Tackling Health Disparities- the Health Consequences of Racism
The spontaneous protests that have erupted across the country reflect the continuing plague of racism in our society, as well as the shocking disparities in wealth and health that are its consequence. We see rates of Covid deaths that are 2–3 times higher for blacks than whites, infant mortality rates for blacks that are double those of whites, and disturbing differences between blacks and whites in important medical procedures such as amputations, transplants, and cardiac procedures. Let’s consider what steps we can take to eliminate these disparities and make individuals and our communities healthier.
There is growing recognition of the important role that social determinants play in health and disease. The conditions in which we are born and live are influenced by money, power and resources. Significant disparities in health outcomes experienced by disadvantaged populations reflect the very real consequences of these social determinants of health.
Traditionally, social determinants such as housing and food insecurity have been the purview of community agencies. However, the emergence of population health, which can be defined as a holistic approach to health and health care that encompasses social determinants, has made social determinants an important issue for health care organizations as well. This is particularly true for accountable care organizations receiving value-based care payments, where controlling costs as well as improving quality is rewarded. In value-based care, accountable care organizations are incentivized to keep patients healthy and address social determinants because it can lead to fewer expensive emergency room visits and hospital stays.
Population health also helps us conceptualize how to provide care for all patients, not just those who are sick, and to consider how to best manage low risk or healthy populations, rising risk populations including those with chronic diseases, and high-risk patients. Arguably the two most important aspects of keeping people healthy are a good diet and regular exercise. Some of the best tools for efficiently and effectively addressing diet and exercise come from the field of public health. The benefits of healthy behaviors can be extolled through public service announcements that reach thousands of people through billboards, radio, TV, or social media, and community-wide interventions such as walking trails and support for access to fresh fruits and vegetables can lead to healthier lifestyles in ways that individual health maintenance checkups to the doctor cannot.
Neither social determinants of health nor public health are core competencies of health care organizations. With the growth of value-based care, health care organizations have a vested interest in collaborating with community agencies addressing social determinants, and public health departments that can support keeping patients healthy.
Many of the resources already exist for us to more systematically address social determinants of health and support public health initiatives. What is missing is the infrastructure to improve communication between organizations and break down silos. Health care providers can screen for social determinants of health and assist in coordinating services available in their communities. Resources can be earmarked for team-based approaches utilizing medical assistants and office staff and workflows that free up more expensive physicians to remain focused on medical care. Community leaders working with community agencies and public health departments can assist by creating an infrastructure that coordinates social services. Investing in an infrastructure to coordinate services and a network of patient navigators would reap major dividends in improved efficiency in service delivery and health outcomes.
We can tip health care in the right direction by focusing more explicitly on how health care is delivered. We can link the health of our communities with the health care we receive by bringing together community leaders, representatives from government and community agencies that address social determinants, public health departments, and health care organizations. These discussions could occur at a local, regional, state, or national level. Let’s harness the attention now focused on racial inequality to create a health care system that addresses social determinants and eliminates the shocking health disparities that exist today.
John Zweifler, MD, MPH is a family physician with decades of experience in medical director roles, patient care, medical education, and managed care. He is the author of the e-books, “Tipping Health Care in the Right Direction” and “Pop Health” and is a medical consultant for the Fresno County Health Department.
He can be contacted at john.zweifler@terrygroup.com
