SPECIAL REPORT
Accessing health equity
In the United States, health disparities the preventable differences in disease, injury and opportunities for optimal health that exist between different populations—are found widely throughout medicine. The origins of these disparities are complex and can be traced to the deep historical roots of American society.
We know the key risk indicators. The data inform us that, compared to the overall population, Black and Hispanic Americans have a lower life expectancy, higher infant mortality rates, higher incidents of cancer, stroke and heart disease and a higher prevalence of chronic diseases such as hypertension and diabetes. Gender impacts access to care and implicit bias; women with peripheral artery disease and coronary artery disease are more likely to be misdiagnosed than their male counterparts. Populations from lower socioeconomic strata struggle with equity in accessing care and implicit bias within healthcare intuitions.
Elderly Americans are disproportionately impacted by PAD and other chronic conditions, and lack of mobility and income often prevent adequate treatment and management. Lower-income populations struggle with food insecurity, lack of shelter and access to medical care. Lesbian, gay, bisexual and transgender individuals face stigma and violence, and bias within healthcare systems. And those living in rural areas are more likely to die from heart disease, cancer or stroke than those who live in urban areas, in part due to limited options for specialty care.
Further, many bedrock clinical trials do not contain a diverse study population, meaning the standard of care has been normalized to reflect outcomes in a predominantly Caucasian male population from the upper two-thirds of the socio- economic ladder. Factors in medical institutions relating to the public image, physical environment, systems and practices, patient interactions, and disparities in workforce representation intensify these problems.
An individual’s race, ethnicity, gender and gender identity, sexual orientation, income, and geographic location can all intersect, creating a pernicious and intimidating barrier to care. This barrier is compounded by factors like workforce shortages, limited health literacy, lack of funding and low cultural competency among medical works. The result is a system of suffering that robs our society of human potential and increases national healthcare spending.
These issues may accumulate throughout an individual’s life, turning often-preventable health concerns into potentially deadly—and expensive—problems.
However, through determination and intention, there are ways to close these gaps.
We can advocate for legislation to expand access to care that will improve overall outcomes. We can dedicate ourselves to educating our patients on preventative measures and encourage them to join our awareness campaigns. We can arm ourselves with the facts and data of the problems facing our patients so we can better understand their needs, and we can support the education and success of physicians who come from these populations. In our own practices, we can cultivate environments that cater to the comfort and security of all patients. And when we conduct research, we can intentionally craft a diverse team and ensure representation in the study group reflects the population we serve.
Within this special report you will find articles highlighting healthcare disparities we commonly encounter in IR and discussions on action-based solutions that may bring us closer to equity. Accompanying these articles is a glossary of the common terms we encounter in diversity, inclusion and equity work. Our hope is that this special report not only educates our readers, but sparks conversation and action as innovative partners in care.
No one in IR intentionally created these disparities— we inherited this system. But with focus and intention, all of us can play a role in improving outcomes by promoting equity in medicine.
Sincerely,
Special report editorial board Hirschel D. McGinnis, MD Rex Pillai, MD Jaimin Shah, MD Roger Tomihama, MD
14 IRQ | WINTER 2023
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