I recently had two contrasting experiences in the same day related to racism in healthcare that I haven’t been able get out of my mind. First thing in the morning, I received a copy of a commentary piece in the Wall Street Journal, Tell Your Doctor Your Symptoms, Not Your Race. In the piece, the author, an experienced doctor, shared his concerns about a US Department of Health and Human Services (HHS) rule related to Medicare changes to physician fee schedules and other payment policies. The author was concerned that the “underlying message of this policy is that medical professionals are racist” and ended the piece with the statement that “a physician’s job is to care for his patients’ health, not to resolve poorly defined social ills.” While I understand that physicians want to provide the best care for all of their patients, regardless of race, and would prefer to separate race from symptoms, a physician should treat the whole patient. And the reality is that “social ills” such as racism impact their patients’ health, and it is a physician’s professional and moral responsibility to address these aspects to achieve the high quality, equitable care, and health outcomes that everyone deserves.
Later that same morning, I participated in the Kentuckiana Health Collaborative’s all-member meeting with guest speaker Michele Shelton who spoke on how companies invest billions of dollars annually on diversity, and still, many diversity efforts are seen as ineffectively addressing the needs of the BIPOC community. For example, 2020 saw an 84% increase in corporate chief diversity officer hires, yet research shows most diversity officers and programs are set to fail.
The juxtaposition of these two views was startling to me, especially given the equity work that the KHC has undertaken with the Healthcare Equity Advisory Committee and Healthcare Equity Learning Series, along with equity discussions at the KHC Annual Conference in April. Data, not opinions, shows that there is indeed racism and bias in our healthcare system that leads to health disparities.
Until recently, a race modifier was used in the eGFR measure used to diagnosis chronic kidney disease which led to disparate health outcomes for people who are Black compared to those who are white. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) have recommended its removal. Additionally, we know that Black people in Kentucky die at a higher rate from cardiovascular disease. Nationally, studies have shown Black and Hispanic patients receive fewer heart disease interventions than white patients. Furthermore, the maternal death rate per 100,00 births is 42.1 for Black mothers compared to 17.2 for white mothers. These are just a few snippets of the available data that shows there are disparities in our healthcare delivery system and in health outcomes by race, nationally and locally.
Healthcare professionals may not think they are racist or biased. However, the data shows that the healthcare system continues to deliver disparate treatment to people who are not white. If we do not begin to recognize and account for the differences and educate ourselves about bias and racism, we cannot correct and eliminate these disparities. HHS’ new payment structure and requirements related to implicit bias training and anti-racism plans are just a small step toward a credible understanding of and solution for the issue. There cannot be change without an understanding of the current state – and that current state is unacceptable for our healthcare system. Dr. Martin Luther King Jr said in 1966: “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”