As a writer, I wish I could claim the title of this column as my own. But it rightly belongs to Dr. Michael A. LeNoir, an Oakland physician who is trying to educate patients and policymakers about approaching remedies for health disparities “from the bottom up, instead of the top down.”
A “health disparity” usually refers to a higher burden of disease, disability, or mortality experienced by one subpopulation in comparison to another. In the U.S., health disparities are common, and they often reflect population differences characterized by race, ethnicity, gender, age or socioeconomic status.
For example, African-American men and women are more likely to die of heart disease and strokes than white people experiencing the same diseases. A recent study showed among preschool children hospitalized with asthma, 21 percent of white children were prescribed medications to prevent future hospitalizations, compared to only 2 percent of Hispanic and 7 percent of black children.
The troubling fact is that health disparities are many, widespread, long-standing and persistent. And studies rather consistently show that gaining access to a health care system does not necessarily ensure that patients will receive higher quality care. Racial and ethnic health disparities often persist even when insurance status is comparable — a sobering acknowledgment as we approach near-universal coverage anticipated under the Affordable Care Act.
During our recent interview, LeNoir insisted that new approaches to the problem were urgently needed. He said “much of the money that has been targeted to reduce health disparities has been given to large universities to study ways to make the health system more sensitive to the needs of poor underserved and minority populations. That has not worked.”
He provided a recent example of a major university in Northern California discovering high rates of vitamin D deficiency in African American Children in Oakland.
“But,” he said, “after the research was finished, I was told they had no money to tell people in Oakland.”
Indeed, just last month the U.S. Department of Health and Human Services released its 2012 “National Healthcare Disparities Report” — an annual report on disparities as they relate to population differences.
Among its major conclusions — despite all we’ve learned from traditional top-down methods of studying disparities — “disparities are not changing.”
The report also reaffirms that health care quality and access remain suboptimal “especially for minority and low-income groups.”
LeNoir proposes a “bottom up” approach to reducing health disparities in which research funding is channeled to community providers caring for poor, underserved and minority populations. Such providers could better collect and act upon health information to directly benefit their patients.
“We need to put money into giving people the tools they need to demand the care they deserve,” he emphasized, and “to invest in community clinics and community providers, in patient care coordinators.”
But LeNoir also claims that too few people — whether patients, doctors, politicians, or policymakers — are even aware of the pervasive disparities in American health care. That has to change if we are to hope for any successful strategic approach to reducing disparities.
“But,” he asked, “when was the last time you saw a newspaper article or popular YouTube video about disparities? There’s no rap song about health care disparities.”
Bolstering LeNoir’s point, Health Affairs published a study in 2011 tellingly titled “Awareness of racial and ethnic health disparities has improved only modestly over a decade.” Among 3,159 adults surveyed by researchers, only 59 percent were aware of racial and ethnic disparities that disproportionately affected African Americans and Hispanics — comparing to 55 percent in 1999. Furthermore, the survey also documented low levels of awareness among racial and ethnic minorities about disparities that disproportionately affected their own communities.
LeNoir asserts that, once armed with education and information about health disparities, “patients need to be encouraged to take more control of their health and demand appropriate care, get as upset when it does not happen as when someone cuts in front of them at the grocery.”
For his part in educating and motivating, LeNoir has worked in radio and television for more than a quarter century. While his career by choice has been to practice medicine in high-risk communities, his “passion has been to provide people with information using media.”
Most recently working with KPFA and KBLX radio, LeNoir believes that “media — both traditional and nontraditional — can and will play a role in reducing health disparities.”
In August, LeNoir plans to make his views known to a wider national audience as the incoming president of the National Medical Association (NMA) — the largest collective voice of African-American physicians in the U.S.
In his leadership role, he will work toward reducing health disparities by focusing on one of his primary objectives: “to close the gap between the health outcomes of African Americans and the rest of America.”
LeNoir’s voice and vision are encouraging. But eliminating disparities in health and access to care will require vigorous efforts from all of us, given the social, political, and environmental factors that influence disparities and health care policy-making. And, in the meantime, a rap song or two wouldn’t hurt.
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