Health Disparities Update"While we are talking, our patients are dying."*Rogers Kane, M.D., David Page, M.D., MPH
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| (*Anton Simmelweis, MD circa 1840, to Swiss physicians re: hand-washing in obstetrics; it was forty years later that it
was widely accepted.)
At a recent meeting on "Globalization of Medicine", a non-US physician queried Americans in the group: "Considering the gross disparities in resources and outcomes within US healthcare, how can the US assume a leadership role on globalization?" Indeed, our system is an easy target for such criticism. In Jacksonville alone, excess deaths attributable to disparities count into the thousands each year. In last month's issue of Jacksonville Medicine we looked closely at disparities experienced by African Americans, considering root causes, and actions to address them. The focus on these disparities is not to suggest these are the only disparities important for Jacksonville. Disparities between genders, geographic regions, age groups, socioeconomic groups and others are undoubtedly critical for our city as well. However, because African-Americans are one third of our population, every disparity in health outcome affecting African-Americans is an urgent issue. The glaring disparities in the health status of the nation's minority group can no longer be ignored. While the 20th century has given rise to dramatic improvements in our nation's health status, racial and ethnic minorities have benefited less from these improvements. Significant disparities exist in access to care utilization of services, and health outcomes between majority and minority populations. With the expectation that "people of color" will be 40% of the total US population by 2030, we as clinicians need to check our own pulse and be aware of our attitudes, beliefs, biases and behaviors that may influence the care of our patients. As importantly, these factors may influence our interactions with colleagues and staff from different ethnic/socio-cultural backgrounds. Racial and socio-cultural biases that have been incorporated into medical school curricula have resulted in our schools producing physicians who subconsciously make bias-based decisions. There has been a 12% reduction of minorities in medical school admissions since 1994. African-Americans represent only 3% of practicing physicians and 2% of medical school faculty. These facts may explain biased referral patterns for consultation and procedures, limited numbers of "culturally competent" health professionals, restrictive hospital admission practices, limited patient education, and difficulty hearing and understanding minority patients symptoms and health seeking behaviors. Though great strides were made in medicine in the 20th century, in the area of disparate health outcomes, research has focused on documenting and not eliminating disparities. We have failed to "close the gap". For example while we recognize the disproportionate burden of stroke in African Americans, we have failed to include sufficient minorities in epidemiological, observational, and clinical trial research to give necessary information. While we are sure that lack of health insurance and other barriers to health services diminishes minority use of both preventive and treatment services, better designed research efforts inclusive of minorities will certainly diminish health disparities. It is encouraging that national health care policy is beginning to address adverse consequences of disparities. Initiatives such "Healthy People 2010: Closing the Gap" are welcome. It is also heartening to see the AMA join with ASIM, AAFP and AAP in calling for a national program of universal health access. However, the challenge here at home to address and eliminate disparities must be met head on by all of us. The Duval County medical community must challenge itself to eliminate all forms of sexism, age-ism, racism, class-ism, and prejudice that occur in our day to day clinical encounters. We must also act as an organized profession to ensure that system biases are addressed at the state and local level. Can we wait forty years to claim success? February, 2001/ Jacksonville MedicineWhat's New
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