Reducing Disparities in Our Community

Thomas Jefferson stated in the Declaration of Independence that “all men are created equal,” but in early 21st century America, not all people are treated equally in terms of health care.
 
“In 2010, based on race, income and the language you speak, your health outcomes will be vastly different,” said Jenny Englerth, executive director of Family First Health in York. “Census data show that by 2025 or thereabout, the majority of the population in this country will be nonwhite. If changes are not made to the way we deliver health care in this country, we will be subject to a lot of negative outcomes that we want to avoid.”
 
“People assume that if you have good financial status and insurance coverage, your health care is going to be the best,” Englerth said. “But data shows race and ethnicity have an impact regardless of financial status or insurance coverage, so that a black female with a good income and good insurance will have poorer health outcomes than her white counterpart.”
 
According to the 2003 National Healthcare Disparities Report published by the U.S. Department of Health and Human Services:
· Patients of lower socioeconomic positions are less likely to receive recommended diabetic services and more likely to be hospitalized for diabetes and its complications.
 
· When hospitalized for acute myocardial infarction, Hispanics are less likely to receive optimal care.
 
· Blacks and poorer patients have higher rates of avoidable hospital admissions (i.e., hospitalizations for health conditions that, in the presence of comprehensive primary care, rarely require hospitalization).
 
The same report states that there are significant disparities in the use of evidence-based preventive services for certain populations. Smoking is the single most preventive cause of mortality, yet rates of counseling to help patients quit smoking during hospitalization is only 40 percent. But for blacks, that rate is only 29 percent.
 
“Given the significant impact on morbidity, mortality, outcomes, and costs of care, efforts to target preventive services to populations most at risk would be a critical aspect of an improvement strategy to decrease disparities,” the report concluded. (see the full report at http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm)
 
Newsweek reporter Mary Carmichael stated in her Feb. 10, 2010 article “The Great Divide” that the U.S. government’s Medical Expenditure Panel Survey “put the health data in financial terms and found that race-related differences in health care cost the country $229 billion between 2003 and 2006, a result that Health and Human Services Secretary Kathleen Sebelius called "just stunning and shocking." (see Carmichael’s full article at http://www.newsweek.com/2010/02/14/the-great-divide.html)
 
Put simply, quality health care is doing the right thing at the right time in the right way to achieve the best possible outcome for every patient.
 
“If you ask any health care provider, they will tell you that they are delivering equal care to all of their patients, regardless of race or ethnicity,” said Englerth. “But the data shows otherwise. That is not to say that the providers are making those choices in a conscious way. “
 
AF4Q South Central PA is reaching out to patients and doctors to alleviate these disparities. Several initiatives are taking place that will help ensure all people in Adams & York counties receive quality care, regardless of their race, ethnicity, or income. In the upcoming editions, we will focus on the specific initiatives and how disparities are being reduced in our communities.  
 
Englerth said that starts with making access to basic health care easier in the first place.
 
“That’s something to focus on, that people have access,” she said. “We have to get them through the door. We have to make sure that once through door they are in an environment that respects their culture, beliefs, and background.”
 
At the core of reducing disparity in care is assembling as much information as possible from the providers and patients alike to track outcomes.
 
“We need to see where we are consistently not performing well,” Englerth said. “It is not an easy path, because in our culture, physicians are highly revered and rarely questioned. But the paradigm has shifted to where we are more critical. We are asking providers to improve their performance, and asking the patients to increase their own level of engagement take responsibility for their health. We find we make the best progress when we engage patients in their own care.”
 
 Sharing data and coming together as partners can bring optimal health care to stakeholders who have been, after all, after the same goals all along.
 
“Health care is not one size fits all,” Englerth said. “It is a matter of customizing education and support for patients.  Taking race, ethnicity and language into consideration when designing and delivering health care is key to achieving optimal health for everyone.”
 

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