In shedding light on health care inequalities due to race and ethnicity, keynote speaker Brian Smedley, PhD, spoke to a group who could make a difference: clinicians, scientists, professors and future health care professionals at Western University of Health Sciences in Pomona, Calif.
Smedley, research director and co-founder of the Opportunity Agenda, spoke at the Ray Symposium at WesternU on April 17, 2008. The Opportunity Agenda, founded in 2004, is a communications, research and policy organization that works across social justice issues to build public support for greater opportunity in America.
WesternU’s College of Pharmacy organizes the annual symposium in honor of Max Ray, MS, PharmD, dean emeritus of the College of Pharmacy. He joined WesternU as professor of pharmacy practice and director of pharmacy practice and development in 1996 and served as dean of the College of Pharmacy from 1999 to 2006.
The symposium provides a forum that brings a nationally-recognized speaker to campus to discuss issues of importance to the entire academic community, said Daniel Robinson, dean of the College of Pharmacy.
“In 2002, the Institute of Medicine (IOM) released ‘Unequal Treatment,’ a Congressionally-mandated report, concluding that minority patients receive lower quality care than whites,” Robinson said. “This may not come as a surprise to some, however, when you consider that the disparity persists even after taking into account differences in health insurance, health and economic factors, such disparity is appalling.”
Smedley was the study director of the 2002 IOM report, and the problems addressed by that report have not improved. The 2007 National Health Care Disparities Report by the Agency for Healthcare Research and Quality concluded, “across all core measures and for all priority groups, the number of measures of quality and access where disparities exist grew larger between 2000 and 2005.”
The reasons for these disparities are complex. Minorities are more likely to be uninsured or underinsured, more likely to live in medically underserved communities, more likely to experience cultural and linguistic barriers to care and they may be victims of subtle bias and stereotyping, Smedley said.
Geography plays an important role. Even minority patients who are well insured often live in communities that lack the same availability of health care services as predominately white communities, Smedley said. Sometimes hospitals and clinics in minority areas don’t have the same quality of staffing and equipment.
“People of color tend to get a lower quality of health care even when they have the same health coverage and present with the same problems, Smedley said.
Language is another factor – one in five limited-English-proficient patients avoid seeking care because of language barriers, he said. Also, in many cases, minorities suffer higher rates of chronic diseases such as diabetes.
“Communities that have the highest health care needs often have the fewest health care resources,” Smedley said.
The “Unequal Treatment” report asks if it’s possible that bias and stereotypes cloud the judgment of health care providers, resulting in lower quality of treatment and poorer treatment outcome for minority patients.
On the face it’s an unlikely proposition. Doctors and other health care providers are highly dedicated to their work. The vast majority care deeply about their patients, Smedley said.
But a large body of research shows most people socialized in the U.S. harbor biases they may not be consciously aware of that affect thinking and behavior, such as a pro-white, pro-male viewpoint, Smedley said.
Racial bias negatively affects judgments and diagnostic treatment decisions, he said. Physicians who have a higher pro-white bias are shown to recommend less aggressive, less effective treatments for minority patients.
There are many ways to address the problem.
“The first step is to become aware of (biases) so as we’re interacting with people, we take the time to learn more about the person we’re interacting with so we don’t fall back on stereotypes to fill in the missing information,” Smedley said. “That’s easier said than done. Physicians have a very short time to interact with patients, an average of 12 minutes.”
On the structural side, an important first step is to promote universal, comprehensive health care coverage, he said. Universal coverage might help balance the structural problems of health care resources being allocated most and first to communities with the most money, he said.
Diversity is also important. Some students may not be aware of their options in entering the health field.
"Equality should be among the top four or five issues that health professionals should be concerned about, particularly in this day and age,” Smedley said. “Health professionals have to keep up with this diversity to effectively service the population.”
WesternU students are aware of these issues and exemplify the trend toward more diversity.
“As future health care providers we could at least look for middle ground,” said Peter Reding, DO ’11. “If we don’t see the problems we can’t look for solutions.”
A health care professional should not look at race, said Oanh Trinh, PharmD ’10.
“You look at the patient as a human,” she said.
The Ray Symposium served as a historic moment for Western University of Health Sciences. For the first time in its history, WesternU bestowed the title of Dean Emeritus to Max Ray, PharmD, MS. Dr. Ray joined WesternU as professor of pharmacy practice and director of pharmacy practice and development in 1996 and became dean of the College of Pharmacy in 1999. He retired in 2006. The WesternU Board of Trustees approved the honor on March 8.
The pharmacy program still resonates with Dr. Ray’s ideals, attracting students with diverse backgrounds, said WesternU President Philip Pumerantz.
“What distinguishes Max as a leader is his philosophy,” he said. “When he was dean he cared for his students, his faculty and his community. He made a real impact in this community and nationally.”