Advancing Health Equity
How to overcome barriers to equitable care
By Dr. Michelle Terry and Sherry Williams July 17, 2023
Being a patient is a vulnerable reality. Whether you are not feeling well, are injured, or having a routine checkup, it is natural to feel trepidation as you encounter a rush of medical information and feel pushed to make health decisions quickly during a short appointment time.
Developing a trusting, therapeutic alliance to encourage recuperation and recovery takes time. Core values in an ideal health system include prevention, precision, and equity, because each patient should have access to a treatment that has the best possible chance for cure.
Race is often mentioned when talking about health care disparities because there is uneven access to care for Black, Indigenous, and People of Color (BIPOC). Because BIPOC populations may have unfavorable health outcomes, some researchers have postulated that it is because of the person’s biological makeup.
However, in 2003, Phase 1 of the Human Genome Project demonstrated that humans are on average 99.9% identical at the DNA level. Race is now generally accepted by scientists as a social construct that perpetuates segregation in education, employment, and environment.
Unfortunately, many algorithms can adversely affect the care a patient receives. Research reveals that using race as a variable has the potential to overestimate Black patients’ kidney function by as much as 16%. Race variables also downplay the relative risk of breast cancer in BIPOC women, and some of the machines used to measure lung volume employ general correction factors for persons labeled as Black or Asian. These variables may discourage comprehensive testing and could lead to inadequate treatment.
Many health systems are working to eliminate these “race norming” processes in their protocols; however, it is challenging to change long-established practices across many medical specialties.
Many Black and brown people also experience structural racism in their everyday lives. If the local bus service has limited runs in a neighborhood due to urban planning, people are less likely or unable to travel to their doctor’s office. If there are no supermarkets within five miles, people cannot provide healthy meals for themselves and their families. If a neighborhood is unsafe for any reason, people are unlikely to let their children play outside and get healthy physical activity.
Health equity is a fundamental human right, and a critical component of an equitable society
Structural racism has a profound impact on health equity. Black women are three to four times more likely to die from pregnancy-related complications than white women. Black people are much more likely to die from cancer than their white counterparts. The causes of such health disparities are complex and multifaceted and can be traced back to a history of structural racism and discrimination.
We must address health equity in all areas of health care. Health care providers can address social determinants of health by screening patients using a standard tool such as the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PREPARE) tool. This step helps identify patients who may need assistance.
Clinicians can provide patient education on lifestyle choices, nutrition, and physical activity on how those things impact their health. Providers can refer patients to community resources like housing assistance programs, food banks, and job training. Providers can collaborate with community projects to provide a comprehensive plan for their patients.
Health care organizations can improve communication by decreasing language barriers and improving understanding of specific community cultural norms. If English is not a patient’s first language, schedule an interpreter during the visit. Learn and understand the culture and norms of the communities you serve and listen to the needs and concerns of the patients.
One way to improve access is to engage with people outside of a health care setting in their communities. Meeting with people in their places of worship and other gathering places facilitates authentic conversations about health care needs and concerns. This approach improves awareness and trust in our health care institutions, provides a welcoming environment, and increases access to health services.
Health equity is not simply a matter of improving health outcomes of certain populations. It is a fundamental human right, and a critical component of a just and equitable society. By improving health equity, we improve the quality of life for all of us.
Dr. Michelle Terry is assistant dean of Underrepresented in Medicine and Science Career Development at the University of Washington; clinical professor at the UW School of Medicine; and attending physician at Seattle Children’s.
Sherry Williams is vice president of community engagement and external relations at HealthPoint, a nonprofit community health center.