Racial disparities in health care
Tracy
Lieu, MD, MPH,is a Children's pediatrician and the
director of the Center for Child Health Care Studies, a research
and teaching collaboration between Harvard Medical School and
Harvard Pilgrim Health Care. She recently talked to Pediatric
Views about the implications her research may have for understanding
racial disparities in health care.
| How Children's Hospital Boston
is addressing cultural competence:
In 1999, Children's staff published "Honoring Patient Preferences:
A Guide to Complying with Multicultural Patient Requirements"
(Jossey-Bass).
This is one of many resources made available to Children's
staff on understanding diverse religious and cultural traditions.
In 2001, Children's established a Diversity and Cultural
Competency Task Force to focus on cultural competence issues
in family education and services, human resources and staff
training, and clinical and support services.
Beginning in 2004, Children's new director of Diversity
and Cultural Competence will lead a comprehensive analysis
of the hospital's existing diversity initiatives and resources
in this area, and will be charged with improving, coordinating
and expanding upon those efforts.
For more information on Dr. Lieu's work, see "Racial/Ethnic
Variation in Asthma Status and Management Practices Among
Children in Managed Medicaid," Pediatrics,
May 2002.
|
How serious are racial disparities in health care?
It's quite a serious problem, and extremely pervasive. The healthcare
system has effective ways of improving health, but these are sometimes
not reaching the populations that need them most. It would be
a simple issue if we could blame all of the disparities on financial
access to care, but it turns out to be far more complex than that.
In studies that have looked at patients who have good insurance
and good financial access to health care, it turns out that black
adults and children are sometimes still less likely to receive
effective services than white children and adults. There are many
researchers trying to figure out why that is.
What can your research on asthma tell us about health
care disparities in general?
Asthma is one of the most important diseases in childhood, and
it affects black children more often and more severely than it
affects white children. No one, however, has been able to say
exactly why. In addition, if a black child and a white child have
asthma attacks of equal severity, the black child is more likely
to be hospitalized. This raises some complex questions: Are doctors
less likely to recommend preventive medicines to black patients?
Are black families less likely to adopt these medicines if they
are recom-mended? We don't completely understand what's going
on, but we think that the lapse in care probably lies in patterns
of communication between physicians and parents. For example,
a doctor might recommend appropriate preventive medicine for a
child with asthma, but if a communication gap occurs, the parent
may not understand that it's meant to be used every day. The hypothesis
is that these types of gaps arise more frequently for black and
Latino families.
Your research focuses on "culturally tailored interventions."
What do you mean by that?
Culturally tailored interventions try to take into account the
fact that families from different cultures come to the healthcare
setting with different beliefs about what causes disease, what
medicines are for and the risks that medicines may have.
How can this understanding be integrated into patient
care?
There are many types of policies that health care systems may
put into place to try to address these issues. They may hire more
bilingual providers or interpreters, or give everyone training
in cultural sensitivity. There are also fairly simple logistical
steps, like printing patient information in different languages
and representing all races in your printed materials.
In one recent study, we found that practice sites with stronger
policies promoting cultural competence not only received more
positive feedback from families, but also showed better rates
of preventive medicine use among minority patients. That was surprising
to me‹I wouldn't have guessed that improvement in care would be
so closely associated with action at the policy level.
