Without changes to how health care systems are funded and accredited, more financial and public accountability for poor patient outcomes, and increased efforts to end the income inequality and residential segregation linked to lower life expectancy for many people who are Black and brown, the country’s pervasive racial health disparities won’t be eliminated.
The National Academies of Sciences, Engineering, and Medicine’s “Unequal Treatment” report, which was released 20 years ago and was the first significant report to point to racism — not a lack of insurance, poverty, or a refusal to seek care — as a major factor in causing health disparities, came to some of those conclusions.
A group of health equity leaders are meeting this week to build on that work.
The National Institutes of Health is hosting a series of open seminars for the group over the coming months to discuss the state of health disparities in the country and potential solutions.
However, many in attendance at the gathering could not help but express their dissatisfaction that, as STAT has noted, there has been such little advancement since the report’s 2003 publication.
‘Twenty years’. David R. Williams, a renowned expert on health equity and the head of the social and behavioral sciences division at the Harvard Chan School of Public Health, stated on Wednesday, “I was a member of the committee.
“We haven’t really advanced that much. Things must be changed for the better.
Tina Cheng, a pediatrician and chief medical officer at Cincinnati Children’s Hospital, was a different speaker who revealed that she had reviewed the report’s 21 specific recommendations again in order to be prepared for the workshop.
Because several of those recommendations were not followed through on, she said that it made her feel a little depressed. “I hope this committee looks into why,” she said.
Since the publication of the report, many of the country’s health disparities have hardly changed, if anything they have gotten worse: Black kids are almost three times as likely to die in infancy than white babies, and black women are three times more likely to die during childbirth than white women.
Black Americans often have shorter lifespans than white Americans, by over six years.
According to STAT’s reporting, reasons the report did not lead to more change included apprehension around racial topics, health care providers’ denial that they might be prejudiced against patients of color, inadequate tracking of racial and ethnic data for patient outcomes, and a consistent lack of political will to address the numerous issues the report had uncovered.
There is still a lack of such political will, many speakers said. Williams declared, “We need a social movement.
Just like they did 20 years ago, many people working to remove racism in health care are often attacked for being divisive and manufacturing problems that don’t exist.
Other presenters expressed concern that, despite the fact that racism and discrimination still have a significant impact on healthcare, the public debate around health inequalities was moving away from addressing these issues head-on.
Carl Hill, the Alzheimer’s Association’s chief diversity, equity, and inclusion officer, noted research his group conducted in 2021 that revealed more than half of non-white caregivers reported experiencing discrimination while they sought treatment. The current emphasis in health care on diversity, equity, and inclusion—rather than racism—creates the “critical risk…we lose a focus on discrimination,” according to Hill.
Hill stated that twenty years after the report provided proof of how bias and stereotyping permeate the health care system, society “is back to debating whether generational multilevel impact of racial and ethnic discrimination is real, and that is disheartening.”
The Morehouse School of Medicine’s Camara Jones, a physician and renowned expert on health equality, emphasized to the panel that identifying racism is the first step in addressing it. “Use the entire word.
“Ask how racism is manifesting itself here,” she remarked. “To create a sense of urgency, we need more conversations around our boardroom tables, faculty tables, and dinner tables.”
Others criticized the two strategies diversity training and unconscious bias training, which are widely used in health care systems to address health disparities, claiming they have minimal impact.
According to Williams, “the two main strategies many healthcare systems are using to assist their professionals are not working.”
He cited the “Devine solution,” a comprehensive training program created by Patricia Devine, a professor of psychology at the University of Wisconsin-Madison, as an exception. It was a 12-week curriculum, not a two-hour class, according to Williams.
There were exercises for the homework. However, only a small number of health systems have committed to these lengthier training sessions.
Other panelists concurred that despite its rising popularity, diversity training accomplished little to bring about change. Irth, an app that enables Black and Hispanic patients to publicly review their birthing, post-partum, and pediatric care experiences, was created by maternal health advocate Kimberly Seals Allers.
“Unfortunately it’s become a tick the box exercise, or the types of trainings are too short to work,” Seals Allers said. According to Seals Allers, health care systems need to improve the treatment they provide to patients from non-white racial and ethnic groups, not diversity training.
The panel claimed that over the previous 20 years, there has been some improvement in the study and comprehension of health disparities. Williams noted that although the investigation indicated implicit bias among healthcare professionals, following research has conclusively demonstrated a clear correlation between implicit bias and subpar care.
Aletha Maybank, chief health equity officer of the American Medical Association, claimed that increasing research on health equity was utilizing the term racism — not just race — and looking at structural racism’s involvement. She added that her organization had embraced racial justice and health equality problems as a result of the 2003 report.
Weekly studies are published that detail various health inequalities, but Williams and others argued that it was time to move beyond simply identifying these gaps and start working to eliminate them. “We’re specializing more in documenting problems than in finding solutions,” he claimed.
When asked what it would take to go from describing issues to taking action, the panelists had a range of responses. Solutions-based research, according to Williams, needs better funding. It’s fascinating, he added, how researches adjust their work in accordance with what they are paid to do.
He added that until hospitals and healthcare systems were held accountable for health inequities, he would not anticipate seeing them reduce. What financial incentives do they have to address these problems? Why should they bother, then?
More accountability is required, according to Andrew Bindman, chief medical officer of Kaiser Permanente, which has pushed to rigorously track patient outcomes. “Accountability was not adequately highlighted in the first report,” he claimed.
In the meeting, Bindman expressed his satisfaction at learning that the Joint Commission, which accredits hospitals, had this month implemented new certification measures that prioritize equity.
However, he expressed his concern that various organizations would establish various measures and yardsticks for equity, creating a “Tower of Babel” that could lead to confusion. We need to move more quickly, he remarked.
The committee intends to convene a number of additional workshops as part of its attempt to update the Unequal Treatment report and assess current health inequalities. Some panelists said they could not help but think back to the words of sociologist W.E.B. Du Bois, who wrote in 1899 about the “peculiar indifference” many people had toward Black life and health as they struggled with how to improve the future health of millions of Americans.
Little has changed, according to Williams, who claimed that not enough people find it unacceptable that Black Americans have a much lower life expectancy. It’s still the largest issue, in my opinion, he remarked.