Truly Caring for All God's People: Combatting Healthcare Disparity
A brief summary and reflection of the Azusa Pacific University Panel Seminar entitled “Practices, Disparities, and Policies in Healthcare” discusses how COVID has shed bright light on healthcare disparity in the US.
Many would concur that COVID-19 has amplified existing health disparities in the U.S. To better understand this, the Center for Research in Science (CRIS) at Azusa Pacific University hosted a webinar entitled, “Practices, Disparities, and Policies in Healthcare” on March 18th, 2021. This is one of our signature Science & Faith events that is open to the community-at-large.
As part of this year’s series, “How Does Science Impact Racial (In)Equity?” and in honor of Women’s History Month, three female panelists of color were featured: Cecilia Florio, Gloria Itzel Montiel and Nia Johnson. Florio is a Program Director for AltaMed’s Family Medicine Residency Program in Greater Los Angeles; she has been serving the underprivileged communities for over a decade and led a team to establish AltaMed’s first residency program focusing on recruiting doctors who are committed to serving ethnically diverse communities. Montiel currently serves as a Senior Grant Writer and Researcher at the AltaMed Institute for Health Equity; she was one of the first DACA recipients to receive a Ph.D. in the U.S. Johnson is a bioethicist, a lawyer, and a doctoral candidate in Health Policy with a concentration in Political Analysis at Harvard University.
According to Montiel, a Center for Disease Control report on COVID-19 racial and ethnic disparities shows that people of color run a higher risk of exposure, are more likely to develop severe illness and complications, have higher rates of hospitalization and death, and lack of access to testing and treatment. The effects of COVID-19 have exacerbated disparities in the pre-existing health outcomes and other significant social determinants of health. In Greater Los Angeles, the disparities are pronounced among Hispanics and Blacks. Although research is an imperative tool in addressing the social determinants of health, the shortcomings in advancing equity include: communities of color being historically neglected or abused in research; the role of structural racism or its effects in vulnerable communities being undervalued; research is often not conducted at nor informed by vulnerable neighborhoods.
History is Not in the Past
As a physician who has been serving at the ground level in communities of color, Florio recognized how people of color have been historically excluded in health conversations and not provided with the same quality and treatment in medicine, which lead to their distrust of health science. For example, from 1932 to 1972, the infamous Tuskegee Syphilis Study enrolled 600 African-American men to record the natural history of syphilis, of which, 400 had syphilis but were not informed of the diagnosis.1 Consequently, treatment was withheld in order to continue to observe the progression of the disease. More recently, it has been reported that there are racial disparities in heart attack treatment rates among patients with similar insurance coverage. Specifically, Blacks were approximately 25% less likely and Hispanics were 5% less likely to receive open heart surgery as compared to Whites with similar insurance.2 As for COVID-19, the disproportionate severity of disease is observed through the hospitalization and death rates of many populations including the elderly as well as among people of color. For Hispanics, the hospitalization rate is 30.4 per 10,000, and the death rate is 5.6; for Blacks, the respective rates are 24.6 and 5.6; for Asians, 15.9 and 4.3, when compared to Whites at 7.4 and 2.3.3 Even though many physicians entered the medical field with strong desires to help those who are ill, the reality is often more complicated than expected.
To understand the broad narratives of health policies, Johnson suggested the need to start with the historical context of how the enslaved were brought over to the U.S. in ships with extremely poor conditions and unethical means. Medical care for enslaved Black people was solely for the purpose of making a profit since they were treated as objects. Hence, the idea that Black bodies can be exploited started in 1619 and has been carried out through the segregation of hospitals. In the 1960s, it was common practice to put Black patients in worse parts of the hospital; physicians would then be less inclined to visit those areas and thus, less care was provided to these patients. Similar practices and the lack of access to medical care created division among minorities. To close such gaps in equity, significant improvements are required in three areas: understand why people are unhealthy through public health initiatives, take public health messaging seriously especially regarding preventive care, and allow honest conversations about racism and its growth in the U.S. to take place.
How to Combat Inequity
The panelists continued to acknowledge the sobering need for more transparency regarding health disparities research among scholars and especially among Christians. With 500,000 deaths due to COVID, there must be renewed interest and commitment to apply equal metrics that disallow false narratives to perpetuate. There is urgency for the academy to prioritize health disparities research and to allow for unbiased conversations that have been absent. COVID-19 actually presents a historical opportunity to increase the research and publication on health disparities. The challenge however, is to reassess how to conduct research by building better models that accurately represent diverse populations.
To close such gaps in equity, significant improvements are required in three areas: understand why people are unhealthy through public health initiatives, take public health messaging seriously especially regarding preventive care, and allow honest conversations about racism and its growth in the U.S. to take place.
Also, mobilizing community building among the most impacted is paramount. The response to fighting COVID could have been much stronger if communities were better informed. Investing in community building through genuine and inclusive dialogues that address the issues of housing, social welfare, racism is an uplifting strategy. For instance, effective engagement can be offered through community clinics. Since providers have been consistently ranked as the most trusted, they can engage the community in transformative ways; clinic staff and administrators can also be mobilized to civically advocate for those they serve. By doing so, a health system will be built instead of a health care system. Such a health system is patient-centric and allows physicians to inform health policies as well.
In closing, we were reminded that this is a very complex issue. In addition to research, policy changes, and community building, humility and honesty must be brought into the health system by making things right for our neighbors—especially those who have been disenfranchised. As Rev. Dr. Martin Luther King Jr. said that one’s heart cannot be changed through legislation, effective changes in health disparities will mean a heart change—some people willing to give up power and privileges so that the marginalized could be lifted up. If we are all made in God’s image, imago dei, then equity and inclusion would require all of us to set aside our biases and selfish gains to work together, and truly care for all of God’s people. Come to think of it, doesn’t this sound familiar? It sounds to me like the great teacher who taught us to deny ourselves, to care for the least of these, and to love our neighbors as ourselves.
Notes & Resources
1. Jones, J. H. (1993) Bad Blood: The Tuskegee Syphilis Experiment. New York, NY: The Free Press.
2. Cram, P. et al. (2009) Racial disparities in revascularization rates among patients with similar insurance coverage. Journal of the National Medical Association 101(11):1132-9.
3. Rubin-Miller, L. et al. (2020) COVID-19 Racial Disparities in Testing, Infection, Hospitalization, and Death: Analysis of Epic Patient Data. Kaiser Family Foundation Epic Health Research Network. https://www.kff.org/report-section/covid-19-racial-disparities-in-testing-infection-hospitalization-and-death-analysis-of-epic-patient-data-issue-brief/
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