Thank you for your engagement with the questions regarding
the interpersonal and structural factors that can lead to health care
disparities.
I wanted to point out a few responses as being particularly thoughtful with respect to these questions
Rafael Chiquillo Sosa gave a thoughtful response to the question about how individual physicians contribute to health care disparities:
“Physicians can individually foment discrimination and health disparities regardless of their expertise and interest in working with underserved populations. Implicit and explicit bias is implied in perpetuating health care disparities in HIV, addiction, and correctional medicine. Historically, persons living with HIV, isolated or co-existing substance use disorders and incarceration history have been stigmatized with maladaptive behaviors and crime. Therefore, it is not unusual that physicians hold undesired, unconscious preconceptions (implicit bias) rather than perceiving individuals as suffering from undiagnosed or untreated chronic medical illnesses. Unfortunately, these concepts transcend to the conscious world (explicit bias), and often, physicians may strongly believe in a punitive rather than a rehabilitative approach to treat addictions, for instance. This is truer for persons with substance use disorders in the criminal justice system, where they could be treated differently from their counterparts without problematic substance use. Other forms of discrimination that contribute to health care disparities in HIV, addiction, and correctional medicine are stigmatization (Social stigma is the disapproval of, or discrimination against, a person based on perceivable social characteristics that distinguish them from other members of society. Social stigmas are commonly related to culture, gender, race, age, intelligence, and health; Goffman, E. (1963) and stereotyping (an over-generalized belief about a category of people. It is an expectation that people might have about every person of a group; Cardwell, Mike (1999). Commonly, providers expect to meet MSM (men who have sex with men) and transgender patients when running an HIV clinic.”
And Hannah Hoban gave a summary of structural issues impacting her area of pediatric genetics:
"- Lack of provider representation often means a lack of language diversity for patients. This is especially challenging when trying to schedule interpreters for less common languages, like Maam, to provide patients with the same level of care. Even with the more common languages like Spanish, appointments with translators take longer, and often providers can be rushed so those that do not speak English could be receiving sub-standard care because of communication challenges.
- Educational resources for testing and treatment options patients can chose often don’t take into account insurance status and those with state funded Medicare are less likely to be able to receive any of the testing and treatment options. These resources assume that patients will be able to make the choice on what testing they would like, however those who are underinsured or often on government insurance those entities get to dictate who receives the treatment/testing. Additionally, the state a patient resides in acceptance of the Medicare expansion also plays into a factor on who is able to get introductory testing that these brochures fail to mention to families because those writing it often have private insurance (while not guaranteed) are more likely to cover testing and families can decide for themselves.
- Genetics is often only available at academic research centers and community clinics (i.e. rural or underserved) have severely less access to even rudimentary testing resources. This can lead to patients being cared for in areas receiving less testing options for diagnoses and even less treatment options for the specialty service of genetics."
Some overall structural issues identified in the homework were as follows:
- Language barriers, including in educational materials
- Lack of representation/diversity in the health care workforce
- Lack of trust in medical system
- Health insurance
- Geography
- Referral patterns excluding certain patient populations
- Lack of cultural training in medical schools
- Lack of access to telemedicine
- Advertisements targeting certain patient populations
Thanks so much, all, and please let me know if you have any questions!