What are Healthcare Disparities?

In Medicine (and in Science) we look for predictable patterns of action and behavior. From these patterns, we identify models and typical presentations and response to illness.  The study of illness and disease results in information about the presentation and treatment of various diseases, like heart attacks, which occurs in predictable ways. These is true even in Angina where this is a mismatch of needed blood supply to heart tissue or to a massive Heart Attack (Myocardial Infarction) where large amounts of tissue is killed from blocked arteries and therefore needed blood supply. Despite low, medium or high severity, patterns exist. Physicians use these patterns to counsel on health promotion and disease prevention, identify individuals at risk and intervene to prevent adverse health outcomes.
 
So, when you have two individuals with the same disease and the same severity of disease, yet one has a much poorer health outcome or consequence of disease, we refer to this as a health disparity. Some populations of people (across gender, ethnic and economic lines) have worse health outcomes as compared to other that can not be explained by disease alone.

We, at the Women’s Health Education Program, focus on sex, gender and ethnic health disparities. For example, many health care professionals were trained that heart disease, specifically heart attacks, are diseases of men. Training of ‘classic’ or ‘typical’ presentation of Angina is exertionally induced pressure sensation relieved by rest and often radiates down the left arm and is associated with diaphoresis (sweating), shortness of breath or dizziness / presyncope. For many years, women were considered immune to coronary artery disease – yet many where found to have abnormal changes on their EKG (termed ‘silent MI’) during screening examination.

AN EXAMPLE: WOMEN AND HEART DISEASE
So, first, was there a gender health disparity in heart disease?
ANS: yes – in fact more than a ½ million women in the US as compared to their male counterparts, die of M.I.’s annually. If there was no disparity, that numbers should be about the same.

Why did this occur?
ANS: Many reasons. First, the onset of MI’s in women occurs about 10 years after men during postmenopausal years. Secondly, estrogen was considered a protective amulet against disease and women were not routinely screened for heart disease risk factors. Third, women may present with ‘classic’ symptoms, but they also present with other symptoms (usually called atypical – and yet, typical for some women) These clinical findings include: unexplained fast heart beat (tachycardia); GI upset or nausea; unexplained severe fatigue. All patients may refer to the sensation as pressure (not chest pain) or heaviness, which can lead health care professionals to consider pulmonary symptoms (not cardiac ones)

What can be done about health disparities?
ANS: Awareness; education and research such as what we do at WHEP. Dedicated centers and agencies such as our Center of Excellence in Women’s Health (and others around the country), the Dept of Health and Human Services Office of Women’s Health and the NIH Institute on Heart, Lung and Blood partnered to raise awareness to consumers and then, to health care providers on Heart Disease and Women (see Heart Truth  VG insert website here!) This unified effort to raise awareness of heart risk factors for women resulted in additional gender specific research that supports the prevalence and unique factors with women and heart disease.

Sadly, disparities are common in many aspects of healthcare, such as gender-based disparities, racial and ethnic disparities, and socioeconomic disparities.  We know, for example, that although prevalence of Breast Cancer is higher in non-Hispanic White women that African American women die at higher rates.
Medical schools are beginning to incorporate education about disparities in their curricula, but these often are epidemiologically-based lectures which are not optimally effective in capturing real-world implications of our patients and their clinical realities.

At the Women’s Health Education Program at Drexel University College of Medicine, we are one of only a few programs in the United States that focuses on the intersection of sex/gender; ethnic and population related healthcare inequality. 

Disparities arise because of cultural, racial, or ethnic differences, gender differences, limits on access to healthcare, socioeconomic factors, environmental factors, communication barriers, and literacy, medical literacy, and patients’ varying levels of trust in their healthcare providers. At WHEP, we provide seminars on these issues and opportunities to engage in active learning working with us on community participatory health education research activities. We explore health outcomes, nutritional issues, the role of healthy and unhealthy relationships as well as optimal communication and culturally effective interventions.

 In order for the medical community to effectively address the needs of patients, we need to improve comprehension of and responsiveness to socioenvironmental factors and methods of communication.  Currently, there is little consensus within the medical community regarding causes of the various types of health disparities, and even less agreement on ways to reduce them.  Although disparities involve whole populations based on racial or ethnic differences, gender differences, or socioeconomic differences, educators and providers find it difficult to think in those terms when they are confronted with individual patients. The Women’s Health Education Program at Drexel University College of Medicine emphasizes the need to think in terms of the whole population, centered in the patient being seen at the moment and in her world. The best fit is one that works for the patient to our best abilities to help her help herself.  From lectures, to seminars, to shadowing in clinical care, to participating in health education projects or creating new solutions, students have the opportunity to work with us during their time at DUCOM.

Within the last decade, the United States Congress has been taking more interest in the issue of healthcare disparities. We know that culturally effective care that addresses health disparities increases safety, decreases errors and improves quality of health for all patients.  Congress mandated the publication of two annual reports by the US Department of Health and Human Services: the National Healthcare Quality Report and the National Healthcare Disparities Report.  These two reports represent the broadest available range of data on healthcare quality and disparities in the nation.  However, this type of data has yet to be incorporated into the daily practice of many clinicians and educators. These resources as well as the Institute of Medicine’s reports on Sex and Gender medicine (VG include title and or link here) and in Health disparities (same, insert title/link here) are fundamentals of our training opportunities here at DUCOM.