Transactions from the Annual Meeting of the American Gynecological and Obstetrical SocietyOf disparities and diversity: Where are we?
Section snippets
Reviewing evidence for disparities
When reviewing evidence for disparities in health outcomes among minority populations and making comparisons over time, several caveats have to be considered.
First, to accurately explore health status and health outcomes among minority populations requires that data collection be impeccable and analyses consistent. Herein lies a problem.
While the race of the population has been collected in every decennial beginning with the first US census in 1790, racial categories, as well as the wording of
Examples of disparities in health
Of the nearly 140 million women living in the US, women of racial and ethnic minorities comprise almost 40 million, or about 28% of the population.13, 14
One need look at any one of several collections of health data, such as the Women of Color Data Book,15 the National Center for Health Statistics,16 the Kaiser Family Foundation,17 Commonwealth Foundation,18 and, most recently, the National Healthcare Disparities Report,19 to know that disparities in health status and health outcomes exist.
Sources for disparities in health status and health outcomes
An immediate response to why disparities in health status exist is to invoke genetic predisposition and biologic factors as the cause, even though these same factors exist among all populations. Therefore, while there may be genetic and biologic factors that contribute to diseases associated with health disparities, such as HLA genotype with human papillomavirus and cervical cancer, and p53 mutations with more aggressive breast cancer,25, 26 one cannot dismiss the fact that the onset or
Interventions
Increasing diversity in the health care workforce, increasing research into health disparities, and emphasizing the incorporation of culturally competent curriculum in medical education have been proposed as a strategies to reduce disparities in health and decrease inequalities in health care.
Research
Continued biologic and genetic research is needed to decrease disparities in health. Encouragingly, the NIH funding classified as supporting health disparities, approached $3 billion dollars in 2003. While biomedical and genetic research is needed, how we approach research to reduce disparities will require a new framework. To this end, I refer to the NIH Roadmap: “Biomedical research traditionally has been organized much like a series of cottage industries—lumping researchers into broad areas
Increase diversity
Several groups of studies provide a strong rationale for increasing diversity among health professionals to influence care. Racial and ethnic minority health care professionals are more likely than their white peers to practice in minority and medically underserved communities, care for poor patients and patients with Medicaid insurance or no health insurance.39, 40, 41 Underrepresented minority physicians are more likely to treat patients of color.39, 42, 43 Minority patients are more likely
Culturally competent curricula
In order to address disparities in health care and eventual health outcomes, the need to provide “culturally competent” health care has evolved as one of the strategies. A MEDLINE search for “culturally competent health care” results in a multitude of references describing cultural competence and its effect on health outcomes. But, it is not entirely clear what is meant by culturally competent health care and why it is important. The Center for Linguistic and Cultural Competence in Health Care50
Summary
Disparities in health status and health outcomes exist. While we are able to measure the existence of racial and ethnic disparities in health, why disparities exist and how to reduce them in many cases is still unknown. The reasons for disparities in health are complex and, thus, a single solution to eliminating disparities in health is not readily apparent. Data on race and ethnicity and uniform data analyses are essential to identify health disparities, to aid in selecting special initiatives
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Cited by (20)
Racial disparities in short-term outcomes after breast reduction surgery–A National Surgical Quality Improvement Project Analysis with 23,268 patients using Propensity Score Matching
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Various factors have been proposed to explain the increase in racial and ethnic minorities seeking cosmetic surgery, including increased availability of financing (e.g., “micro-loans” for health procedures),28 increased cultural acceptance and media saturation, increased affordability, and increased availability and accessibility.29 It is widely accepted that the persistent lack of diversity in the healthcare workforce is an issue that must be addressed if healthcare disparities are to be mitigated.30–37 In this study, the vast majority of procedures were performed by plastic surgeons; consequently, to improve access to breast reduction, the plastic surgeons must come from diverse racial and ethnic backgrounds.38
Equity, Diversity, and Inclusion in Academic American Surgery Faculty: An Elusive Dream
2021, Journal of Surgical ResearchCitation Excerpt :The pursuit of a more diverse physician population holds promising potential to decrease health care disparities. Considerable evidence indicates that a racially and ethnically diverse physician population is associated with better access to quality of care for minority and underserved populations.10,40,41 However, a comprehensive framework is required to address change at the individual, institutional, and community levels.
The diverse surgeons' initiative: Longitudinal assessment of a successful national program
2015, Journal of the American College of SurgeonsCitation Excerpt :Recent reports profoundly state that the continued underrepresentation of minorities in the medical profession is having a deleterious effect on the health of our nation.4,21-23 Underrepresented minority physicians have historically been more likely to deliver care to underserved communities than their Caucasian colleagues.24-28 Additionally, several studies have revealed that there is a positive association between physician–patient racial/ethnic concordance and patients' receiving preventive medical care, being satisfied with their medical care experience, and rating their physicians' participatory decision-making styles as excellent.12,29-31
The diverse surgeons initiative: An effective method for increasing the number of under-represented minorities in academic surgery
2010, Journal of the American College of SurgeonsAddressing the paucity of underrepresented minorities in academic surgery: can the "Rooney Rule" be applied to academic surgery?
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Presidential Address, presented at the 23rd Annual Meeting of the American Gynecological and Obstetrical Society, September 9-11, 2004, Bolton Landing, NY.