Giving Disparities a Voice

Today's post was written by our excellent summer intern, Asantewaa Poku, who is headed off to graduate school at The Mailman School of Public Health at Columbia University.


The healthcare reform debate has brought to light a number of critical issues: driving down costs, covering the uninsured, creating competition, and improving quality. The crucial issue of healthcare disparities is getting lost in the haze of the debate.

The past and present unequal treatment of many vulnerable populations has translated into health disparities for groups lost in the current system. . In fact, these Americans might argue that perhaps what the system lacks most is a commitment to equality.

The Agency for Healthcare Research and Quality has defined disparities as those differences in experiences between one population group and another that manifest themselves in a variety of ways including poor communication between patients and caregivers, provider biases, poor health literacy, and most importantly poor health outcomes .

According to AHRQ, among non-elderly adults 17% of Hispanic and 16% percent of African Americans report they are only in fair or poor health compared to 10% of white Americans. A study by the National Center for Health Statistics found that African-American women have the highest death rates from heart disease, breast and lung cancer, stroke and pregnancy among women of all racial and ethnic backgrounds. The National Business Group on Health found that rates of heart disease mortality have decreased the most for whites and the least for African Americans, for whom mortality rates for heart disease are 50% higher than their white counterparts. Cardiovascular disease is the leading cause of death in the United States and has a direct cost of $296 billion. Real healthcare reform must address the human and financial costs of these disparities head on.

How do we give disparities a voice?

It is easy for stakeholders to lose sight of the issues created by disparities. Real healthcare reform must be patient-centered. By giving each patient a voice in their care we assure better healthcare for all.

In Unequal Treatment, the Institute of Medicine’s disparities report, the importance of patient-centered reform is stressed. Both patients and providers need to be educated and change ingrained behaviors. Patients must learn to take a more active role in clinical decision making, take responsibility for their treatment plan and self care. Providers must learn to become more aware of their unconscious biases and more understanding of the cultural diversity of their patients. By giving both participants tools that foster better communication and overall care we can begin to close the gap in healthcare outcomes for all populations.

By hardwiring the patient’s voice into the clinical suite, we assure that every patient is heard.