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?
Having worked over the past several years in primary care, there is a disconnect between well-intentioned physicians and their patients. A South American philosopher once said, “you can’t understand the experience of the other until you step into their periphery (Dussel, E., 1989).” One main reason that physicians contribute to health care disparities is the belief that all individuals have the same capacity to break down systemic barriers. For example, a physician continuing to reinforce to a patient that his grades are important in high school when this particular adolescent was homeless, did not know where his next meal was coming from, and witnessed ongoing domestic violence. I agree that grades are important but similar to Maslow’s hierarchy of needs, when basic needs aren’t met, I can understand why this particular adolescent wasn’t able to focus on his grades.
A question I’ve always wanted to pose is this: “does attending to the mental health needs of a community make a positive impact on their physical health?” For instance, Latinx youth have some of the highest rates of asthma. If a team of healthcare workers, physicians, mental health workers, case managers, worked together to attend to these individuals, not only to physical health, but to mental health and increased resources, would the asthma rates decrease as the population experiences less toxic stress?
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?
1. Social class. In order to hold a graduate degree (e.g., Ph.D, M.D., etc…) an individual most likely experiences privilege. Having received blind privilege can make it difficult for this same individual to understand the experience of someone that does not come from privilege.
Relevance to my research: This many times results in a lack of attendance with the primary care provider, a lack of understanding the needs of the patient, and increased stress for the community.
2. Access to healthcare. The coming and going of Obamacare has caused structural issues, including access to healthcare. Having worked with the Latinx community, documented Latinx compared to undocumented Latinx are two different populations. The undocumented community has increased stigma around healthcare as they are constantly at heightened risk of deportation. With Obamacare, we were able to see a population that had little prior access to care, and now that is being threatened again.
Relevance to my research: this applies to my research in many ways. Psychology has become very evidenced based. When targeting the Latinx community, interventions have been created that do not attend to the heterogeneity of the population. An intervention that attends to the cultural and social needs of U.S. born Latinx populations does not tend to the needs of foreign-born communities.
3. Language. A structural barrier can be the provider’s ability to communicate with the patient. Translators can cause a divide between the provider and patient. Sometimes the translators are from the same community as the patient, making it difficult for the patient to be open and honest with their needs.
Relevance to my research: As an example, only 1% of all licensed psychologists self-identify as Latinx. This does not mean that there are not providers who are not from the culture that speak Spanish; however, being bilingual and bicultural, in my experience, are equally as important in making a connection with the patient. Many studies in the psychology field have shown that, in order to promote change, a provider needs to have positive relationship with the patient. For example, trauma theory suggests that, in order to attend to someone’s traumatic experience, you can do a “top down” or “bottom up” approach. A top down approach means that the provider has a strong working relationship with the patient.
4. Partner violence. Marriage fraud provisions suggest that women need to be married for two years in to their spouse in order to obtain citizenship. Many times this leads to the women staying in a relationship in order to avoid deportation. This lack of legal rights in the U.S. ultimately causes a decrease in access to healthcare, in fear that the domestic violence will lead to contacting child protective services or adult protective services.
Relevance to my research: For women that are afraid of loss of citizenship and deportation, this structural impediment creates a lack of trust. Women may not seek the care for themselves or their children if they are living in fear of deportation. This increases the toxic stress that the family endures over time, creating further health complications to a family system and community.