FINAL AP (19 pages)
Abstract: Our healthcare environment has grown and developed with each passing year, yet we continue to witness the same difficulties from sixty to thirty years ago, and only modest steps have been done to address them in the last five years. Modern medicine has evolved to be far more reliable and efficient in treatment than most other types of medical practices, resulting in its worldwide application in hospitals. The expansion however has raised the issue of inadequate health treatment and health outcomes for minorities. However, historical and personal factors influence health disparities. Factors such as cultural practices patients may carry, implicit biases from healthcare providers as well as the flow of mistrust in the healthcare environment, and racial discrimination. In order to face and solve the issue of cultural factors, we could have medical staff undergo assessment exams to educate and recognize the various cultures from which a patient may come, which will establish an environment that is welcoming to all cultures. When looking into implicit biases in medicine, it may be seen that numerous ethnic-racial groups are discriminated against and receive inferior healthcare. An approach to solve this could be to provide training and intervention programs to care providers and bring it to their attention that implicit bias impacts the patient's health plan. For the issue of mistrust of medical institutions, researchers and physicians can create transparency with their patients, communicate everything, and make sure everything consents. For racial discrimination, an approach for the solution will focus on quality hospitals in areas that are predominantly minorities and the publication of their performance. Overall, the goal of this research paper is to find solutions to an already existing issue that affects a proportionate number of minorities in America.
University of California, Irvine
“Health Inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.”
-Micheal Marmot
Vivian Girgis
Writing 39C Research & Argumentation
June 6, 2022
The reality of being a minority within America comes with a disadvantage to an already
a polarized society with inefficient healthcare outcomes and quality. The historical context of the issue had always been prevalent, however, as stated “public awareness grew, the US government became involved. In 1984, the US Department of Health and Human Services released a report on the health of the nation, entitled “Health, United States, 1983” [7Links to an external site.]. The report documented that, while the overall health of the nation showed significant progress, major disparities existed in “the burden of death and illness experienced by blacks and other minority Americans as compared with the nation's population as a whole”(Gibbons MD, 2005). Furthermore, the issue is still prominent with many contributing attributes such as cultural factors, mistrust of medical institutions, implicit bias, and racial discrimination becoming a continuing factor of inequality in health care and outcomes. Additionally, the Covid-19 Pandemic has highlighted the effects of these factors causing inequality within healthcare and the differential health outcomes for minorities. This can be inferred from a recent study stating “COVID-19 data shows that Black/African American, Hispanic/Latino, American Indian, and Alaska Native persons in the United States experience higher rates of COVID-19-related hospitalization and death compared with non-Hispanic White populations.[18]Links to an external site. These disparities persist even when accounting for other demographic and socioeconomic factors” (Lopez III MD, Hart IIIMD, Katz MD, 2021). Furthermore, a solution for this issue of quality care and health outcomes for underserved minorities should become a priority for medical professionals. The proper solutions should be introduced to counter the issues minorities face when trying to access quality and equal care. However, progress toward closing the health disparities has been implemented to reduce differentiated health outcomes. According to the article “Addressing Health Care Disparities: Recommended Goal, Guiding Principles, and Key Strategies for Comprehensive Policies” by The Commission to End Health Care Disparities, states “Federal policies to address disparities have been set and implemented through initiatives such as Healthy People 2010 and the Agency For Health Care Research and Quality Annual National Health Care Disparities''. Through these initiatives, it’s clear that actions to eliminate or reduce healthcare disparities among minorities in America by addressing policies to Congress have been enacted. Moreover, through analysis of research and statistics, the current issue is still largely affecting these minorities by creating health disparities. Thesis Statement: Although the issue of unequal and different health outcomes for minorities is rooted in a historical context that has created a health disparity, new solutions such as cultural knowledge/inclusion training, changing implicit bias, and having community bonds to alleviate the mistrust minorities have towards medical institutions and acknowledging racial discrimination towards patients by investing in POC communities and inclusive work areas for employees and patients can altogether close the gap of health disparities for POC.
The first issue derives from how cultural factors have influenced negative health outcomes of minorities and have caused differentiated health outcomes whenever communication between health professionals and patients occurs. The number of different cultures within the U.S. can cause different means of medication prescribed and how medicine is received. In the evidence presented “The influence of culture on health is vast. It affects perceptions of health, illness, and death, beliefs about causes of disease, approaches to health promotion, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer” (Mayhew MD, 2018). This quote refers to the vast number of cultures, the influence culture can have on medication, and how it’s viewed. However, solutions can be placed to respect but still treat patients just as efficiently such as having medical professionals take assessment tests to learn and acknowledge different cultures a patient may be from and creating an environment that’s inclusive towards different cultures. In addition, efforts to create environments that are culturally inclusive have been made to create a suitable environment for patients and physicians to communicate. In the article “CULTURAL COMPETENCE IN HEALTH CARE: EMERGING FRAMEWORKS AND PRACTICAL APPROACHES'' by Joseph R. Betancourt and Alexander R. Green and J. Emilio Carrillo, both professors at Harvard Medical School and Weill Medical College of Cornell University, elaborate that other medical institutions have implemented cultural inclusive environments and interpreters to communicate effectively with minorities in which can create better health outcomes. In their research, the authors evaluate resources to create an analysis of how having trained specific medical professionals can create cultural inclusive workspaces by stating
In addition, Kaiser has developed modules of culturally targeted health care delivery at the San Francisco facility. The multilingual Chinese module and the bilingual Spanish module provide care and services to all patients but have specific cultural and linguistic capacities to care for Chinese and Latino patients. Both modules are multispecialty and multidisciplinary. They include, for example, diabetes nurses, case managers, and health educators, with the entire staff chosen for its cultural understanding and language proficiencies. (Betancourt MD & Green MD & Carrillo MD, 2002, p.7)
The quote infers that efforts to create a culture inclusive within healthcare providers have been implemented to further create clear communication between physician to patient. These implementations that Kaiser Permanente has for their medical staff have aided in overall better health outcomes for patients when interacting with the medical professionals that assist them in a variety of needs like medications.
Furthermore, these efforts have been shown to create positive health outcomes for minorities. Moreover, in the article “How Culture Influences Health”, the author evaluates how having medical staff that can understand patients' cultures creates positive interactions such as their medical needs acknowledged by their cultural values, he states “Health care providers are more likely to have positive interactions with patients and provide better care if they understand what distinguishes their patients’ cultural values, beliefs and practices from their own” (Mayhew MD, 2018).
Moreover, cultural factors have an influence on health treatment and can interfere with communication with physicians, However, with different approaches, physicians can work with cultural differences and create an environment that suits their patients and eliminates health disparities in patients. The article “Cross-Cultural Medicine'' by Gregory Juckett MD, a physician at Parkway Medical Group, states
Physicians should use a patient’s formal name if they are unsure of the appropriate way to address the patient. Patients sometimes will avoid eye contact with physicians out of respect, especially if they are of a different gender or social status. Orthodox Jews and persons from some Islamic sects do not allow opposite-sex touching (even handshaking). In these groups, it is best for patients to have a same-sex physician. In other low-touch societies (e.g., Asians), it is merely necessary for physicians to explain what they will be doing during the examination. (Juckett MD, 2005)
In the article “Cross-Cultural Medicine”, Gregory Juckett MD makes an analysis of different perceptions or beliefs different cultural people may have that could prevent them from receiving proper care and also the right sources to adjust to their beliefs creating proper communication between physicians and patient. In return, these solutions in effect can help medical professionals develop cultural incompetence and in return be able to treat a patient accordingly. Through analysis and examination of the patient to physician cultural competence, the School of Public Health and Tropical Medicine at Tulane University correlates that physicians with a clear comprehensive understanding of their patients can create “Cross-cultural awareness makes healthcare providers more open to unfamiliar attitudes, practices, or behaviors. It also improves collaboration with patients and helps them respond with flexibility. Benefits of cross-cultural awareness include Improved rapport, Tailored treatment plans, Improved patient attendance, and compliance”. These practices can overall better the health outcomes of patients from different cultures and close the disproportionate health disparities in American minority outcomes. Although the solution for one issue can be solved, there's a lack of solutions to cover the whole spectrum of the issue in order to create sufficient and quality health outcomes for minorities.
Although solutions for other aspects of healthcare are feasible, another main issue within healthcare that influences negative health outcomes, implicit biases. Although medical professionals can have implicit biases that might not be directed toward patients, the discrepancy between bias and health outcomes can directly impact minorities by adding to the health disparities within the U.S. In the article “The uncomfortable truth is that we live in a society in which stereotypes about groups of people are ubiquitous, and it follows that almost everyone has some implicit bias.” (IHI’s Chief Emeritus and Senior Fellow Don Goldmann) Implicit biases exist in the general population as well as in professionals in a variety of fields, for example, medical professionals. To minimize implicit biases in health care, multiple strategies should be applied. The first strategy applied will have to do with implicit bias training for medical professionals. However, enactment to reduce health disparities within healthcare by reducing implicit bias and training physicians to realize implicit bias does indeed influence health outcomes. As research suggests that “In a 2015 systematic review by Hall and colleagues, researchers found that implicit bias is significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes”.(IHI Multimedia Team, 2017). Through analyzing the research presented, implicit biases very much have an influence in how patients are treated by medical physicians causing adverse health outcomes, how treatment is given, and decisions of medications for patients. However, with implicit biases affecting patients' health outcomes, the question arises whether if there’s any solutions to combat implicit biases in healthcare.
In addition, a way of countering implicit bias in the workspace from medical staff towards patients would be to take an implicit bias assessment. This test will effectively display who carries implicit bias and how to reduce their implicit bias during work and overall give them a new perspective. Therefore training and acknowledgment of their results can effectively reduce implicit bias and eliminate the unconscious factor of judging a patient or treating them unequally. This method in effect can reduce the health disparities of POC and overall benefit the community their serving. It is never simple to remove implicit bias. It might be especially challenging for committed health care professionals to consider the potential of having implicit views or assumptions; however, these methods like having an implicit bias assessment test can reduce the implicit biases. However, it is argued that unconscious bias isn’t a fixable issue. In the article “Roots of unconscious prejudice affect 90 to 95 percent of people, psychologists demonstrate at the press conference” Joel SchwarzLinks to an external site., a journalist at the University of Washington, stated “The pervasiveness of prejudice, affecting 90 to 95 percent of people, was demonstrated today in a Seattle press conference at the University of Washington by psychologists who developed a new tool that measures the unconscious roots of prejudice” The author infers that the issue of unconscious bias isn’t fixable and can’t be solved using measures that were previously stated in the paragraph. However, research studies have shown that implicit biases can be solved. In the article “How does implicit bias by physicians affect patients' health care?” researchers at the University of Arkansas conducted a research case study to figure out whether physicians who received implicit bias testing and intervention showed lower signs of implicit bias than those physicians who didn’t take their implicit bias test nor intervention. Their research found that
A study by Patrick S. Forscher, Ph.D., of the University of Arkansas, and colleagues found that compared with controls, people who received the intervention were more likely after 14 days to feel concerned about the targets of prejudice and to label biases as wrong” (DeAngelis, 2019).
This evidence indicates that there were two groups that initially showed equal levels of implicit bias but through having assessments, such as implicit bias intervention, the research implies the decrease of implicit bias and self-evaluation of one's actions as seeing implicit biases wrong. Even though implicit bias isn’t something that is permanent, there are methods such as assessment and intervention to change one’s attitude towards other people. Moreover, issues such as implicit bias can be solved through initiatives, and influence minorities' health outcomes.
Furthermore, in healthcare medical mistrust has been prevalent in many communities. For example, the African American and Native American communities. Additionally, historical context such as sterilization of Native American women and untreated Syphilis on African American men have contributed to the mistrust of medical institutions. This experimentation and abuse of these racial groups only add to the mistrust that surrounds the medical practice. Moreover, there are solutions that can heal the trauma and neglect these groups have experienced. Although these beliefs are still reminiscent in current times of whether it’s effective or dangerous for these two groups to believe in medical institutions. With the declining health outcomes for these two specific groups, it’s essential for medical institutions to regain a trusting relationship to create better health outcomes.
To begin to get a proper understanding of why Native Americans have medical mistrust, there needs to be an evaluation of how the mistrust began and how it affected their populations. In the article “The Indian Health Service and the Sterilization of Native American Women” the author Jane Lawrence, A researcher at the University of Nebraska, gives the context of what Native American women went through and experienced through medical institutions created to help them but states
What happened to these three females was a common occurrence during the
The 1960s and 1970s. Native Americans accused the Indian Health Service of steril-
sizing at least 25 percent of Native American women who were between the ages
of fifteen and forty-four during the 1970s. The allegations included: failure to
provide women with necessary information regarding sterilization; use of co-
erosion to get signatures on the consent forms; improper consent forms; and
lack of an appropriate waiting period (at least seventy-two hours) between the
signing of a consent form and the surgical procedure. (Lawrence, 2000)
Historically, both minorities have been oppressed, exploited, and mistreated by medical health professionals. Moreover, another group has experienced a decline in medical mistrust, this being the African American community. Historically, African Americans have been disregarded in every way imaginable in American history. Including their health being exploited as well. In 1972, medical researchers conducted a research case study of Syphilis on African Americans, and even with medical treatment available, they refused and withheld the patients from receiving medicine in the intent to see how syphilis reacted to the human body naturally. The research article “TUSKEGEE AND THE HEALTH OF BLACK MEN” by Marcella Alsan and Marianne Wanamaker, examines the history Tuskegee experiment on African American men creating mistrust towards medical institutions and the practitioners by stating
For forty years, the Tuskegee Study of Untreated Syphilis in the Negro Male passively monitored hundreds of adult black males with syphilis despite the availability of effective treatment. The study’s methods have become synonymous with exploitation and mistreatment by the medical profession. (Alsan, Wanamaker, 2018)
With knowing the historical context of how medical institutions have disregarded Native American women and African Americans, there need to be solutions to regaining and building trust. Although mistrust of medical institutions has negatively impacted communities of color. Different objectives and methods to reduce the mistrust and solutions will be examined, with research and evidence suggesting there will be an efficient way to heal medical mistrust from these communities of color. There are a variety of reasons why patients distrust. There are, however, some steps providers and healthcare organizations can take to create an environment that contributes to creating and maintaining trust. In the article “Care of the Native American Woman: Strategies for Practice, Education, and Research” by Sandra K. Cesario Ph.D., introduced a solution to how trust can be built with Native American women, with knowing the history of distrust and the disadvantages Native American women have. The author then goes on to stating
If written consent is required, the planned procedure should be explained in detail and include all possible side effects, consequences, and implications. Historically, written agreements between Native Americans and agencies or individuals have been misused or obtained under a false pretense. This has led to a distrust of such documents in the Native American community. To establish or maintain a trusting relationship, the nonnative health care provider should be patient and allow sufficient time for the family to consult with a tribal elder or matriarch before the written signature can be obtained.(Cesario RNC, Ph.D., 200)
From this research, the acknowledgment and solution for professionals and the patient themselves contribute to the solution in regards to building trust and properly communicating with medical professionals by disclosing information and closing the gap of mistrust of medical institutions by Native Americans. The solution also has transparency with how documents or procedures are carried out with the Native American women’s families. These actions, it assures there’s the total presence of everyone included and creates more trust within the family knowing. If one side trusts the other and the other has trust then there is a stable foundation that prioritizes the patient-provider relationship. Additionally, medical institutions should work and find solutions as well to counter the mistrust created in the African American community.
Furthermore, the article “Restoring trust in medical research among African-Americans” by Randall C. Morgan Jr, a senior medical doctor, and president of W. Montague Cobb/NMA Health Institute, gives an insight of how researchers are taking new productive approaches to African Americans in research studies by stating
Our team is working to engage African-Americans across the country to participate in All of Us. We regularly publish information about the project in our medical journals and across our platforms. We have also developed informational materials for our network of more than 50,000 African-American physicians so they can talk with the patients they care for about the benefits of participating in the program. All of Us require informed consent. That means participants are able to learn all of the details of the program before deciding to join. This process was designed to encourage transparency and make the aims of the program clear. Enrollees can also withdraw from the research pool at any time. (Morgan Jr, 2018)
In the article, the author creates a foundation of trust for African Americans in medical research. The solution presented publishes the information regularly for the public to see and creates transparency so there’s no information withheld or hidden. The article as well includes African American physicians actively participating in medical research to communicate to test patients if there are any questions or problems that may arise. However, not only does the solution build trust and create clarity of what’s being done, but they also require consent and the patients are able to withdraw whenever they choose to. Moreover, all these efforts put into place for medical research are to create clarity, remove negative stigmas, and resolve mistrust of medical institutions by African Americans.
In continuation of the issues discussed in this research paper, there’s been a prevalent issue that’s been hindering POC from receiving the same quality and health outcomes, this issue being racial discrimination. Racial discrimination within the healthcare setting is described as negative acts or a lack of regard directed toward a person or group based on a specified and unreasonable notion. However, there are different methods to reduce and prevent racial discrimination within healthcare, medical institutions, and medical professionals to aid in closing the health disparities of minorities. Through analysis of different scholarly articles, the examination of different approaches to close or reduce racial discrimination will alleviate the health disparities of POC.
The research article “A Rare Find in Health Care: A Simple Solution to Racial Inequity” by Micheal Blanding, an investigative journalist at Harvard Bussiness School, examines racial discrimination within healthcare and different solutions proposed. The author through an analysis of racial discrimination in healthcare and the health of patients implies that racial discrimination correlates with contributes to lower health outcomes and the increased racial disparities. The author then provides a solution for equal access for minorities and reducing the racial discrimination in healthcare by stating
“Raising the quality of subpar hospitals could take years, but solving these prospective problems could improve care for Black patients immediately. The Centers for Medicare and Medicaid Services could require ambulances to bring patients to higher-quality institutions in a given area. Primary care physicians could also provide patients with outcome data for local hospitals, nudging them toward facilities with better track records.” (Blanding, 2021)
The author Micheal Blanding, introduces a counterintuitive solution to resolve the racial discrimination in health care. He suggests that patients should be sent to higher-quality hospitals to receive treatment in their prospective area. The author includes how hospitals can publish their records with outcomes of patients so patients can decide what hospital or institution they will receive medical care from. Overall, the solution provided can create quality health outcomes and reduce racial discrimination by providing similar health outcomes when compared to different hospitals in statistically diverse regions that compose of African Americans, Hispanics, and other races.
In conclusion, this research essay discussed four topics with solutions to cultural factors, mistrust of medical institutions, implicit bias, racial discrimination, and their correlation to poorer health outcomes for minorities in the United States of America. Through an analysis of these complex racial and socioeconomic issues, research studies to create solutions are effectively closing the health disparities of minority groups in the United States and in effect progressing
towards a society of equality. These issues, however, are still reminiscent in different areas but with the proper training and call for action, these issues will be addressed and resolved.
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