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 contribute to disparities through racist or biased behaviors. An example from my own area of research is in opioid prescriptions. My research has indicated that physicians at UCSF are less likely to prescribe opioids to Black patients, controlling for other clinical and demographic factors. They also prescribe shorter courses of opioids for Black patients for similar conditions. This is all retrospective and descriptive. It would be interesting to take the research further and interview physicians regarding their treatment decisions or observe interactions with different patient groups at discharge.
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?
I take some issue with the concept of structural racism. It can take away the sense of responsibility to directly identify the issues that are solvable at a very human and policy level. Race underlies all structural contributors to disparities. Some structural issues that contribute to disparities include housing, generational wealth/inheritance, civil rights/voter suppression, and access to mentoring. Voter suppression leads to a class of politicians that do not advocate for their constituents in a representative manner. When I think of the demonization of African American communities during the crack epidemic and the way in which White communities are treated during the opioid epidemic, the disparity is evident.