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?
I believe that individual physicians contribute to health care disparities mainly through personally mediated discrimination and unconscious bias. In my area of research, many previous studies have shown how Black women are at an elevated risk of maternal morbidity and mortality, compared to white women. Black women experience racial discrimination from different physicians across the life course, however mistreatment from maternity care providers has been the focus of recent research. This research posits that Black women are commonly ignored/dismissed, threatened, and even shouted at during labor and delivery by physicians and other allied health care professionals, which in turn causes adverse birth outcomes.
To help decrease the adverse effect of mistreatment by health care providers towards Black women, several Black women have collaborated to create the grassroots #ListenToBlackWomen movement, which encourages self-advocacy and recognizes that Black women are the experts of their own bodies. As part of this movement, one of my current research projects centers on Black women’s experiences of mistreatment during maternity care. All of the women in the study were asked to create a list of recommendations for the physicians, which we will now be integrating into an implicit bias training curriculum.
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?
Some common structural barriers within health care delivery include lack of continuity of care, cost prohibitive services, lack of culturally responsive caregivers, geographically limited services. All of these issues can be relevant within the context of perinatal health research. For example, lack of cross-talk or continuity between a women’s obstetrician is something that often comes up in qualitative research (i.e. women feel uncomfortable when the OB on-call switches unexpectedly during their labor/delivery and they are not informed). Moreover, numerous women who lack health insurance coverage are unable to access adequate prenatal care due to high costs. In addition, a dearth of culturally competent health care providers is a common structural barrier to the initiation and up-take of obstetric care in communities of color. Lastly, historical geographic inequalities (e.g. red-lining) has created inequality in the access/distance to healthcare facilities, impacts a woman’s ability to visit their health care provider throughout her pregnancy.