In the 1990s, before I started my second year of medical school at University of California, San Diego (just 30 minutes north of the Mexican border) I made a decision that would change my life. The second-year curriculum allowed for a number of elective courses. We were supposed to select from a catalogue of options—radiology, advanced anatomy, medical ethics, and many others. Most students chose two per semester. I chose one that spanned the entire year: Medical Spanish.
We have known for decades that income, education, race, gender, and other social factors have a bigger impact than medical care on people’s health and life expectancy. Social determinants of health (SDOH) are well documented by respected organizations such as the Centers for Disease Control (CDC) and World Health Organization (WHO).
After more than a year of in-depth reporting in Baltimore, The Atlantic has published a long read that explores why, as a group, black Americans are significantly less healthy than white Americans. The piece follows a woman named Kairra, who is 27, black, very overweight, and suffers from a host of health problems that are usually associated with people three times her age. In Baltimore, as well as other segregated cities like Chicago and Philadelphia, the low-income, mostly black neighborhoods have a life expectancy that is 20 years lower than more affluent, whiter neighborhoods. The gap can be attributed to several factors, including violence, diet, environmental hazards, substance abuse, and stress.
The Congressional Tri-Caucus, made up of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus, has introduced the Health Equity and Accountability Act of 2018 (HEAA), a bill that attempts to address health disparities based on race and ethnicity. The authors note several reasons for these disparities, including language and cultural barriers to care.
To date, 1,656 organizations, 51 state hospital associations, and 11 municipal hospital associations have signed onto the American Hospital Association's (AHA) #123forEquity Pledge to eliminate healthcare disparities. That means every state, and nearly 30% of our nation's hospitals, are represented in the movement to improve health equity. But the road between pledging good intention and effecting actionable change can be poorly marked, and dotted with unseen obstacles. In this post we'll review the key tenets of the AHA's Equity of Care Campaign, rationale for participation, and key actions hospitals and health systems can start to focus on today.
The maternal mortality rates in the U.S. are grim, but the number of women who suffer postpartum complications that nearly cause death are even worse. For every woman who dies after childbirth, at least 70 come close. Some estimates put the number of women who suffer "severe maternal morbidity" at around 80,000 per year. A report by NPR/ProPublica finds that many of these complications are preventable, and there's a common theme that postpartum mothers don't feel their concerns are taken seriously by healthcare providers.
We've reported extensively on the dismal maternal mortality rates in the U.S., and the crisis in black maternal mortality in particular. A new piece by NBC News follows the stories of two black mothers who experienced serious complications with their deliveries. Both women felt their medical teams were dismissive and brusque, and that their health problems may have been avoided with better communication. They are among the 32% of black women who feel they’ve been discriminated against in physicians’ offices. Unconscious (or implicit) bias on the part of healthcare providers has very real consequences for patient outcomes. Bias training may not be the complete solution, but it is part of the solution, and should become a standard practice in all medical schools and healthcare organizations.
Growing evidence shows that more empathetic care can keep people healthier and reduce hospital visits. A new piece by NPR's Marketplace profiles Philadelphia's Penn Center for Community Health Workers, which pairs community health workers with patients who frequent hospitals due to chronic illness, poverty, or mental health problems. The community health workers visit patients at their homes and help them navigate their health issues. The Penn Center makes an effort to match its staff with patients who share a similar background, in order to inspire trust. A randomized, controlled study showed the Center reduced hospitalizations by 30%.