Health DESPAIRities: Are we on the road to equity?

[Bryant Cameron Webb]

Healthy People 2010 was designed to achieve two overarching goals:
Goal 1: Increase Quality and Years of Healthy Life: The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life.
Goal 2: Eliminate Health Disparities: The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population.

Former Surgeon General David Satcher demanded that the second goal read "eliminate health disparities" rather than "reduce health disparities" in an effort to set the bar higher and achieve more progress.  However, with the year of reckoning quickly approaching,  there is much debate surrounding the progress (or lack thereof) made in achieving this major goal of the Healthy People 2010 initiative.

How do you feel about our nation's progress on eliminating the well-documented disparities in health and health care?

[DocK]

I think that an honest effort is being made to eliminate health disparities. However, the strategies that we are using to combat this problem are not as high-yield as we expected them to be. Health disparities has become a buzz word that has become so cliche and overused it's saddening. Everybody TALKS about it. No public health talk is complete without the "Disparities in Health care" section. We do need to increase the awareness of these problems, but we need to DO something about it. We can quote statistic after statistic and change nothing. We prescribe earlier detection and frequent screening for a variety of diseases in at-risk populations, but many negative stats keep climbing. Why??? Access! We all know this. It doesn't matter if we mandate that at-risk groups get checked for certain diseases more often if they don't have a PCP. Health fairs only go so far. Without available and affordable health care, people aren't going to be screened, followed up, or educated on their health. When we have "Members" of our government administration saying that we don't have a health care access crisis because you can just go to the emergency room...There is a PROBLEM!

[ibjules]

It is unfortunate that people are beginning to use the ER as their form of general medical care.  I was shadowing at a rural hospital in Minnesota and quite a few people would just come into the ER for minor illness such as a fever or chronic shoulder pain.  One of the ER patients confessed he preferred to use the ER because it was easier to walk-in as oppose to making an appointment at the local clinic. 

There appears to be a lack of knowledge in the community on proper use of medical facilities. 

[vrayRDX]

We are making extremely slow progress towards eliminating the disparities. We are now years into knowing about healthcare disparities, with a pubmed search of the word showing 9443 hits. Hate to be the pessimist but eliminating health disparities will remain on the list for at least 2020, maybe longer.

[Tolu]

I think we are on the road but we're taking baby steps down that road. I think part of the reason for such baby steps is that people say there is not much scientific support that any intervention is going to work. Eliminating health disparities requires intervention at several levels--government, health care institutions and patient/community level. In order to fully eliminate health disparities, we need a multidisciplinary approach at once. These approaches have been shown to be effective in eliminating health disparities by the REACH 2010 project (REACH stands for Racial and Ethnic Approaches to Community Health). This project showed dramatic reduction and in some cases complete elimination of health disparities within 2 years of implementation although the goal was 10years of implementation. If we can implement REACH 2010 project interventions throughout the United States, we may eliminate health disparities by 2012. I guess in 2010 when the REACH project is complete, there will be scientific support that we can truly achieve the goal of eliminating health disparities.

[mrussell]

One of the greatest frustrations regarding the slow progress of eliminating health disparities is the disparity in research that identifies and quantifies health disparities and the research that rigorously evaluates health disparities solutions programs.  In addition to the development of programs such as cultural competency education and efforts to increase screening or access to care, we need program evaluation.  Knowing how and why programs are or are not successful would be extremely informative in moving forward to reduce health disparities.  Evaluated programs could then serve as models to be implemented throughout the country rather than only being effective in their own communities or states.  Equally importantly, understanding why programs have not been successful will inform the development of new programs so that they will not make the same mistakes.

[bucopres08]

I agree with everything that has been said. The issue of fighting health disparities is a multidisciplinary one, which is part of the reason I believe we have found it so hard to combat. Like the fight for better education in our schools, the fight against health disparities requires us as a people to analyze and critique many different facets of our health care system, and our interpersonal relationships. Yes, to combat disparities we need to improve access to health care, screening, research and studies to discover new techniques to aid in this cause. In addition to all these things, we need to be advocates for our patients as Tolu stated on a National, State, and Local levels, as well as in the hospital. This idea of being an advocate for our patients is one that I believe many of our health care providers don't fully understand. Providers need to learn to advocate for patients in every area of care, whether it be with others when the care being provided isn't to the best level possible, or by RECOGNIZING and acknowledging their own biases that may affect the care they are providing. By improving patient advocacy in every area of health care I believe many of the other problems will start to fix themselves. Being a better advocate will improve patient retention, continuity of care, reduce unnecessary ER visits and cost allowing more people access and coverage. Bottom line is we need to develop TRUST with our patients, but in order to do that we must give patients a REASON to trust us. We in the health care arena are in a culture that holds on to the fact that people have respect for us because we can help heal their pain and suffering, although that may be true RESPECT is not enough we need TRUST. The fight to eliminate disparities is going to be a slow process because we are asking patients and providers alike to make wholesale changes in their lives. The answer to this problem isn't only to increase diversity in the workforce although that would definitely help, we also have to "teach" our classmates and fellow providers how to relate to those patients we do not understand, to recognize our own biases, blind spots, and inexperience dealing with people from different cultures and backgrounds. We are human and aren't expected to know or understand everything about every race or culture. These biases and defects in our knowledge don't become a bad thing until they encroach on our effective patient care. Recognition, Advocacy and Trust!! This issue is a multifaceted problem which will require a multifaceted solution that everyone supports, because until that happens we will not achieve the wholesale change we need to effectively eliminate disparities anytime soon. That being said, I am encouraged by the increased awareness, support, and progress being made.