Section outline

  • Lecture: Multi-level etiologies of health in diverse populations, Part 2: Health systems and health care determinants

    While the social determinants of health are key in determining who gets sick, health care access and quality is key to determining the outcome of illness.  This class will review how ethnic/racial (and other) health care disparities play out in the highly complex US health care system.  We will discuss the contributions of provider bias, health system structural inequities, and segregated care to health care disparities while also examining how fundamental assumptions about the role of the individual, family, and society play out in the care of acute and chronic illness. Finally, we will review the experience of quality improvement programs in mitigating health care disparities.

    Faculty:  Christine Dehlendorf and Cassondra Marshall

    Location (Access restricted to registered students): Zoom URL

    • Session Slides:

    • Slides on HCD File

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch -Live Lecture Media Resource
      Not available unless: You belong to Registered Students Only
    • Lecture - Please review before Jan. 19 Media Resource
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Hidden Curriculum Brooks File
      Not available unless: Your ID number contains 02

    • A brief and powerful narrative piece describing how clinical providers (specifically, physicians) are acculturated in a way that produces health care disparities.

    • chapman Bias File
      Not available unless: Your ID number contains 02

    • A review of implicit bias among physicians, including its etiology, research documenting its presence and impact on care delivery, and strategies to mitigate its impact.

    • LEP DM File
      Not available unless: Your ID number contains 02

    • A empirical research study documenting the impact of a structural factor – having language concordant care providers – on health care outcomes.

    • pnas.201516047 pain article File
      Not available unless: Your ID number contains 02

    • We only ask that you read the abstract and the concluding remarks for this paper. This paper presents empirical evidence about one particular aspects of implicit bias that is related to inaccurate beliefs about the biological basis of race.

    • Optional Reading:

    • iom on health disparities.020601 File
      Not available unless: Your ID number contains 02

    • Summary of the IOM Report Unequal Treatment

    • 5. Sacks - Race and Gender Concordance File
      Not available unless: Your ID number contains 02
    • A qualitative analysis of patient perceptions around racial concordance with providers, including the need to consider broader structural factors that impact health care interactions regardless of the presence or absence of concordance.
    • Infant Mortality File
      Not available unless: Your ID number contains 02
    • A paper with sophisticated statistical methods documenting the relationship between racial concordance and neonatal mortality.
    • Dovidio 2008 File
      Not available unless: Your ID number contains 02
    • A review of implicit bias and its effect on health care using a social psychology lens.
    • implicitbias review File
      Not available unless: Your ID number contains 02
    • A systematic review of implicit bias and its influence on health care

    • Assignment:

      Please post to the forum by 8:45am on the day of class

      1. Write a paragraph describing how individual physicians may contribute to health CARE disparities in your area of interest. Then briefly describe what research could be done to either understand the effect of individual physicians on health disparities in this context, or to decrease this effect?

      2. While interpersonal bias is often the focus when thinking about health CARE disparities, structural issues within health care delivery are also implicated in health care disparities. An example of a structural issue is a lack of representation/diversity among health care providers. Please brainstorm 3 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?