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Second in a series of papers on disparities and discrimination in health care provides recommendations to address inequities in health care access

Feb. 19, 2021 (ACP) – In the United States, racial and ethnic-minority populations face tremendous health disparities due to factors like racism and discrimination. The �������ý has created a new framework that will guide the nation toward reducing and eliminating these gaps. In the second of a series of policy papers on this topic, ACP provides recommendations to address disparities in coverage, access and quality of care.

“We need to let our membership, the medical community, our patients and policymakers know where we stand: Racism is a public health crisis, and the health inequities that we see in medicine are the root of systemic racism in America,” said Dr. Tracey Henry, an Emory University School of Medicine internist and member of the ACP Health and Public Policy Committee. “We can no longer stand idly by but must be active in addressing the issue.”

ACP offers guidance in the policy paper titled “Understanding and Addressing Disparities and Discrimination Affecting the Health and Health Care of Persons and Populations at Highest Risk.” The paper, which is available online via the ACP website, is one of a series of reports that comprise “A Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care.”

According to Henry, “Systemic racism is the origin of many of our health-related issues, including both physical and mental health-related issues such as hypertension, depression, and posttraumatic stress disorders. In persons of color, we see it manifested in our increased rates of maternal mortality, especially in African Americans, inequities in health care access and rates of cardiovascular disease, still-higher death rates and lower survival in those stricken with most cancers.”

The pandemic has shone a spotlight on these inequities, Henry said, as people of color suffer higher COVID-19 death rates and the Black community is more hesitant about vaccines.

In the policy paper, ACP makes the following recommendations:

• Policymakers must consider discrimination and hate against any person on the basis of personal characteristics as a public health crisis.
• Policymakers must address the effect of social drivers of health, like poverty, on the health and health care of those affected, while addressing disparities associated with personal characteristics independent of, or in addition to, socioeconomic status.
• Public policy must focus on improving coverage, quality and access to care for everyone, while addressing the disproportionate effect on those at greatest risk because of their personal characteristics.
  “Health care coverage/access is one of the pieces of the puzzle,” Henry said. “Of note, the 12 states that have not expanded Medicaid to date have the largest population of Black Americans, and more than 90 percent of uninsured patients live in nonexpansion states in the South.”
• Public policy must acknowledge the long history of racism, discrimination, abuse, forced relocation and other injustices experienced by Indigenous persons and commit to focused and culturally appropriate policies to address their present reality of injustice, disparities and inequities.
• Physicians and other clinicians must prioritize meeting the cultural, informational and linguistic needs of their patients with support from policymakers and payers.
  “Interventions include engaging with communities, outreach and education programs to address health literacy and to facilitate a trust and confidence in the health care system by community members,” Henry said. “We also need better understanding on the part of physicians and other health care providers. This highlights the need for a diverse and culturally humble workforce.”
• Public policies should reflect the unique effects of country of origin, language, immigration status, workplace and culture on health disparities.
• Health care delivery and payment systems should support physician-led, team-based and patient- and family-centered care that is easily accessible to those affected by discrimination and social drivers of health.
• Policymakers should recognize and address how increases in the frequency and severity of public health crises – including large-scale infectious disease outbreaks, poor environmental health and climate change – disproportionately contribute to health disparities for Black, Indigenous, Latinx, Asian American, Native Hawaiian, Pacific Islander and other vulnerable persons.
• Policies must be implemented to address and eliminate disparities in maternal mortality rates among Black, Indigenous and other women who are at greatest risk.
  “There is not a one-size-fits-all answer to this problem, but the solution starts with addressing the drivers of poor health outcomes in America, especially for racial and ethnic minorities,” Henry said. “We need a national strategy and big-picture solutions. For example, increased access to insurance coverage is a much-needed policy intervention: Not all postpartum women have insurance coverage through the postpartum period, which contributes to the poor outcomes we are seeing. There are also counties in some states where there aren't any OB-GYNS or family physicians who practice obstetrics.”
• More research and data collection related to racial and ethnic health disparities are needed to empower policymakers and stakeholders to better understand and address the problem of disparities. Collected data must be granular and inclusive of all personal identities to accurately identify socioeconomic trends and patterns.

What's next? “We hope this policy paper will spark open dialogue and start crucial conversations that lead to meaningful action and change for our patients, for our medical community and for the United States at large,” Henry said.

More Information

The policy paper “Understanding and Addressing Disparities and Discrimination Affecting the Health and Health Care of Persons and Populations at Highest Risk” is available on the ACP website.

Back to the February 19, 2021 issue of ACP Advocate