1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Individual physicians bring to their practice implicit biases which influence their treatment choices and care for their patients. The Chapman article points out the automatic nature of stereotyping and evidence of implicit biasing specifically influencing healthcare of non-white patients. In reproductive health care, there is a growing body of evidence revealing that there is significant provider bias in relationship to contraceptive counseling which can lead to coercive counseling and recommendations. Coercion has been shown to be present in relationship to race, class and obstetrical history. I am interested in research focusing on creating an intervention for providers to not only acknowledge contraceptive coercion acknowledgement of implicit bias.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Structural and Institutional Racism: as discussed above, implicit biases of health care providers contribute to disparate care. In the health care system these biases have contributed to a normalization of many health care dynamics that routinely advantage white patients. This structure is rooted in the foundations of white supremacy. When this occurs within the institution of a hospital, it results in disparate policies, treatment and opportunities based on race which are perpetuated by deeply rooted societal structures. Ultimately this results in poor outcomes for non-white patients. This is relevant in all areas of research including my own.
Proximity of clinical care: this includes time to travel to clinical care, transport costs and parking costs. Many patients have to travel farther for care and may not have the means to cover transport and parking. This is most relevant to my study related to self-managed abortion. Restrictions related to abortion care have contributed to clinic closures and increased travel time. Those with lower SES have increased barriers to care related to travel cost and may be more likely to self-manage their abortion.
Childcare: often overlooked, child-care can be an incredible barrier to accessing medical care. I have had patients who have traveled over an hour for an ultrasound only to be turned away because they have one of their children with them. People with lower SES are more likely to have trouble accessing childcare.
Appointment Times: most appointment times related to clinical care are only being available during the day. This prevents people who have inflexible daytime work schedules to access care. These people are also more likely to have lower SES, resulting in disparate health care access.