During a recent review of four websites ((https://www.apha.org/Topics-and-Issues/Health-Equity, https://minorityhealth.hhs.gov/briefs-and-publications, http://www.cdc.gov/minorityhealth/CHDIReport.html, and http://www.healthypeople.gov/) devoted to discussing and elevating the importance of dismantling health disparities in the US, I found a few data points that signify a growing movement toward health equity, as well as areas still requiring improvement by clinicians and healthcare professionals.
1. Black Maternal Mortality
One of the first health disparities that I found further data on is the ongoing maternal mortality rates amongst Black women in the U.S. The American Public Health Association (APHA) (2022) created an educational video on YouTube that provides additional details about this topic. In this informative video, the data shows that despite global mortality rates having decreased by 43% between 1990 and 2015, in 2015, Black birthing parents were 243% more likely to die during childbirth. Unfortunately, this data points to insufficiencies in clinical care delivery to Black birthing parents. Whether it is clinicians not fully listening to Black birthing parents or letting biases get in the way of effectively delivering maternal care, these health disparities must be remedied to prevent further harm to a community that is still battling systemic racism, as well as other social injustices.
Further highlighting the need for greater action by healthcare leaders and professionals is the study by Callahan et al. (2021) that was referenced on the Centers for Disease Control and Prevention's (CDC) website. In that study, Callahan et al. (2021) suggest the need for greater review and surveillance of Black birthing parents to reduce maternal mortality rates. When combined with issues of poor communication and potential biases on the part of the providers, the lack of attention and focus by healthcare organizations could be further impacting the ability of the healthcare industry to reverse these concerning maternal mortality statistics within the Black community.
2. Representation Matters in Healthcare
Similarly to the need for American minority populations to see themselves reflected in media and education, the same can be stated for the healthcare industry. According to Terlizzi et al. (2019) a majority of non-Hispanic Blacks believe that it is either highly (31.7%) or somewhat or slightly (29.4%) important to be cared for by a clinician who understands or comes from their culture. Hispanics and non-Hispanics of other races also felt similarly to Blacks in that the majority of them would prefer a provider who understands or is from their culture (Terlizzi et al., 2019).
For White non-Hispanics, the majority (57.9%) do not believe that it is important to be seen by a clinician who is from or understands their culture. This difference in the need to be represented during their healthcare experience suggests that for non-White ethnic groups, having healthcare providers who understand their culture is a priority and could impact whether or not they positively engage with the healthcare system.
3. Improved Clinician Bedside Manner Is Still a Work in Progress
While reviewing the Healthy People 2030 website, I came across a concerning update regarding their efforts to improve the communication between clinicians and their patients. Unfortunately, the Healthy People 2030 objective of reducing the proportion of adult patients reporting that they feel the communication between them and their clinicians is poor has had no detectable change. Healthy People 2030 has a goal to get the percentage down to 8.0%, but it is currently at 9.0% (Healthy People 2023, n.d.). This data highlights the need for increased health literacy and communication training among clinicians. The ability of patients to effectively support positive health outcomes is heavily dependent on being able to understand their health condition and the clinicians' instructions. If a patient can't understand their healthcare provider, the chances of health complications will increase.
Reflections on the Data
Based on the data found, it is clear to me that healthcare providers need to be better informed about how disconnects in communication and cultural understanding can negatively impact their ability to deliver whole-person care. It is unacceptable to compound the high costs of healthcare in America with patients being underserved and unsupported when dealing with medical challenges that are already stressful. With all clinicians taking the Hippocratic Oath, there should never be an issue with healthcare providers adding to the harm patients are experiencing while in pain or in need of medical support. In the same way that people view raising children as the work of entire communities, healthcare providers should view their role in caring for patients as being part of a village aimed at improving the entire community's health through coordinated, empathetic, and supportive delivery of services.
Also, being that I am Black and pregnant with my second child, issues related to Black maternal mortality are especially concerning for me. My decision to be a mother was made with the hope that I could be there to raise my children. The idea that biases within my care providers or their inability to believe me when I am describing an issue or medical challenge could result in my death is beyond disappointing and painful. I hope that the ongoing attention to this important disparity will lead to significant improvements for Black birthing parents.
Opportunities for the Future
My hope is to use this data to be a disruptor of the healthcare system through advocacy and strategic roles at healthcare facilities that are receiving poor ratings in their ability to improve patient health outcomes and deliver quality care. I also plan to use my education to open practices for clinicians where I establish a model of care that emphasizes the importance of understanding diverse cultural experiences and values, as well as knowing how and when to engage culturally-savvy community-based organizations to help us connect with communities when there is a deficit in cultural understanding. This will mean intentionally hiring community leaders and advocates to serve as "cultural navigators" who can be called upon when a patient needs additional support during appointments or throughout their treatment process. In addition, I plan to consult hospitals and healthcare systems looking to implement a culturally-informed, integrated behavioral health model by sharing the expertise gained during my time at Cummings Graduate Institute.
References
American Public Health Association. (2022). Healthy births & Black Americans: Why are death rates still higher? Episode 18 of #ThatsPublicHealth. Retrieved January 14, 2024, from https://www.youtube.com/watch?v=JqE8sCFojV4.
Callahan, T., Zaharatos, J., St. Pierre, A., Merkt, P. T., & Goodman, D. (2021). Enhancing reviews and surveillance to eliminate maternal mortality. Journal of Women’s Health, 30(8), 1068–1073. https://doi.org/10.1089/jwh.2021.0357
Healthy People 2030. (n.d.). Decrease the proportion of adults who report poor communication with their health care provider - HC/hit‑02. Decrease the proportion of adults who report poor communication with their health care provider - HC/HIT‑02 - Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-communication/decrease-proportion-adults-who-report-poor-communication-their-health-care-provider-hchit-02
Terlizzi, E. P., Connor, E. M., Zelaya, C. E., Ji, A. M., & Bakos, A. D. (2019). Reported importance and access to health care providers who understand or share cultural characteristics with their patients among adults, by race and ethnicity. National Health Statistics Reports, 130 (1), 1-11.