{"id":1226,"date":"2014-08-29T18:02:37","date_gmt":"2014-08-29T22:02:37","guid":{"rendered":"http:\/\/www.eimpactconsulting.com\/?p=1226"},"modified":"2022-10-26T14:54:38","modified_gmt":"2022-10-26T18:54:38","slug":"health-care-equity-causes-paradigm-shift-medicine","status":"publish","type":"post","link":"https:\/\/eimpactconsulting.com\/health-care-equity-causes-paradigm-shift-medicine\/","title":{"rendered":"Health Care Equity Causes a Paradigm Shift in Medicine"},"content":{"rendered":"

From\u00a0AAMC Reporter: June 2014<\/p>\n

…\u00a0at the University of Michigan Medical School in Ann Arbor, the Office for Health Equity and Inclusion was established in 2013 to try new approaches to mitigate health disparities. Among those, the office is looking at ways to inspire people of all races and nationalities to consider health care as a career. While anyone can learn to be sensitive to other races and cultures, according to Carmen Green, M.D.<\/a>, associate vice president and associate dean for Health Equity and Inclusion, research has shown that patients might be more likely to open up with doctors who come from similar backgrounds.<\/p>\n

And the doctors, likewise, may ask different questions, or even phrase questions differently. \u201cThere are a lot of subtleties,\u201d Green said. Michigan is trying to expose young people to the medical profession through visits to public schools and community colleges and a summer immersion program for science teachers. \u201cWe believe health equity and educational equity are synonymous,\u201d she said.<\/p>\n

Awareness of health disparities also can help close the gap, Green said. At Michigan, the Talk Health Equity Campaign asked everyone throughout the institution to share, in eight words or less, what health equity meant to them. More than 2,000 people responded, she said.<\/p>\n

\u201cDoes health equity mean the same thing for my grandmother as your grandmother?\u201d Green said. \u201cThrough that lens we can develop better policies and practices, work in partnership with other schools and colleges at Michigan, and change disparities.\u201d<\/p>\n

The medical school cannot address all cultural and historical barriers on its own, Green said. Michigan is looking to leverage the expertise of its 19 schools and colleges. \u201cWhen different people come to the table, we can start seeing things 20\/20,\u201d she said.<\/p>\n

\u201cThis is not a time to sit on the bench,\u201d Green added. \u201cPeople are dying before their time, babies being born before their time. There is a social cost and a financial cost, and they are crippling our country.\u201d<\/p>\n

<\/p>\n

\u2014By Jennifer Anderson, special to the\u00a0Reporter<\/em><\/p>\n

In several Detroit neighborhoods, infant mortality rates have rivaled those of developing countries. In the past, the health care system might have written off the losses as a foregone conclusion.<\/p>\n

But this notion is no longer acceptable in health care delivery. Leading the way, medical schools and teaching hospitals are redefining the health care model and addressing social determinants of health by rethinking how real-life situations affect health\u2014all in a concerted effort to narrow the health outcomes gap among various demographic groups.<\/p>\n

Ana E. N\u00fa\u00f1ez, M.D., associate dean of Drexel University College of Medicine\u2019s Office of Urban Health Equity, described a paradigm shift in health care.<\/p>\n

\u201cWe strive for health excellence\u2014but is it excellence for everyone?\u201d N\u00fa\u00f1ez asked. Rather than accept differences in overall health, life expectancy, or infant mortality, providers are asking, \u201cHow can we intervene?\u201d<\/p>\n

At Drexel, N\u00fa\u00f1ez recalled diabetes patients in certain neighborhoods having trouble keeping their blood sugar under control because they were unable to keep insulin refrigerated.<\/p>\n

\u201cIt would be very unlikely for a clinician to ask, \u2018do you have a functioning refrigerator,\u2019\u201d she said. The health care model needs to change, and more people need to join the \u201cteam,\u201d N\u00fa\u00f1ez said.<\/p>\n

\u201cThere are things that have nothing to do with blood pressure that influence your health,\u201d she said, describing an \u201ceagerness\u201d to look at different health care models to achieve better outcomes.<\/p>\n

N\u00fa\u00f1ez dates the formal health equity movement to a 2001 report by the Institute of Medicine (IOM) calling for, among other changes, \u201ccare that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.\u201d Other factors that contribute to health equity include disability and sexual orientation.<\/p>\n

At the request of Congress, the IOM followed up the next year with a report concluding that racial and ethnic minorities in the United States are less likely to receive routine medical procedures and experience a lower quality of health services, according to a summary of Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.<\/p>\n

Another driver to improve health inequities is cost. A 2009 report by the Joint Center for Political and Economic Studies found health inequities and premature death in the United States totaled $1.24 trillion from 2003 to 2006.<\/p>\n

\u201cIt is imperative that we be prepared to address the health needs of an increasingly diverse population,\u201d according to the report, The Economic Burden of Health Inequalities in the United States. The report stressed the importance of focusing on reducing health inequity, or efforts to solve disparities resulting from population- or community-based factors, calling health equity \u201ca goal that is not only consistent with the American promise of opportunity, but in our long-term economic interest, as well.\u201d<\/p>\n

The Affordable Care Act also created an opportunity to address inequities by requiring nonprofit hospitals to conduct community health needs assessments and develop strategies to address health needs in their communities to avoid tax penalties.<\/p>\n

Distrust of health research, health providers, and vaccines<\/p>\n

At Wake Forest School of Medicine in North Carolina, the Maya Angelou Center for Health Equity looks not only at life situations but also at social, ethnic, cultural, and historical issues that can influence health outcomes, said Ronny A. Bell, Ph.D., professor of epidemiology and prevention, and center director.<\/p>\n

\u201cAfrican-Americans have significantly lower vaccination rates for pneumonia and influenza,\u201d he said. \u201cAre there cultural issues? Is there a view that the vaccine causes you to get the disease? Does it go back to not trusting the health care system?\u201d<\/p>\n

Barriers to employment and the relatively high incarceration rate for black men are additional cultural phenomena increasingly recognized as factors in health outcomes\u2014part of what Bell described as a \u201ccascade of issues\u201d related to health.<\/p>\n

Awareness is part of the solution. At Wake Forest, first-year medical students staff a medical clinic in a lowincome area and work with mentors to address real-life issues that have an impact on health. For example, if a patient lives in an urban area without access to healthy food or a safe area to exercise, that will certainly affect his or her ability to lose weight or lower blood pressure, for example.<\/p>\n

\u201cIf an obese patient visits the clinic, can you simply advise her to eat more fruits and vegetables?\u201d Bell asked. \u201cWhat if she lives in a food desert? How do you overcome those issues?\u201d<\/p>\n

Medical students need a better grasp of so-called cultural competency\u2014or the ability of health providers to relate to patients of different racial, ethnic, or socioeconomic backgrounds\u2014not only because patients depend on it, but also because the industry insists on it. Indeed, cultural competency questions increasingly are turning up on the U.S. Medical Licensing Examination, and reimbursements more and more will be tied to health outcomes.<\/p>\n

Barriers to change<\/h4>\n

Research can help inform the way health systems address disparities. Like other institutions pursuing efforts to ensure health equity for all populations, research into health equity at Henry Ford Health System is largely funded through state and federal grants, from the National Institutes of Health, Department of Defense, and other agencies and organizations.<\/p>\n

Sometimes grants can address a specific disparity. Kimberlydawn Wisdom, M.D., senior vice president of Community Health & Equity and chief wellness officer at Henry Ford, noted that 40 percent of African-American males, statistically, never see age 65. When Henry Ford redefined senior citizen from age 65 to age 50, the National Institute on Aging responded with a $5 million grant, awarded in the late 1990s.<\/p>\n

There are other institutional barriers to health care. Just as Wake Forest experienced lower vaccination rates among some groups, Henry Ford wanted to know why African-American women were not getting mammograms at the same rate as Caucasian women. It turns out there were many reasons, according to Wisdom\u2014scheduling difficulties, inconvenience, concerns about discomfort, and a lack of encouragement from family members.<\/p>\n

After careful study, Henry Ford opened its mammogram clinic on Saturdays, no appointment necessary. \u201cWe found we were entirely able to close the mammogram screening gap,\u201d Wisdom said.<\/p>\n

Group care and other new models<\/h4>\n

For those pregnant women in neighborhoods with traditionally high infant mortality rates, Henry Ford added new members to its health care team.<\/p>\n

Through grant funding, it hired six community health workers and positioned them in neighborhoods with the highest infant mortality rates. Similar to social workers, the community health workers help the women get to their appointments, follow doctor recommendations, eat healthy, protect themselves from violence, and handle any other challenges that arise in their lives.<\/p>\n

\u201cWe\u2019re seeing the infant death rates drop precipitously in these neighborhoods,\u201d Wisdom said.<\/p>\n

And for pregnant women having trouble getting to their doctor appointments on time, the health system is considering group care. Patients would be given a big slot\u2014perhaps two hours or more\u2014to drop in anytime and meet with a provider and other patients as a group. \u201cWe\u2019re looking at creative ways to best utilize physicians\u2019 time,\u201d Wisdom said, while also reducing the impact on the clinic when patients arrive late.<\/p>\n

All of the women would be in the same trimester and could learn from each other\u2019s experiences, she said\u2014perhaps even encourage each other in ways that may not resonate when coming from the physician.<\/p>\n

Nearby, at the University of Michigan Medical School in Ann Arbor, the Office for Health Equity and Inclusion was established in 2013 to try new approaches to mitigate health disparities. Among those, the office is looking at ways to inspire people of all races and nationalities to consider health care as a career. While anyone can learn to be sensitive to other races and cultures, according to Carmen Green, M.D., associate vice president and associate dean for Health Equity and Inclusion, research has shown that patients might be more likely to open up with doctors who come from similar backgrounds.<\/p>\n

And the doctors, likewise, may ask different questions, or even phrase questions differently. \u201cThere are a lot of subtleties,\u201d Green said. Michigan is trying to expose young people to the medical profession through visits to public schools and community colleges and a summer immersion program for science teachers. \u201cWe believe health equity and educational equity are synonymous,\u201d she said.<\/p>\n

Awareness of health disparities also can help close the gap, Green said. At Michigan, the Talk Health Equity Campaign asked everyone throughout the institution to share, in eight words or less, what health equity meant to them. More than 2,000 people responded, she said.<\/p>\n

\u201cDoes health equity mean the same thing for my grandmother as your grandmother?\u201d Green said. \u201cThrough that lens we can develop better policies and practices, work in partnership with other schools and colleges at Michigan, and change disparities.\u201d<\/p>\n

The medical school cannot address all cultural and historical barriers on its own, Green said. Michigan is looking to leverage the expertise of its 19 schools and colleges. \u201cWhen different people come to the table, we can start seeing things 20\/20,\u201d she said.<\/p>\n

\u201cThis is not a time to sit on the bench,\u201d Green added. \u201cPeople are dying before their time, babies being born before their time. There is a social cost and a financial cost, and they are crippling our country.\u201d<\/p>\n

As seen in Association of American Medical Colleges.<\/a><\/p>\n<\/span>","protected":false},"excerpt":{"rendered":"

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