Health Beat: The need for health equity

Dr. Darin Bell

Every one of us will need healthcare at some point in our lives, regardless of who we are or where we live. Our first experiences with the world usually involve doctors, nurses, midwives and others.

Often, many of the last interactions in our lives are with healthcare professionals. And for most people, between birth and death there are countless trips to the doctor’s office, and hopefully fewer trips to the hospital. This holds true regardless of race, ethnicity, or socioeconomic status.

Unfortunately, as national and global events of recent weeks and months have clearly shown, there are significant inequities in people’s lives. This fact reveals itself in numerous ways large and small, including in both health and healthcare.

It is well documented that our healthcare system has disparities built into its very structure. People experience barriers to care based on their skin color, gender identity, sexual orientation, ability to pay, and where they live, among countless other obstacles. I have personally seen this play out everywhere I have practiced – from Dallas, Texas to rural Alaska to Western Montana.

While many may think of Montana as fairly homogenous, my experience and the data tell a different story. We have a large indigenous population (about 6.5%), and substantial populations of other people of color, from a variety of backgrounds, heritages and experiences.

Sadly, the statistics show that people of color and minority populations have shorter lifespans (4.4 years shorter for American Indians), increased maternal mortality (Black and American Indian/Alaska Native women are 2-3 times more likely to die from complications in pregnancy than White women), as well as increased risk of chronic disease and complications from those diseases (Black people are twice as likely as White people to die of heart disease). These are facts that must be acknowledged, accounted for and addressed in the way we provide healthcare for our community.

If we focus on the impact of COVID-19, we see a repetition of the same sorts of disparities as mentioned above. COVID-19 has disproportionately affected people of color, communities with lower socioeconomic resources, and other marginalized groups. The CDC reports that 33% of patients hospitalized with COVID-19 are Black, from communities where they represent only 18% of the population. Death rates from COVID-19 for Black and Latinx people are 2 and 1.6 times higher respectively than for White people. These disproportionate representations among minority groups are similar to other recent public health crises, such as HIV/AIDS, cancer, and the epidemics of diabetes and other chronic diseases.

Our healthcare system has been designed to work very effectively for those with the power to write the rules and regulations, but has overlooked those who historically have not had a voice. Addressing the inherent inequities requires a focused and deliberate effort. We, within the healthcare community, must reassess how we provide care and the barriers that the system creates. This begins with listening to those who have been on the receiving end of injustices, like the stories I hear from my patients in clinic on a regular basis. Then we should take that information and work to actively remove obstacles to care.

To change the system, those of us who are medical educators must learn ourselves, and then teach both current and future healthcare professionals about what is broken as well as what works. There should be an increased emphasis in healthcare education on social determinants of health, societal issues that lead toward poor health, inequities within the system, and approaches to leveling the playing field for all. This begins with conversations and training around social justice and both implicit and explicit biases.

Working for over a decade in not-for-profit healthcare has provided me with a humbling perspective on large cross-sections of society. Because of that exposure, I am forced to acknowledge that the discrimination experienced by others is real and should be corrected, even if I have not experienced it myself.

We, as a community, must be willing to hear those who are different from us and engage in difficult conversations. This is uncomfortable, and leaves us vulnerable as we make mistakes and get called out for our errors and insensitive actions. But only through a willingness to admit our own shortcomings will we be able to make the deliberate changes needed to improve a broken system that has consistently left large segments of our community feeling like their lives and health don’t matter.

Dr. Darin Bell is the Assistant Director of Rural Education for the Family Medicine Residency of Western Montana. He practices family medicine and instructs resident physicians at Partnership Health Center.