Guest Commentary: Changing the American legacy of healthcare disparities

This month we celebrated the 238th birthday of our country. This summer also marks the 50th anniversary of the Freedom Summer—a time when the Congress of Racial Equality and the Student Nonviolent Coordinating Committee mobilized to register black voters in the U.S. South. Both “revolutions” required upsetting the status quo so the country could move forward.

As we focus on national and personal freedoms, let's not forget that “upheaval” is also needed in healthcare. With patriotism must come national self-reflection—a collective look at our failures to ensure equitable healthcare for all. I continue to wave the flag of freedom from inequitable healthcare for people who are poor and elderly, or otherwise treated differently.

As an American, I cannot accept that any citizen is free until we are all free. My “independence” is highly dependent on my neighbor being free from the visible and not-so-visible shackles of discrimination and indifference in healthcare provisioning and management.

Notable disparities in healthcare still persist in the U.S.—one of the greatest countries on earth in terms of medical education, health research, innovation and patient care. Healthcare disparities are often a hidden and silent form of discrimination; even the victims may not know they are being victimized.

For at least five years, our national consciousness has been consumed with healthcare policy reform. While I am thrilled about the millions of people who have health insurance thanks to Affordable Care Act mandates, I remain troubled by those who do not receive the quality of care they need because they are elderly, poor or immigrants—or because they have black or brown skin.

Let's look at a few known health findings:

• Social economic disadvantage (SED), is associated consistently with every aspect of poorer health, including higher mortality, decreased life expectancy and higher infant mortality.

• SED is also associated consistently with increased risks for pain, including musculoskeletal, sciatica and ulcer. My research indicates evidence of differences in pain frequency, severity, disability and treatment by race and ethnicity.

• Elderly women who are people of color experience more pain from cancers such as breast and multiple myeloma than their white, non-poor neighbors. Researchers believe this is a result of how pain medication is managed with elderly female patients, especially those from poorer neighborhoods.

My colleague, Dr. John Carethers, chair of internal medicine at the University of Michigan, released a study last month that found African-Americans with colon cancer are half as likely as Caucasian patients to have a type of colon cancer that is linked to better outcomes. This finding may provide insight into why African-Americans are more likely to die of colon cancer than whites in the same stage of the disease (PLOS ONE, June 28, 2014).

Today, we have much within our power that we need to reduce health disparities, and to finally bring about our true American legacy of equality and justice for all. Those of us in the healthcare system—doctors, nurses, social workers, researchers, physician assistants, medical technicians and others—must open our eyes to care disparities based on factors that should not matter: age, income, where the patient lives, race, or place of birth, to name a few.

Patients must also educate themselves to better understand how their personal socio-cultural history too often does affect the type of healthcare they receive.

In an effort to capture critical regional and national data on health disparities, my department at U-M—the Office for Health Equity and Inclusion—has launched a healthcare-equity research effort. Data we collect will be used to help transform healthcare delivery by our U-M providers initially, but will ultimately be shared with healthcare providers, academics, other researchers and medical associations across the country.

Our goal is greater freedom for patients who most often suffer silently. Eventually, every person in this county will be a patient. It is our commitment that when you do seek medical care, your experience will be equitable, color-blind and free from other forms of disparity.

Let's work together to make sure we all have equitable healthcare, a particularly patriotic notion. Together we can write the new American legacy of healthcare.

Take the next step at www.healthyconversation.org.

Dr. Carmen R. Green is associate vice president and associate dean for Health Equity and Inclusion at the University of Michigan Health System, Ann Arbor. She is also a professor of anesthesiology, obstetrics and gynecology at the U-M Medical School and professor of health management and policy at the U-M School of Public Health.