Category Archives: Disparities in quality of care
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males. His work seeks to identify sources of individual, cultural, and organizational social capital to promote health behaviors, and health care access and utilization, to advance and improve the health and well-being of African American males. This is part of a series of posts looking at diversity in the health care workforce.
I became a public health professional because I recognized a need to find opportunities and strategies to prevent the chronic diseases I saw silently killing African Americans in the community where I grew up. I vividly recall as a child the whispers surrounding the deaths of community members about cancer, diabetes (or sugar-diabetes, as it is commonly referred to in many communities still today), heart attacks, and strokes. I knew there was stigma and fear, but never heard of programs, interventions, or opportunities to stop these trends.
My interest in addressing these problems led me to pursue summer programs and internships during high school that allowed me to witness amputations of uncontrolled diabetic patients who had a range of clinical and social co-morbid conditions. Many of these amputees were living in poverty, they had Medicare or Medicaid, and the majority happened to be African American. This experience raised the question about prevention: How could I prevent African American men and women from having amputations? I never heard this conversation around prevention in my community. Many people seemed to accept the reality of developing these chronic conditions as a fate that could not be controlled.
I knew there had to be another way.
Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.
I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.
Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.
The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nalo M. Hamilton, PhD, MSN, WHNP/ANP-BC, Assistant Professor at the University of California Los Angeles School of Nursing and an RWJF Nurse Faculty Scholar.
As 2012 approaches, I hope that the United States remains resolute in providing access to equitable health care for all, especially women.
We live in a time where women have made significant contributions in academic, social and political areas but their contributions to women’s health care are eroded with every passing year. Currently, as the working poor, a record number of women are living in poverty and are unable to access affordable health care.
Thus, their diaspora of medical conditions go without primary care management resulting in acute conditions that are stabilized in the emergency department. However, once the condition is stabilized, a woman is sent home without the ability to follow-up with her primary care provider, thus continuing the cycle of acute onset, ER admission and discharge.
In my current practice I primarily manage: hypertension, tobacco dependence, obesity, anxiety, depression, dyslipidemia, breast disorders, diabetes, hypothyroidism, infections, dysfunctional uterine bleeding and family planning. For me this list represents the many organs that exist between a woman’s eyeballs and toes. Additionally, these conditions highlight how critical it is for women to have access to health care, not only for chronic conditions but for preventative screening as well.
The Affordable Care Act is a critical first step but much remains to be done at local and national levels.
A new year brings with it new opportunities and hope, so raise your glass with me in a toast to 2012—the beginning of health care equity.
The high-quality health care system that health reform aims to advance cannot be achieved unless “pervasive and persistent” disparities in health care are addressed, two experts associated with the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program write in a commentary published in the Journal of the American Medical Association. The piece, by Matthew M. Davis, M.D., M.A.P.P., co-director of the RWJF Clinical Scholars program at the University of Michigan, and Clinical Scholar Jennifer K. Walter, M.D., Ph.D., was published online on August 9 ahead of print publication.
Confronting disparities in sex, race/ethnicity, social class, insurance status and language is necessary for the highest-quality health care, they write. “If we don’t address disparities in health and health care, we will fundamentally limit how much health care quality will improve,” Davis said in a statement.
They cite the reduction in the number of deaths of disadvantaged children from measles a decade ago as an example of a success story. A collaborative effort on the part of policy, public health and clinician communities ensured that more children in predominantly minority communities were vaccinated, thus simultaneously reducing inequalities and saving lives.
Read a United Press International (UPI) story on the commentary.
Do you think the nation is doing enough to reduce health disparities? Register and leave a comment below to share your views.
Five major organizations issued a national call to action to eliminate disparities in health care last week. The “Equity of Care” campaign is a collaboration between the American Hospital Association, the Catholic Health Association, the American College of Healthcare Executives, the Association of American Medical Colleges and Catholic Health Initiatives. It was announced July 18 in San Diego at the American Hospital Association's Leadership Summit.
The campaign calls on health care providers to address the following areas:
- Data Collection and Use - Increasing the collection of race, ethnicity and language preference data to facilitate its increased use.
- Cultural Competency - Increasing cultural competency training for clinicians and support staff.
- Diversity in Governance and Leadership - Increasing diversity in governance and management.
"How do you know that the patients within your walls are getting the same care, and if they're getting the same care, are they getting the same outcomes,” American Hospital Association President and CEO Rich Umbdenstock said to Health Leaders Media. “I hope [a few years down the road] we can say that we're seeing a narrow gap in the actual care and outcomes for minority populations. We want to see that needle move in the right direction.”
What do you think are the most important actions the government and health care providers can take to reduce disparities both in health care and health outcomes? Register and leave a comment below to share your views!
For more information on the new initiative, visit www.equityofcare.org.
Renee Y. Hsia, M.D., M.Sc., is an emergency physician at San Francisco General Hospital and an assistant professor in the Department of Emergency Medicine at the University of California San Francisco. She is a Robert Wood Johnson Foundation Physician Faculty Scholar.
A few weeks ago, my colleague Yu-Chu Shen, Ph.D., and I published the results of a study in the Journal of the American Medical Association (JAMA) (abstract) showing that if you are unlucky enough to have a heart attack on a day that your hospital is busy, you have a higher risk of dying. More specifically, we found that for every 100 patients unfortunate enough to have a heart attack when their emergency rooms are diverting ambulances for long periods of time – a key indicator of a busy ER – there are about three potentially avoidable deaths in the 30 days after patients are admitted to the hospital.
Why might this be? We know ER crowding has become rampant; we’ve all experienced the annoyances (as patients, family members or providers) of hours-long waits to be seen. Many of us have also experienced the panic of worrying that a loved one isn’t getting the best care they could because the ER is crowded.
As an ER doctor at a busy county hospital that’s also a trauma center, I feel the stress of providing care to patients under tense circumstances. It’s a daily – sometimes an hourly – challenge. None of our staff – technicians, pharmacists, nurses and doctors – feel good when we are crowded to the point that we cannot provide the best care possible.
This post is part of an ongoing series of Voices from the Field by scholars, fellows and alumni of RWJF Human Capital programs. The author, Sarah Gollust, Ph.D., is an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program. Read more about her latest research.
In graduate school in public health, I was taught that health disparities are differences in health that are “avoidable, unfair, and unjust,” using Margaret Whitehead’s 1992 definition. Most readers of this blog would likely agree that health differences across groups defined by race, ethnicity, or social class are unfair. But does the American public agree? Does the public consider such differences across groups to be an injustice, or simply unfortunate? Do members of the public even know about disparities at all? And if they did, how would that knowledge affect their opinions about policy?
Arriving at Penn as a Health & Society Scholar in the summer of 2008, I was delighted to discover that Julie Lynch, Penn faculty member and an alumnus of the Robert Wood Johnson Foundation Scholars in Health Policy Research program and an RWJF Investigators Award recipient, shared my curiosity regarding these questions. And—thrilling for a junior researcher like myself—she actually had the data to begin to address them.
This post is part of an ongoing series of Voices from the Field by scholars, fellows and alumni of RWJF Human Capital programs. The author, Gina S. Lovasi, Ph.D., M.P.H., is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program, an assistant professor in epidemiology at the Columbia University Mailman School of Public Health and an investigator with the Built Environment and Health Project at Columbia.
A few weeks ago, I had both the great honor and the arguable misfortune of presenting my latest health disparities research to a gathering of the RWJF Health & Society Scholars at the National Institutes of Health. The honor part is obvious: As an alumna of the program, I was thrilled to spend time with fellow scholars, and to get their thoughts on my work. The misfortune part? That had to do with a bit of intimidating scheduling: I ended up on the program immediately following a giant in the field, Sir Michael Marmot.
In case you’re not familiar with him, Marmot is regarded as a true rock star by health disparities researchers. Perhaps his best known contribution was chairing the World Health Organization’s Commission on Social Determinants of Health from 2005 to 2008, but before and since, he’s reshaped the contours of the profession, and inspired researchers across the globe to pursue health disparities research.
For better or worse, I didn’t know I’d be following him until that morning, sparing me additional pre-presentation anxiety. And the actual event went just fine. His broad theme that day – and indeed, the theme that runs throughout his work and the work of the Health & Society Scholars—is that health disparities are not inevitable, that we can address them.