The Color of Health Care

Sharon West, Executive Director of ABIPA

by T.J. Moore

The
symptoms for this disease include but not limited to-bias by health
care provider, clinical uncertainty when treating and interacting with
minority patients, stereotypes by the provider about minority health
and behavior, and the patients’ avoidance or delay in seeking care.

Health
care disparities among minorities is a chronic social disease with many
layers. If ignored, the complications of disparities have a way of
catching up to one in the long run. “It (disparities) has been a
cumulative effect.” says Asheville Institute of Parity Achievement
(ABIPA) Executive Director Sharon West, “A lot of things over the years
such as socioeconomic status, health and environment has not been
addressed. When not addressed, the issues accumulate and like a
festering sore, the problem gets worse.”


Early Detection and Diagnosis


Seven years ago, Congress requested the IOM to observe and monitor the
degree of racial and ethnic disparities in the health care field. Their
observations included research of insurance status and the correlation
between care and payment, the possibility of subtle and overt biases of
the health care provider, and possible solutions. After reviewing the
hundreds of studies, the IOM discovered findings that suggested there
were evidence of bias and stereotyping on the part of healthcare
providers that contributes to unequal patient treatment.


The findings of
those studies made its way into a 700 page report titled ‘Unequal
Treatment: Confronting Racial and Ethnic Disparaties in Healthcare’.
The findings in the book shocked the health care world, since it is
known that the industry’s providers and practitioners are sworn to
beneficence and by law cannot discriminate against any patient on the
basis of race. The book cited some of the most convincing evidence of
health care disparities in the areas of cardiovascular care,
appropriate cancer diagnostic tests, among other diseases.


One of the
studies in the book address the matter of minority patients being more
likely to refuse treatment, and the studies showed that refusal of
treatment proved to be a non-factor in fully explaining disparities. If
the statistics on refusal of treatment by the patient is irrelevant in
the overall scheme of disparities there may be another more alarming
explanation for the health care racial divide, an explanation that is
the main worry of West. “My biggest concern is the denial of the right
to access quality care.” she says, “This is when a procedure is
recommended and the provider does not introduce or discuss it as an
option of treatment.”


West’s concern
is valid. In the disparity assessment studies, percent of the problem
attributes to behavioral choices. A percentage of that can be
contributed to provider bias. The remaining percentage however is
unexplained.


In addition to
pre-conceived stereotypes that the doctors and patients may have about
each other, factors in health care disparities may be found not only
through the color line, but through the bottom line. According to West,
in 2004, 75 percent of the people who filed for bankruptcy in North
Carolina did so to due to medical and health related issues. Of that 75
percent, 50 percent had insurance. West believes that these statistics
have a negative effect on the health care divide. “If we have people
filing for bankruptcy with insurance, what happens to those who are
uninsured and have no medical home?”
she said.


Another factor
in health care disparities is the alarming statistics may be
self-inflicted wounds.

According to the 2006 state report card on
health care disparities. The statistics imply that the lifestyle of the
minority patients as well as lack of insurance may be a factor in the
problem. African-American and Hispanic patients, for instance, have
high percentages in poor nutrition: 81.2 percent of African-American
and 87.8 percent of Hispanic patients do not eat five or more fruits
and vegetables a day, Similarly, 32.7 percent of African-American and
46 percent of Hispanic patients do not engage in exercise.


Monitoring and Treatment


To observe
health care disparities more effectively, the North Carolina Office of
Minority Health developed an annual report card. This 17-page document
examines areas such as social and economic well being, maternal and
infant health, adult health. This monitoring method is considered to be
one step in fighting the problem. “The (disparity report cards) keep us
abreast and make us aware of disparity issues for the state and how we
can be advocates in addressing disparities,” West said.

While the report
card method seems to be useful in measuring disparities, the statistics
found in the report are useless without significant treatment of the
problem. West believe in a old-school approach to a new-age problem.
“During the Civil Rights era, we were empowered and united. Now, the
conscious to take care of ourselves declined significantly. We don’t
have the same commitment to our health anymore.” she says, “We must
regain that sense of pride of who we are as a people — strong,
resilient people.”

Asheville-Buncombe Institute of Parity Achievement (ABIPA) – Parity Achievement Community Empowerment (PACE) Team Members Left to Right: Kookie Springs, Bonnie Love (Volunteer Coordinator), Dr. Charles Blair, Joann Smith (Program Manager), Jeanne Blair, Josephine Hall, Sarah Gayle, Marvin Chamber,(Chairperson).

Addressing the problems


Several area
health care organizations, including ABIPA, are working to address both
the disparities in medical care, and the particular illnesses and
symptoms that disproportionately impact members of minority groups. For
Mission Hospital’s office of diversity director Randall Richardson, the
treatment and ultimately cure for disparity is two fold.


Beyond the
hospital doors, Richardson and other Mission staff recently provided
free prostate and breast cancer screening. “Early detection is most
important,” he points out. “We are more than likely able to treat
diseases when we catch them early enough. The sicker you become, the
more challenging it becomes to treat it.”


The screenings
are a staple in Richardson’s method of fighting health care
disparities. “It is something that we do on a regular basis. Our whole
approach is to fundamentally provide screens to offset some of the
(heath) challenges we have.”


In addition to
community outreach, Richardson believes in fighting disparities with a
diverse staff. Nine years ago, Richardson established a scholarship
program for Mission Hospitals to help minorities further careers in
health care.


Over a million
dollars in scholarships have been awarded since the program’s
inception. To further solidify the commitment to diversifying the
health care industry, Richardson also developed an extension to the
scholarship program in 2000. “We provide internships for students who
are pursuing a degree in health related fields. We usually have 7-10
interns to work for the summer,” Richardson said.

ABIPA recently
launched the Parity Achievement and Community Empowerment initiative or
PACE.

Powered by a generous grant from the North Carolina Health
Wellness Trust Fund-Health Disparities Initiative, PACE will focus on
the treatment of disparities related to prostate cancer, breast cancer,
and diabetes.


PACE will combat
the disparities related to those diseases by providing screening,
assessments and referrals based on the patient’s needs. “When the
client comes to our office, and identified as a PACE participant, they
will be referred to various health care agencies based on their needs,”
says PACE Program Manager Joann Smith.


Health care
disparities among minorities is the type of disease that can be treated
and even cured. Elimination of this problem is ultimately a team effort
between the patient and the physicians. While the cure will not happen
overnight, gradual steps should be taken to help close the gap.