Healthcare Inequity - in Conversation with Susan Leggett-Johnson

Healthcare inequities have existed in this country for centuries. However, it wasn’t until the Institute of Medicine’s 2001 report Unequal Treatment, commissioned by the United States Congress, did we openly discuss the causes of healthcare disparities racial and ethnic minorities experienced and potential solutions to help reduce disparities. We understand that access to care is a factor but not the only factor that results in healthcare inequities. Social and political determinants of health have created systemic inequalities that result in social, economic, environmental, and structural disparities. In addition, unconscious bias and the power of privilege have had an impact on intrapersonal, interpersonal, institutional, and systematic mechanisms that organize the distribution of power and resources — for patients and healthcare workers alike. Surprisingly enough, this affects not just those who seek healthcare, but those who provide it as well.

We are in conversation with Susan Leggett-Johnson — a physician, transformational leader, and advocate for diversity, equity, and inclusion. Susan shares with us some of the driving forces of inequity in healthcare and how we can create a more bias-proof system.

Patient-provider — organizations; are interconnected and need each other to be successful. In all these entities, there is a lot of inequity that leads to all sorts of issues and problems. There is a need for equity in all its aspects; from pay gaps to unconscious bias, etc — we need to build a bias-proof system, intentional and focused. Why is this critical and how would you approach and implement such a system?

“Exactly as you point out, inequity is reflected in healthcare on many levels — patient, physician, and organization. Members of marginalized communities suffer disproportionally from chronic diseases like diabetes, renal failure, asthma, cardiovascular disease, cancer, and HIV/AIDS. Many of these illnesses are preventable or treatable. However, care is impacted negatively by social and political determinants of health and unfortunately, until recently, not much has changed to effectively address these disparities. In addition to social determinants of health, patients from minority groups often experience the effects of unconscious bias — in terms of their diagnosis, the type of treatment they receive, and how their concerns are addressed. This inequity that persists in an increasingly diverse population is felt by patients and clinicians alike. Minority healthcare professionals are often not only aware of and witness the existence of health disparities, but they are also often recipients of disparities when seeking care and victims of unconscious bias and microaggressions too, whether during patient-physician interactions, hiring and promotions, and interprofessional interactions.

“When speaking of racially and ethnically diverse healthcare professionals, an important aspect of increasing inclusivity would start by addressing barriers to STEM programs, college, and/or medical school. Accessibility and inclusion in medical education is a prevalent problem. Many give up along the way due to a lack of financial support, networking, and preparatory resources. Identifying cultural and structural barriers that curb some individuals and advancing support to all qualified learners regardless of age, sex, race, nationality, etc. would take the medical fraternity a long way. Increased diversity, addressing unconscious bias, and reducing health disparities would just be the start.

“For patients, access to care is just one part of the puzzle. Care delivery and unconscious bias within the system are the roots of many. We must continually work to build systems that have processes and systems in place to automatically prevent us from acting on our biases. We innately have implicit biases, but we must train ourselves to look for opportunities to help eliminate them impacting our actions or decisions. There are many methods we could use in the healthcare industry to tackle this ‘pandemic’ of unconscious bias. One way would be to use data analytics to help evaluate where and how bias shows up, healthcare employees could be mandated to take the implicit bias test to identify their bias and so on.”

Susan, can you share some examples of how we can go about fixing bias?

“A method that HR can use to eliminate bias during the hiring process would be to blind the name, age, and/or gender of a candidate when reviewing the work experience and credentials of a potential candidate.

“Another method would be to introduce all professionals with either their first name or their professional name. This will help curb the microaggressions that are experienced by female professionals when called by their “first” names, whilst males are called by their professional names.”

Thanks for sharing, Susan.

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