare system. It should be abundantly clear that the current system is either intentionally or unintentionally entrenching disparities. Whether the disparities are intentional or not, if a system is continually creating differences, then there is a problem. At this point in time, there should not be disagreement that a problem exists. If it is possible to get to that point, then coordinated and collaborative effort should occur to create positive change.

The description of the steps means going beyond just getting everyone the chance for access. Looking at health equality alone is not enough because that does not take into account differing circumstances. Recognition of past wrongs and issues must occur. If not, then the equity suggested will not be possible.

What Next?

The future should hopefully always come with a degree of optimism. However, it may be difficult for non-white communities to find that optimism because change has been yet to occur. Now should be the time to not let attention fade from health disparities. Instead, ongoing effort should be made to drive health equity. Ultimately, overall public health and wellbeing benefits from all populations being able to improve their health and improve their lives.

This article was originally published on The Pulse blog and is republished here with permission.