Attaining equity in health care requires improved access to care, a more diverse health care workforce and more responsible citizens doing their part to address the protection and enhancement of their own health.
That was the message from Louis W. Sullivan, MD, keynote speaker for the fifth annual Dr. Philip Pumerantz Distinguished Lectureship at Western University of Health Sciences, held Oct. 24, 2013 in Pomona, Calif. The lectureship was established in 2009 in honor of WesternU President Philip Pumerantz, PhD, through a donation from Drs. Elaine and Daljit Sarkaria of Orange.
Sullivan is the former Secretary of the U.S. Department of Health and Human Services. He is President Emeritus of the Morehouse School of Medicine, and is chairman of the Sullivan Alliance to Transform the Health Professions.
“All of us are in a very drastic situation in our country right now,” Pumerantz said. “This country needs wisdom and compassion. With his background and his experiences, Secretary Sullivan is the perfect spokesman for compassion and wisdom.”
Sullivan began his talk, “The American Journey to Health Equity,” by giving a history of medical education in the U.S.
The report “Medical Education in the United States and Canada,” released in 1910 by Abraham Flexner, evaluated every medical school in those two countries at the time. It was critical of many of the medical schools, resulting in several schools closing and others adopting curriculum and practices that continue today, including medical students studying two years of sciences basic to medicine such as anatomy and physiology, followed by two years of training in clinical sciences.
“We now can say without question in the U.S. that we have the strongest program for health professions training of any country in the world,” Sullivan said. “We have a strong scientific base for health professions education, reinforced by the scientific discoveries from our nation’s laboratories.”
As a result, the health of Americans has improved tremendously, Sullivan said. But although the U.S. spends more money on its health care system than any other nation, it’s not the healthiest nation in the world because of a distribution problem, he said.
“That strong science, those well-educated individuals, that system that we’ve developed, doesn’t reach all of our citizens in an effective way,” he said.
Studies show that health care quality and access are sub-optimal, especially for minorities and low-income groups, Sullivan said. Ethnic and racial minorities that present acute cardiac symptoms are less likely to receive catheterization, less likely to have angioplasty or bypass surgery or receive beta blockers, and less likely to receive implantable cardioverter-defibrillators.
There is also a disparity in the percentages of minorities practicing in the health professions compared to the overall population. Native Americans, Native Hawaiians, African Americans and Hispanics make up 30 percent of the U.S. population, but comprise only 12.3 percent of medical doctors, 11 percent of RNs and 10 percent of pharmacists.
“The health professions are science-based professions, but they’re practiced in a social setting,” Sullivan said. “We need and we want and we demand that our health professionals are well trained to have the knowledge base to carry out the procedures that they do, to see that the lives that are entrusted them are taken care of. But to be effective in using that science, they have to be effective communicators.”
“That’s why we need to have more diversity in the health professions,” Sullivan said. “It doesn’t mean that any one specific health professional needs to be limited to one person of their own race, but it does mean that in the barrio or the ghetto, if we are to address the needs in those communities, we need have more diversity.”
A 1996 UC San Francisco study showed that Latino and African American physicians are three to five times more likely to establish their practices in the barrio or ghetto, Sullivan said. Their practices had a higher percentage of patients on Medicaid, or patients who had no payment mechanism whatsoever. A higher percentage of Latino and African American graduates also enter primary care.
“So all those reasons argue for having a more diverse health workforce,” Sullivan said. “Having the scientific knowledge and base, but not being able to communicate with patients, not being able to establish that therapeutic relationship, means that scientific knowledge goes to waste. If you can’t develop trust with a patient, if the patient doesn’t understand your recommendations, or the patient has an unpleasant experience and decides not to come back or follow through with therapy, then that indeed is a visit that is wasted.”
The U.S. spent 11 percent of its gross national product (GNP) in 1989 on health care. Health care spending is now approaching 18 to 19 percent of the GNP, and in another 10 to 15 years, it could climb to more than 30 percent if changes aren’t made, Sullivan said.
The individual actions of each person are important — getting a flu shot, having a child immunized, eating a proper diet to guard against obesity.
“We have to have a more responsible citizenry to really do their part in addressing the protection and enhancement of their own health,” Sullivan said. “We clearly have a bureaucratic system. We need to do it with the finesse of a surgeon’s scalpel, not with a sledgehammer, which is what some legislative measures would do.
“We need to remember that as health professionals, we are entrusted with the lives of people. We are expected to be sure that the interest of the patient and that patient’s life and health and family are first, not the payment for services. We need to be sure that we continue to earn the respect and trust of the community by behaving as caring professionals rather than as cold business people who focus on the bottom line.”
In addition to treating patients, health-care providers have a broader responsibility to advocate for things needed in the community, Sullivan said, such as advocating for reducing air pollution.
“As health professionals I say you have a dual responsibility to individual patients who come to you for service, but broader service to the community as well,” he said.
The lecture concluded with Sullivan receiving a gift from WesternU and the addition of his name to the lectureship plaque, presented by Dr. Pumerantz, WesternU Provost and COO Gary M. Gugelchuk, PhD, and WesternU Senior Vice President Thomas G. Fox, PhD.
Sullivan joins Dr. John Kitzhaber, governor of Oregon, who spoke at the inaugural Pumerantz Lecture in 2009; Kimberly Belshe, former secretary of health and human services for the state of California, who was the 2010 speaker; Robert Margolis, MD, former managing partner and CEO of HealthCare Partners, who made the keynote address in 2011; and Cliff Holland, Corporate Vice President for Worldwide Government Affairs and Policy for Johnson & Johnson, who spoke in 2012.