COVID-19 pandemic data reinforces previous evidence that Black, Latino, and Asian American and Pacific Islander people in the United States often encounter dramatically higher death and hospitalization rates than white populations. In fact, healthcare disparities for minority populations have a long history of impacting racial minorities, LGBTQIA+ communities, and those with disabilities, resulting in delayed care, poor outcomes, and an overall lack of confidence in a system that should provide the help these groups need.
Pinpointing the root cause of healthcare disparities is often fraught with division and highly politicized opinion. In addition, the implicit bias of many healthcare workers and policymakers often prevents a patient-first approach to healthcare. Fortunately, many of the best medical schools in the United States are taking a pragmatic and active approach to addressing inequities in healthcare. From diversity, equity, and inclusion training (DEI) to evolving admission policies and student resources, many medical schools strive to combat these disparities one student at a time.
As a prospective healthcare practitioner, choosing a school with a strong DEI component is essential in preparing you for navigating your role in the world of healthcare while giving fair and equal care to every patient. To help you in this effort, this guide explores the roots of healthcare disparities, identifies concrete ways to combat them, and highlights schools that boast a strong dedication to diversity, equity, and inclusion.
History of Disparities in Healthcare
The history of disparities in healthcare reveals the challenges faced by various racial, ethnic, and socio-economic groups despite many advances over the last 50-60 years. Wayne J. Riley, MD, MPH, MBA, MACP notes many these inequities in depth in his paper, Health Disparities: Gaps in Access, Quality and Affordability of Medical Care, citing higher infant mortality rates, lower life expectancy, and greater disease risk among other health-related factors as being some of the significant inequities faced by minority populations.
The following section explores how racial minority groups, the economically disadvantaged, women, disabled Americans, and LGBTQIA+ individuals have encountered a long history of healthcare disparities that continue to be contemporary issues. Learning this history and how the issues have evolved to impact healthcare today provides an understanding of current access to competent and compassionate health services.
Black, Indigenous, and People of Color (BIPOC)
Racial minority groups in the United States offer a consistently clear example of historical inequities within various healthcare systems, and the roots of race-based healthcare disparities can be linked to broader issues like slavery and colonialism. Current data, such as that showing Black Americans have higher mortality rates stemming from heart disease, breast cancer, and strokes, indicates that these inequities still exist.
While the Obama Administration’s Affordable Care Act took dramatic steps to narrow racial gaps in healthcare access, the Brookings Institute notes that Latinos are almost three times more likely than white Americans to be uninsured. From inadequate immigration policies to a history of reliance on undocumented workers, this group often lacks easy access to essential healthcare services.
Often linked to higher mortality rates and various health problems, socioeconomic status is a significant indicator of health disparities. Socioeconomic status is impacted by a broad range of elements, including economic stability, education, and community/social factors. Whether a person lives in a low-income neighborhood or works a low-paying, high-stress job, these factors can lead to widespread health issues like diabetes, cancer, hypertension, and low birth weight.
Individuals with access to higher education, better wages, and growing social capital typically, according to the New York Times, have an increased life expectancy. These Americans normally can access quality healthcare and mental health services out of reach for the economically disadvantaged. Race is also entangled in socioeconomic discussions with Kaiser Family Foundation data showing that about 20% of both Black and Hispanic communities report having fair or poor health statuses.
While the Americans with Disabilities Act of 1990 (ADA) was a landmark piece of legislation and went a long way in protecting the rights of disabled citizens, disability status often still leads to healthcare disparities. Before the passage of the Affordable Care Act, insurers could refuse coverage for individuals with chronic health conditions and disabilities.
Americans with disabilities often go unrecognized in discussions about avoidable health inequities, but data from the American Journal Of Public Health reveals that adults with disabilities are four times more likely to report their health as fair or poor. Determining disparities for those with disabilities is challenging because differentiating between underlying health issues and avoidable factors is complex.
Addressing LGBTQIA+ health disparities can reduce healthcare costs, increase longevity, and enhance mental and physical health. While these differences in care are just beginning to be addressed for this long-ignored and stigmatized population, the fervor of the vitriolic attacks on transgender individuals reveals the significant political, social, and cultural barriers that exist.
From the AIDS crisis in the latter portion of the 20th century to today’s onslaught of anti-trans legislation, the healthcare disparities for LGBTQIA+ populations are real. Even in the face of numerous studies revealing that gender-affirming care can save lives, politicians across the country brandish this wedge issue as a political weapon.
Gender-based healthcare disparities data reveal that states offering more preventative care can narrow the healthcare gender gap. Additionally, the Kaiser Family Foundation notes that the racial and ethnic healthcare disparities in women’s healthcare show that Black and Latina women are more likely to report their health as fair or poor. Also significant is that women have, according to America’s Health Rankings from the United Health Foundation, higher rates of frequent mental distress, depression, and physical inactivity.
Additionally, the seemingly perpetual war waged on women’s reproductive rights may soon have real consequences. In 2022, the United States Supreme Court is slated to rule on a Mississippi-based case that may dramatically reduce women’s access to reproductive healthcare.
How to Combat Disparities in Healthcare
In recent years, medical school curricula have evolved to take an active role in addressing disparities in healthcare. Student education, comprehensive diversity training, and community education are believed to be the way forward in fighting inequalities in healthcare. Similarly, diversity training initiatives can lead to a cultural competency that enhances care and even saves lives.
However, just as healthcare disparities vary between groups, combatting inequities also involves a community-based approach. Here are some ways medical schools, medical professionals, and various other groups are preparing students for a career in medicine by injecting equity into various healthcare systems.
A growing number of medical schools are now integrating diversity training into their curriculums and focusing on the many, long-ignored healthcare inequities. Providing ways for students to understand others’ experiences along with evolving curricula are just some of the approaches medical schools are using to address healthcare disparities.
- Understanding Various Experiences The University of South Florida Morsani College of Medicine has implemented a poverty simulation where students are placed in family units and live like a low-income family for a while to better understand the disparities.
- Evolving Curricula The academic status quo at medical schools has played a role in perpetuating healthcare disparities. Instructors, researchers, and medical students are making strides in how underserved populations are viewed in healthcare settings by crafting curricula that address health disparities. Changing how and what medical students are taught, according to Acad Med, can impact where they decide to practice.
Comprehensive Diversity Training for Healthcare Providers
Effective diversity training for healthcare providers not only enhances the quality of unbiased, compassionate care but can also save lives, according to David Skorton, a member of USA TODAY’s Board of Contributors and president and CEO of the Association of American Medical Colleges. Many schools and state healthcare systems are responding to this in a variety of ways.
- Racial Bias Training In response to how unconscious racial bias can significantly impact healthcare outcomes, schools like Johns Hopkins University are employing online training in sexual orientation and gender identity, cultural sensitivity, and unconscious bias.
- Cultural Competency Training While cultural competency training is often dismissed as inherently political, strong evidence provided by County Health Rankings & Roadmaps suggests it adds to practitioner skills and benefits patients from various ethnic, cultural, and economic backgrounds. This type of training has expanded in recent years with states like Washington and New Mexico requiring diversity training for their healthcare professionals.
Community Outreach and Education
From a lack of trust in healthcare to a lack of education in various underserved communities, community outreach, and education can go a long way in disrupting disparities in healthcare. Regardless of position or organization, addressing the unique needs of varying communities can also mitigate inequities in healthcare. Additionally, the Health Resources & Services Administration makes clear the value of effective communication in healthcare and highlights the need for targeted cultural and linguistic competence.
As various communities have their own unique set of healthcare issues, taking a local approach with healthcare initiatives can expand access to healthcare and combat disparities. For example, community-targeted initiatives and educational programs see community health workers using their expertise in attempting to reduce health disparities like substance abuse, heart disease, and physical inactivity.
Schools That Actively Integrate Diversity Training Into Their Curriculum
While actively integrating diversity training is becoming more common, some schools prioritize diversity and inclusion more than others. Forward-looking medical schools not only offer diversity training but are also home to a network of student resources, policies, and philosophies designed to expand equity while simultaneously mitigating disparities in healthcare.
Multiple schools that actively expand diversity and equity on campus are spotlighted below. They’re setting the standard for integrating DEI training into healthcare curriculums and for creating campus-wide initiatives to actively acknowledge and fight the disparities in healthcare.
Interview With a DEI Expert
Dr. Susan Cheng is the Associate Dean for Public Health Practice & Diversity, Equity and Inclusion at the Tulane University School of Public Health and Tropical Medicine.
1) How can practitioners at every level address healthcare disparity for minority patients?
Practitioners need to establish a sound knowledge base of the social determinants of health and the political/systemic determinants of health that impact how risk factors affect populations differentially. Both risk factors and prognoses are impacted by external factors to the individual that are driven by systemic, historic, and structural factors beyond individual risk factors. Exploring and achieving competence in how to identify, address, and dismantle these external determinants of health are vital to addressing the root causes of health disparities across populations and individuals.
2) What are some common issues in this arena that the wider population may not consider?
When working with specific communities, sometimes there are historical roots of mistrust or previous unethical behavior that create a challenging dynamic when seeking buy-in and engagement from within the population. Understanding and addressing those historical interactions will help guide how to build trust and agency among community members to increase the efficacy of new interventions and initiatives. Engaging community members early in the planning and development of new initiatives is also vital to success.
3) Where can healthcare students and practitioners find resources to help educate themselves?
The National Institute on Minority Health and Health Disparities has a resource page where students and practitioners can start the process of educating themselves on health disparities. The American Public Health Association and the Centers for Disease Control and Prevention also have Health Equity resources available online. Health Equity Tracker is a newer project that launched as a response to the health disparities highlighted by the COVID-19 pandemic. It seeks to aggregate and track data to help visualize health disparities across multiple conditions and track potential progress in mitigating those differences.
4) What advice would you give to healthcare students looking to address these issues intheir future practice?
Lead with empathy. Every individual is different, and every situation is different. Prognoses and statistics tend to drift towards the average experience or set of symptoms, but individual data points can differ significantly across all possible ranges. Treat each patient like an individual, guided by science, but not dictated by “normal” predicted outcomes or timelines. Seek out trauma-informed care training and resources, and actively listen to each patient. A deeper intake interview can sometimes prevent missed data or symptoms later. Research shows that respect and empathy from care providers are linked to better overall care and outcomes.