Slides references: (Left to Right)
NC Department of Health and Human Services. (2018). Racial and Ethnic Health Disparities in North Carolina. North Carolina Health Equity Report 2018, 1-25. https://schs.dph.ncdhhs.gov/SCHS/pdf/MinorityHealthReport_Web_2018.pdf
Chang, E. T., Clarke, C. A., Cockburn, M., Gomez, S. L., Miller, T., & Yin, D. (2010). Racial and social class gradients in life expectancy in contemporary California. Social science & medicine (1982), 70(9), 1373–1380. https://doi.org/10.1016/j.socscimed.2010.01.003
Script:
Hello everyone, my project is about the intersection of race and socioeconomic status, and how it impacts health outcomes for African Americans in North Carolina.
There have been studies that show a connection between socioeconomic status and health outcomes, where a higher socioeconomic status equates to a higher life expectancy (Abraham S,2001-2014, pp 6). It has also been well documented that on average African Americans have a lower socioeconomic status than whites in North Carolina. (NC Department of Health and Human Services, 2018). However, even African Americans of higher socioeconomic status on average have lower life expectancies compared to their white counterparts of lower socioeconomic status (Chang T, E. et al, 2010, pp 17). As a result, this combination of race and socioeconomic leads to a greater disparity in health outcomes between white and African American patients.
One cause of health disparities is miscommunication, especially between a white physician and an African American patient. According to a study by Kendrick, these miscommunications can be exhibited through a lack of health literacy, a lack of understanding of the treatment, and not feeling comfortable disclosing information to their physician. Poor communication between physicians and their patients reduces the efficiency of treatments and diagnoses which contributes to this disparity.
Another cause of health disparities is racial bias, and according to one study physicians have the same amount of racial bias as the general public (Fitzgerald and Hurst, 2017, pp 29). Implicit biases are harmful because of the misconceptions they cause, which can manifest through differences in treatment recommendations and amounts of medicine prescribed. One study found doctors prescribed opioids less frequently and in smaller dosages to African Americans for the same amount of severe pain reported as whites (Axt et al, 2016, pp. 4).
A possible solution to address these health disparities is education, which can disprove racial misconceptions, increase health literacy, and help diversify the physician career. Several studies have shown that African American patients are more comfortable communicating with an African American doctor, and African American men lacking in health literacy are more likely to participate in preventative treatments. When combined, these aspects of education would help limit racial bias and facilitate better physician-patient communication which will improve health outcomes, the quality of life, and increase life expectancy for the 22.1% of the population that is African American in North Carolina (NC Department of Health and Human Services, 2018, p 7).
Paper:
Unfortunately, within our country there are many examples of inequalities, and this also includes healthcare. The grim reality is that the quality of healthcare is based on a multitude of different factors which also include race and socioeconomic status. In North Carolina, the average life expectancy of a white person is on average 4.7 years longer compared to that of an African American (Paul Buescher and Ziya Gizlice, 2002, p 4). This disparity is very problematic, as it leads to an increased risk of mortality and lower quality of life for the African American population, which accounts for 22.1% of the population (NC Department of Health and Human Services, 2018, p 7). However, these factors don’t just impact health outcomes separately, they are also connected in a very complex way that contributes to the health disparity across both. There is a connection between socioeconomic status and health outcomes, where a higher socioeconomic status equates to a higher life expectancy. However, African Americans of higher socioeconomic classes on average have lower life expectancies compared to their white counterparts of lower socioeconomic classes. As a result, the combination of both race and socioeconomic status leads to a disparity in health outcomes between white and African American patients.
A study found a distinct correlation between socioeconomic status and the life expectancy of a person, where a higher socioeconomic status equates to a higher life expectancy (Abraham S, 2016, pp 6). This isn’t surprising considering the number of resources that are available to those with higher socioeconomic status, especially in the case of famous celebrities. According to a CNN news article while delivering a baby, Serena Williams, one of the most famous tennis players, had some complications that required extensive emergency care. Thankfully, she survived her major complications, as she commented that it was possible, she could have died during delivery. She lamented that there are many other minority mothers out there who don’t have the resources that she has and end up dying in childbirth. Another study looked at the socioeconomic status of women, and how this affected the care they were able to receive through their insurance. According to the study done by Lindsay Admon, they found that African American women had higher rates of uninsurance and higher insurance instability due to lower socioeconomic status, which resulted in inconsistent physician care and poor health status. This combination leads to a disparity in both infant and maternal mortality, for African Americans across the US. In North Carolina black infants are 1.5 times more likely to die compared to the state average (NC Department of Health and Human Services, 2018, p 11). According to the North Carolina Department of Health and human services, black mothers are a little over 2 times more likely to die during childbirth compared to the state average.
Another main cause of health disparities is the miscommunication between a white physician and an African American patient. There was a study that interviewed physicians about health disparities across race and socioeconomic status and what they believed was the cause. The results of the study show that African American patients were unable to follow the recommended medical treatment mostly due to socioeconomic status (Kendrick et al, 2015, pp. 15). Patients might want to follow the treatment instructions, but if it’s more than what they can afford they have no choice but to forgo the treatment. The study also noted that patient’s lack of health literacy and general miscommunication between physicians and their patients affected both racial/ethnic as well as socioeconomic disparities in health care pertaining to hypertension (). If patients are presented with information, but they are not able to completely understand it they might not be able to effectively follow through with the treatment plan.
Since this topic covers racial disparities there is the problem of racial bias of physicians towards their patients and how this impacts health outcomes. One study conducted tests to determine the effect of racial biases within the healthcare system and found that physicians carry the same amount of racial bias as the general population (Fitzgerald and Hurst, 2017, pp 29). However, the implications are far reaching, and widely concerning especially now that it impacts the well-being of patients. One way these racial biases impact healthcare is through misconceptions about race in the medical field. According to a study done by Williams, the way we talk about race in the public health and medical fields is mostly related to differences in genetics and rates of contracting certain diseases or ailments. This can lead to certain misconceptions about different races and contributes to implicit bias throughout the healthcare process. A study that explored how these misconceptions related to health outcomes, specifically in accordance with pain treatment recommendations by physicians found that there were beliefs in fictitious biological differences between whites and blacks, such as African American blood coagulating faster (Axt et al, 2016, pp. 4). These beliefs led to racial biases that were shown through inaccurate pain treatment recommendations. We can also see this through the unequal distribution of pain medication given to African Americans compared to whites. The study noted that African Americans were less likely to receive pain medication for reported moderate pain and were less likely to receive opioids for severe pain compared to their white counterparts.
One area for potential growth that could help alleviate this problem is education. When thinking about the implicit racial biases and how they affect healthcare, one way to offset those beliefs is through proper education about race and the role it plays in the medical field. Through education we can provide evidence against these beliefs which will allow for more accurate evaluation on African American patients with less implicit racial bias. Another benefit of education is the diversity of doctors. Studies have shown that African American patients who have a doctor of the same race/ethnicity are reportedly more comfortable with the evaluation, communication, and rated their physician higher as compared to a white doctor (Loren et al., 2020, pp 9). There have also been studies that show among black men, especially those lacking health literacy, were more likely to participate in preventative care if their physicians were also African American (Aslan et al., 2019, p 1). In addition, education can also help to inform those who are not fully health literate. As more patients are better educated, they can follow through with treatment and greater benefit overall. When combined these aspects of education would help limit racial bias and facilitate better physician-patient communication which will improve health outcomes for African American patients. Overall, this would greatly improve health outcomes. the quality of life and increase life expectancy for the African American population in North Carolina.
References
Abraham, S., Bergeron, A., Chetty, R., Cutler, D., Lin, S., Scuderi, B., Stepner, M., & Turner, N. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, 315(16), 1750–1766. https://doi.org/10.1001/jama.2016.4226
Admon, L. K., Daw, J. R., Dalton V. K., Kolenic G. E., Kozhimannil, K. B., Winkelman, T., Zivin, K. (2020). Racial and ethnic disparities in perinatal insurance coverage. Obstetrics and gynecology, 135(4), 917–924. https://doi.org/10.1097/AOG.000000000000372
Alsan, M., Garrick O., and Graziani, G. (2019). “Does Diversity Matter for Health? Experimental Evidence from Oakland.” American Economic Review, 109 (12): 4071-4111.DOI: https://doi.org/10.1257/aer.20181446
Axt, J. R., Hoffman, K. M., Oliver, M. N., & Trawalter, S. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113
Buescher, P.A. & Gizlice, Z. (Jan. 2002). Healthy life expectancy in North Carolina, 1996-2000. SCHS Studies: A Special Report by the State Center for Health Statistics, (129), 1-17. North Carolina Department of Health and Human Services, https://schs.dph.ncdhhs.gov/schs/pdf/schs-129.pdf
Buescher, P.A., Harper, M., & Meyer, R. E.(April. 2001). Enhanced Surveillance of Maternal Mortality in North Carolina. CHIS Studies: A Special Report Series by the Center for Health Informatics and Statistics. (125), 1-8. North Carolina Department of Health and Human Services, https://schs.dph.ncdhhs.gov/schs/pdf/CHIS125.pdf
Cooper R., David R. (1986) The biological concept of race and its application to public health and epidemiology. Journal of Health Politics Policy and Law, 11 (1): 97–116. doi: https://doi.org/10.1215/03616878-11-1-97
FitzGerald, C., Hurst, S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18, 19 (2017). https://doi.org/10.1186/s12910-017-0179-8
Kendrick, J., Leiferman, J. A., Nuccio E., & Sauaia A. (2015). Primary care providers perceptions of racial/ethnic and socioeconomic disparities in hypertension control. American Journal of Hypertension, 28(9), 1091–1097. https://doi.org/10.1093/ajh/hpu294
Loren, A. W., Mitra, N., Sawinski, D. L., Shin, D. B., Shultz, J., Takeshita, J., & Wang, S. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open. 3 (11):e24583. doi:10.1001/jamanetworkopen.2020.24583
NC Department of Health and Human Services. (2018). Racial and Ethnic Health Disparities in North Carolina. North Carolina Health Equity Report 2018, 1-25. https://schs.dph.ncdhhs.gov/SCHS/pdf/MinorityHealthReport_Web_2018.pdf
Williams D. R. (1996). Race/ethnicity and socioeconomic status: measurement and methodological issues. International Journal of Health Services : Planning, Administration, Evaluation, 26(3), 483–505. https://doi.org/10.2190/U9QT-7B7Y-HQ15-JT14
Williams, Serena. (2018) Serena Williams: What my life-threatening experience taught me about giving birth. CNN. https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html
Featured image:
Fulce, J. (2016) Doctor Talking to Black Male [Photograph] Jay Harold Enlightened Practical Information. https://jay-harold.com/wp-content/uploads/2015/03/Doctor-talking-to-Black-Male2-e1425476704859.jpg
