As a result of the Affordable Care Act, disparities in access to insurance and healthcare have declined dramatically. Though they persist—and constitute an enduring indictment of our healthcare system and society at large—our nation’s healthcare providers are seeing more persons of color and diverse ethnicity than ever before.
This trend will only accelerate as a result of the nation’s changing demographics.
The question is, are we ready? Are our nation’s health professionals and healthcare institutions prepared—culturally, psychologically, linguistically and organizationally—to provide the care that our historically diverse patients will require over coming decades? Looking back over my career as a primary-care physician, health system manager, and policymaker—and looking at current health outcomes among persons of color in the U.S.—I fear we are woefully ill-equipped.
As part of a diversity, equity and inclusion program at my own organization, a national healthcare philanthropy called the Commonwealth Fund, I recently read Stamped from the Beginning, a history of racist thought in America by Ibraham Kendi. This powerful volume blew away my complacency about prevailing attitudes toward race and the behavior of the healthcare institutions in which I have trained, practiced, taught and managed.
Racism in the U.S. has been and remains pervasive, and overcoming it requires daily efforts to recognize its influence and counteract it. And it also requires that institutions aggressively support anti-racism efforts in their own organizations.
This is tough and uncomfortable work, especially for the many dedicated healthcare leaders and professionals who deeply believe that they are personally unbiased, and provide compassionate, high-quality care to all their patients. I was one of those. As a result of our diversity and inclusion work, and reading Kendi’s book, I am no longer so sure. And this is something that can’t be left to chance.
If it is, we will continue to see black women dying from pregnancy-related complications at three to four times the rate of white women and black infants dying before their first birthday at more than twice the rate of white infants. Further, despite slightly lower incidence rates for breast and uterine cancers, black women have death rates for these malignancies that are 41% and 98% higher, respectively, than white women.
Other contributors to Modern Healthcare’s Breaking Bias column have identified some of the measures required to overcome the history of racism and racist thought with which our healthcare system must struggle. Diversity and inclusion at every level of our healthcare organizations—from boards to managers to front-line staff—are essential, but that’s only a start. Anti-bias training is also essential, as is measurement and benchmarking of the comparative experience and outcomes of care among patients of differing races and ethnicities.
The advent of high-tech healthcare solutions will only add to this challenge. The possibility, for example, that artificial intelligence will hard-wire bias into powerful decision algorithms—because it fails to capture the experiences of diverse populations—is disturbing and so is the possibility that differential access to technology will leave the poor and people of color behind as care relies on new sources of connectivity. In the U.K., the National Health Service is experimenting with using Amazon’s Alexa as a source of healthcare advice for patients. The issue of “techquity” will soon be on the agenda of our healthcare system.
Public policy, demography and the march of technology are making ever more pressing the need for healthcare providers—individually and institutionally—to confront one of the most important but difficult challenges any society can face: to end racism where it originates, in the thoughts and attitudes of a country that has embraced racism, overtly and covertly, for most of its history.