Improving Health Equity, Together

The United States is perhaps the world’s leading innovator in health care, yet we trail the performance of our peer industrialized nations in metrics like life expectancy and infant mortality. Underneath the veil of our national health status, there are significant differences in the health enjoyed by populations in cities and rural communities across the country. This phenomenon, known as health disparity, refers to worse health status among distinct segments of the population (because of social or demographic factors), relative to others.

Growing up in Shreveport, Louisiana, I observed as a teenager that the employment, income, housing and educational status of members of my family and community had an impact on their access to care and their oral and physical health. As my interest in medicine matured and I became the first physician in my family, I realized that excellent care could make a difference in the lives of patients – but maintaining good health was about much more than health care. Years later, the plight of those who nurtured my growth and development is not remarkably different, and the structural nature of the existing barriers have come into clearer focus. While I continue to enjoy the privilege of caring for patients as an emergency medicine physician, I experience joy in mentoring and supporting programs that enhance opportunities for the disadvantaged. My executive roles across sectors over the last decade have allowed me to support efforts, at scale, which reduce health disparities through improvements in health care quality and the social determinants of health.

I’d like to propose three potential solutions to address health disparities which can ultimately help move us toward a state of health equity.

1.     Financially incentivize and support efforts to reduce health care disparities.

Significant variations in health care quality and costs are widely known challenges. In the industry, value-based care delivery models have emerged as a modern solution to reduce these variations by linking provider payments to clinical quality, evidence-based practice and resource efficiency. Too often, these well-intentioned models fail to measure health care disparities, a major driver of excess direct medical costs nationally. Ensuring that quality programs in value-based care delivery models include a focus on health care disparities is a health equity imperative.

2.     Think beyond the physician’s office.

Across the continuum of care, we need to be more aware of the social determinants that serve as major drivers of health. Exploring the geographic course of highways or certain types of industrial complexes relative to where people live, work and play may enable identification of populations more prone to certain health problems and help care teams and patients achieve better health outcomes.

Asthma, for example, is one of the most common medical conditions among children, and can be managed. Yet too many children with asthma miss school due to hospitalization. Many of the sickest children with asthma are affected by low socioeconomic status, housing with environmental allergens, chronic stress, exposure to violence or less than optimal use of controller medications. Reducing disparities in childhood asthma is within our collective power and requires a multi-faceted approach through initiatives such as Health Care Service Corporation’s Enhancing Care for Children with Asthma program in collaboration with the American Lung Association, where we have effective interventions such as enhanced provider training, patient education programs and home environmental assessments.

3.     Help providers strengthen awareness of their implicit bias and develop strategies to mitigate negative effects on patients.

On a daily basis, our unconscious thoughts and patterns of associations help us make decisions with ease. In today’s fast-paced health care delivery system, the amount of time that physicians and other providers spend with patients is under pressure, yet clinical decisions must be made. For example, a 2016 study of resident physicians providing pediatric emergency care demonstrated that implicit racial bias increased during stressful shifts or ED crowding.

Research suggests that some physicians may unknowingly have implicit bias in their clinical decision-making. Women, for example, often receive less optimal care than men following a heart attack, including lower rates of balloon angioplasty, coronary bypass surgery and coronary angiography. While more research is still needed in this area, we can work to educate health care providers so that they are aware of this potential bias and give them tools to help address it.

The solutions are not swift or simple, but we all have a responsibility to work together and address health disparities and help ensure better health for all Americans. I am confident as an industry we have the power to hold ourselves accountable and come together to improve social determinants of health and reduce costly disparities in care. I look forward to hearing your thoughts around improving health equity and continuing the conversation.

About the Author: Derek J. Robinson, MD, MBA, FACEP is Vice President - Enterprise Quality and Accreditation at Health Care Service Corporation (HCSC) and a practicing emergency medicine physician. Dr. Robinson is a diplomat of the American Board of Emergency Medicine and the American Board of Quality Assurance and Utilization Review Physicians. He has been recognized with a number of awards including: Crain’s Chicago Business Top 40 Under 40, The Urban Business Roundtable 40 Game Changes Under 40, Diversity MBA Top 100 Under 50, and Xavier University of LA Young Alumni Award. He holds an appointment as adjunct assistant professor of emergency medicine in the Feinberg School of Medicine at Northwestern University and Volunteer Clinical Assistant Professor of Emergency Medicine at Indiana University School of Medicine. He is a Fellow of the Institute of Medicine of Chicago, member of the Economic Club of Chicago, and has been recognized as a “Hero in Emergency Medicine” by the American College of Emergency Physicians.

To see more of Robinson’s articles and insights, click the "follow" button or follow @DrDRobinson on Twitter.