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Tuesday, February 26, 2019

African Americans Still Lag Behind in Health Outcomes: Increasing Representation Among Providers Must be A Part of the Solution

Noelle Thompson

Health Equity Intern

Black History Month is an opportunity to elevate the accomplishments of African American trailblazers who may be missing from the history books. For example, in health care, we may remember Roselyn Epps, the first black president of the American Medical Women’s Association, or Ida Gray Nelson Rollins, the first black female dentist. We need to continue highlighting individual achievements because inclusive, representative narratives are an important tool for dismantling racism. However, we also need to dig deeper and tackle root causes: implicit bias and institutional, systemic, and structural racism. One indispensable element in narrowing the persistent inequities in African American health status and outcomes is effectively addressing both representation and structural inequities in the health care arena.

Our health care workforce is not representative of our population, particularly when it comes to the communities most affected by inequities 

If we look at the very top of the health care workforce spectrum, African Americans make up only 5.7% of all physicians. Yet, African American providers have proven to be critical in providing greater access to health care for Black communities. Compared to their white counterparts, they are more likely to practice in underserved areas that comprise a large percentage of black families, and are more likely to accept patients who are covered by Medicaid. However, improving access to care is only one dimension of how they serve their community—they also have been linked to improving the quality of care African Americans receive.

Given generations of mistreatment by the healthcare system, building trust with the African American community by diversifying the health care workforce is a necessary health equity strategy

The history of the health care system’s mistreatment of African Americans is well documented, and at the root of ongoing mistrust many Black people harbor about health care. This goes beyond the historical trauma caused by generations of the medical abuse of black bodies. Today, nearly one-third of African Americans report feeling discriminated against when they seek medical care. In fact, multiple studies have shown that African Americans are less likely to get the standard of care than their white counterparts, in areas including pain management, asthma treatment, and even getting a simple aspirin in the ER when they present with angina. This unequal treatment, along with the lack of representation, continues to undermine this community’s trust that the healthcare system values them. This may be one of many reasons why African Americans are significantly more likely to wait until their health has deteriorated so much that they are desperate to see a doctor, and seek care in emergency rooms more than any other racial group, even if they are insured.

Diversifying the health care workforce is an important strategy for addressing the persistence of bias in health care and the distrust it engenders. Studies show that patients are more likely to utilize preventive care services and report care satisfaction when treated by a health professional who shares their own racial or ethnic background. This is one reason it is imperative that we think more broadly about who needs to be a part of an interdisciplinary health care team to better address gaps in cultural competency and ensure the provision of high-quality, language accessible care that effectively improves outcomes. From physician assistants, to interpreters, all the way down to community health care workers, to name a few, increasing the racial and ethnic diversity in these roles should have a positive effect on how communities of color relate to the health care system and how the system treats them.

Diversifying the health care workforce provides an opportunity to address other systemic issues that influence health

Implementing programs to increase the representation of people of color in the industry will have other positive effects for these communities in addition to improving the access to and quality of care they receive. With health care comprising roughly 18 percent of the economy, these strategies are also likely to increase job opportunities and improve several of the socio-economic factors that influence health.  

It's past time we commit to advancing policies to eliminate the grievous inequities that continue to undermine Black communities across our nation. Cultivating innovative and sustainable pathways towards a well-trained, ethnically and culturally diverse workforce will improve our country’s health as a whole. Together, let’s make Black health inequities history.