Research Paper On Health Disparities

What are Health Disparities and why do they matter?
As much as those in society may like to believe that all people, no matter their skin color, have equal health outcomes and equal access to quality health care, this is simply not the case. The fact is that health disparities, which are health or health-care differences among racial-ethnic groups, exist. Health disparities can also be defined as differences in morbidity, mortality, and access to health care among different populations based on criteria like socioeconomic status, gender, and race/ethnicity [1]. Knowing that these disparities exist, we can begin to analyze why they may be occurring. One of the main contributors to this phenomenon that is deeply rooted into the system is the

idea of social determinants of health, which are the conditions in which people are born, grow, live, work, and age which determine vulnerability to health-enhancing or health-damaging conditions in daily life [2]. Because racial and ethnic minority groups, more specifically black and Hispanic populations, disproportionately experience poorer environmental conditions, segregation, discrimination, and physician bias in comparison to their white counterparts, these groups tend to have diminished access to health care and poorer health outcomes resulting in outrageous costs that could have been prevented had these disparities not existed. The excess cost of these health disparities has been found to be more than $1.2 trillion [1]. Health disparities present themselves in several different ways, but targets remain consistent. For example, black men in New York City, have a 50% higher rate of premature death than white

men in outcomes like cardiovascular disease, cancer, and HIV. Additionally, black women have a 10 times higher rate of death in childbirth than white women according to 2012 data from New York City [4], pointing to differences in access and quality based on race. Another example involves a study by Goyal et al. showing that there are racial disparities in the prescribing of pain medication in emergency departments. They studied white and black children with appendicitis in emergency departments and found that black children had one-fifth the odds of receiving opioid medication than white children, even after adjustment for confounders [5], indicating yet another instance of a quality deficit based on racial differences. As seen in Figure 1, the differences in quality of health care between non-minorities and minorities can be attributed to several factors like clinical appropriateness, the ecology of health care systems, and discrimination biases. This policy brief will be focusing specifically on (1) the lack of diversity in the health care system and (2) provider-level biases as causes of racial health disparities and how they perpetuate cycles of poorer health outcomes specifically among minority populations.
Lack of Diversity in the System
The health care system is structured in a way that perpetuates these disparities and makes it very difficult to overcome racial structural barriers.

One downfall of the system is a lack of diversity in care providers. Evidence shows that 13% of the U.S. population is black, but only 4% of U.S. physicians are black [4]. Diversity in the health care workforce is important because minority doctors are more likely to practice in underserved areas treating minority patients [6], which increases access to a provider for these groups. Also, having diverse providers in the workplace is an organizational way to provide education to other providers who may not have been exposed to different cultures and beliefs, increasing awareness among all providers about the necessity to remain culturally sensitive [7]. However, the data shows that most medical school graduates continue to be white and the number of black men completing medical school has been trending downwards since 1997. This deficit in minority care providers can be attributed to a decreased ability for schools in areas with high populations of minorities to prepare students for college, a lack of federal support in such areas, and the financial inability for these students to pursue higher education [6]. As seen in Figure 2, by a very large margin, white medical school graduates are the majority (green) while black (purple), Hispanic (blue), and American Indian (red) graduates are greatly underrepresented [7]. Not only are there racial disparities in the distribution of medical students, but they also exist in medical school faculty. This is significant because it creates an environment in which black medical students lack a significant presence of role models in their educational setting. A study described in Ansell et al. showed that black faculty members were less likely to have been retained than any other group. They were also less likely to be promoted, to hold senior faculty or administrative positions, and

to receive research awards than their white counterparts [8]. While the demographics of medical school students and faculty may seem detached from observable health disparities in communities, they are closely connected because medical schools are institutions that create the next generation of doctors, and when the demographics of the physician workforce do not reflect the diversity of the world they will be serving, it indicates potential problems in quality and access to care for minority populations.

Provider-Level Biases
Evidence has shown that explicit race bias, or intentional racism is very rare among providers. However, many health care providers do hold racially-based stereotypes about their patients implicitly or unconsciously. Implicit biases are racial stereotypes that can develop either from cultural experiences or from a lack of interracial interactions [8]. Multiple studies, like Ryn and Burke (2000) and Malat (2001) have shown that racial dynamics significantly affect the doctor-patient relationship and that discrimination affects doctors’ treatment recommendations [9]. In terms of exactly how racial dynamics affect the doctor-patient relationship, a study done by Dr. Elizabeth Hooper showed that the provider’s interviewing skills, measured using open-ended questions, eliciting details, and allowing patients time to ask questions, were significantly lower with Hispanic patients than with white patients despite being treated by the same provider. Additionally, measure of physician empathy measured by ability to acknowledge the patient’s feelings, mood, and emotional needs, was also significantly lower among Hispanic patients than among white patients [10]. A different study done by Dr. Rachel Johnson demonstrated that physicians spoke more during visits with African American patients than they did with white patients, indicating the tendency towards verbal dominance with black patients [10]. There was another study indicated in the IOM report “Unequal Treatment” in which physicians rated their feelings towards hypothetical patients, and per their responses, African American patients were widely perceived to be less intelligent, less educated, more likely to have substance use problems, less likely to abide by medical advice, and less likely to have social supports in place [3]. These findings are indicative of the unconscious and conscious uncertainties, misconceptions, and stereotypes many providers have against African American and Hispanic patients, which contribute to a system in which minority groups do not receive the same quality of care that white patients do, ultimately resulting in disparate health outcomes between minority patients and white patients.