Please read required readings and write your responses and upload to the CLE by 12 pm February 7.
1) 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?
There are so many…
A common one that I hear about and witness is transportation difficulties to get to the hospital or clinic. Because I work with pregnant women and those with small children, bus transfers and long commutes take on additional meaning if you imagine doing this while 8 months pregnant and with a toddler in tow. Another structural issue in my work is about lack of affordable, accessible quality early childcare in our country and that women feel they can’t bring their children with them to appointments. If a family can’t afford childcare, then a job that may include health insurance as a benefit as well as the difficulty in attending health care appointments are all affected. Not to mention that a quality preschool can impact kindergarten readiness which then has associations with a whole host of developmental and health outcomes throughout the life course of that child. Another structural issue in healthcare delivery relevant to my work is the separation/silo-ed funding and service delivery between substance use disorders/addiction and other types of mental illness. In spite of the clear science and epidemiology that shows how often these types of illness occur together, it is very difficult to get treatment in one place at one time for these co-morbidities. Finally, as discussed in some of the readings, there is an obvious disconnect between the demographics of healthcare providers and the demographics of our general population. I have had many direct conversations now with Black women about how unlikely it is that they would talk about their own mental health with someone who looks like me--- a White woman, without getting to know me or have some sort of reason to trust me first. This is why the work of real dialogue, community engagement, collaborative partnerships, and understanding and addressing implicit bias from all sides is important.
2) 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?
As I mentioned in my answer to the first question and as highlighted in the JAMA opinion piece we read, implicit bias is one way that individual physicians contribute to health care disparities. We all have implicit bias and at least when I went through medical school our dialogue and curriculum and attempts to confront and address these biases and the associated disparities in the healthcare we deliver were pretty minimal. Since mental illness also has significant stigma associated with it, the interface between stigma and implicit bias results in profound disparities in terms of the diagnosis and treatment access of mental illness. One research possibility I could think of to examine this would be to randomize a bunch of psychiatry residents to some sort of implicit bias training and others to education as usual. You could then do some sort of pre and post-test about their knowledge or “cultural competence” related to implicit bias. It would be even more interesting to somehow measure their actual care of patients (diagnoses they give, treatment plans they recommend) as an outcome.