What Determines Your Health?

Nov 17, 2014, 9:00 AM, Posted by Minoo Sarkarati

What determines your health?  Is it your ZIP code? Is it the clinic or hospital you go to? Is it the physician you see? Or is it you?

I could not say that the answer to this critical question is solely any one of these. However, understanding how each component plays a role in one’s health, as well as exploring further determinants, is vital to building healthier communities.

This year’s American Public Health Association (APHA) Meeting theme is Healthography. It is an opportunity to explore how our environment—whether it is access to clean air, safe housing, transportation, healthy foods, safe places to exercise, jobs, or quality health care—plays a role in our health. 

As a medical student training in a safety-net hospital, I have seen how each of these elements plays a role in one’s health. Without addressing these factors, a large part of medical care is lost. Encouraging regular exercise is not so simple when you do not have sidewalks or green spaces, or you do not feel safe being outside in your neighborhood. Writing a prescription to treat diabetes becomes meaningless if your patient cannot fill it because he/she does not make enough income to purchase the medication.

One aspect of health that I have been particularly concerned with, especially as a future medical provider, is access to quality health care. It is a concept I am still trying to define. As a medical student, it is clear that we are charged with learning as much as possible about disease processes, clinical presentations, and how to prevent, diagnose and treat disease. The educational process includes learning how to effectively communicate with patients and work in an integrated team environment. We slowly gain decision-making capabilities that help guide our treatment plans that are individualized to our patients’ specific needs. But what happens when we do not really know our patients? Or perhaps we believe we know our patients, but in actuality are misled by our unconscious biases and natural tendency to stereotype.

Unconscious bias, the principle that behavior can be guided unknowingly by past experience, and stereotyping can play a role in one’s health as well. As members of society, physicians, like other people, are subject to developing stereotypes about race, culture, weight, age, gender, sexuality, etc. This unconscious bias, despite the physician holding explicit egalitarian views, can lead to differential treatment of patients and, unfortunately, poorer health outcomes. The medical field, however, has been slow to adopt interventions that address health disparities caused by unconscious bias held by physicians. This problem is compounded by the sparse research that has been done on the effectiveness of such interventions. Addressing unconscious bias is difficult because of the nature of the issue itself as well as the cognitive constraints physicians face in the often fast-paced environment.

A good place to start would be developing an understanding of what our unconscious biases are through implicit association tests.

These tests have been used to help identify our own unconscious bias, and can be used as a starting point for addressing them as well. Cultivating physicians who can surface their biases, become mindful of their assumptions, and understand what is informing their decisions can help alleviate health disparities. I believe just as medical students are expected to become keen clinicians, we should be expected to be diligent in protecting our patients from our biases as well. 

Related Resources

1.  Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine22(9), 1231-1238.

2.  Van Ryn, M., Burgess, D., Malat, J., & Griffin, J. (2006). Physicians’ Perceptions of Patients’ Social and Behavioral Characteristics and Race Disparities in Treatment Recommendations for Men With Coronary Artery Disease . American Journal of Public Health , 96 (2), 351-357.

3.  Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of personality and social psychology74(6), 1464.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.