Health equity will occur when every person has the opportunity to “attain his or her full health potential” and no one is disadvantaged from achieving this goal. So says the U.S. Centers for Disease Control and Prevention (CDC). But even the CDC concedes that vast health inequities persist across the nation.
This year, National Minority Health Month, which is observed in April, is more focused on the impact of COVID-19 on racial and ethnic minorities and underserved communities. But health inequities have persisted since long before the pandemic, and action needs to be taken by community and healthcare leaders to make sure no one is underserved when it comes to a person’s full health potential, according to experts on a recent Baptist Health Resource Live panel discussion, hosted by veteran TV journalist Neki Mohan: Health Equity and How It Affects You.
“Though health indicators such as life expectancy and infant mortality have improved for most Americans, some minorities experience a disproportionate burden of preventable disease, death, and disability,” explains Ms. Mohan before introducing the panel of experts. They include: Sarah Joseph, M.D., a gastrointestinal medical oncologist at Miami Cancer Institute; Marcus St. John, M.D., interventional cardiologist and medical director of Miami Cardiac & Vascular Institute‘s Cardiac Catheterization Lab (Cath Lab); and author Tamara B. Rodriguez, a wellness advocate, breast cancer survivor and champion for Baptist Health’s Miami Cancer Institute.
Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. And they disproportionately affect minorities. Health inequities are reflected in U.S. data that finds a shorter life expectancy, lower quality of life, and higher rates and severity of disease and disability among minorities. Social factors affecting access to healthcare include race, ethnicity, poverty, unemployment, education, and whether you live in an urban or rural setting, says the CDC.
“The disparities comes with not having insurance — that’s one big thing — and not being educated, not having access to healthcare,” explains Dr. Joseph. “So, we have to put telemedicine and leaders into this healthcare disparity. If patients have cell phones, we can reach out and call them. That’s one way to do telemedicine. If they don’t want to come into the institution, we can just call and say, ‘Hey, these are the services; This is what we’re recommending based on your age group.”
Dr. Joseph adds that as an inpatient oncologist she has a GI clinic at her practice and “we apply for financial assistance for patients who don’t have insurance.”
Ms. Rodriguez said that Dr. Joseph is an example of a doctor who advocates for the patient. “I’ve been very lucky to have an extraordinary team at Baptist Health,” she said. “My oncologist has always been transparent with me, and has always given me the right information or has directed me to finding out the solutions for my care. So, I’m very grateful for that. I would say, in my case, I’ve thankfully passed the five-year mark (since cancer diagnosis).”
Dr. St. John emphasizes the lack of access to healthcare and healthy living options among African-Americans.
“One of the things that is likely contributing to African-Americans having disproportionately high rates of heart attacks, stroke, and heart failure, is that they often do not have access to healthcare where they can know their numbers,” explains Dr. St. John. “There’s often a distrust of the medical establishment for historical reasons. They often live in areas … where they don’t have easy access to fruits and vegetables, or safe places to exercise. These are some of the types of things, including the lack of insurance that Dr. Joseph mentioned.”
Here are some Q&A highlights from the Baptist Health’s latest Resource Live. For the full program, go to Health Equity and How It Affects You:
Ms. Mohan: “What kind of disparities really exist when it comes to cancer? What are the facts?”
“That’s a great question … disparities in the terms of rate of diagnosis. Overall, the incidence of cancer is going down but in certain subgroups, Hispanics and African-Americans, it’s not going down. So, one in three African Americans are diagnosed, and one in five actually die of their disease. And it’s because when they’re diagnosed, they’re diagnosed at a more advanced stage. We have a higher death rate and a shorter survival when it comes to African-Americans. And just the rate of diagnosis in certain solid tumors for example, prostate cancer, lung cancer, are higher in African-Americans and breast cancer for example, are higher in African-Americans.
“And why is that? Because when we look at prostate cancer, lung cancer, breast cancer — these can be preventable. And Tamara was great that she mentioned that we need leaders in our society. We need to educate the public. We need to notify them that we have screenings. If you’re a smoker and you have a long history of smoking, we can do CT scans. We can follow that up and check lung nodules. We can prevent it from actually turning into a malignancy — for example, colon cancer. Many of our patients they come in at an advanced stage (of cancer)…”
Ms. Mohan: “Tamara, you are a cancer survivor. You can tell us firsthand how important are these screenings and what do you think can be done to bridge the health equity gap?
“I totally agree with Dr. Joseph that in our community, and especially in the black community, we know that there’s some socioeconomic factors and also cultural factors that lead us to not feel comfortable saying the word ‘cancer.’ We say ‘C word’ or we just say ‘God will handle it.’ Or it’s going go away by itself. And to me, the way to make it better is access to information and having the public health community work with leaders in the community to let the underserved know about the importance of screenings. I know that my early screening saved my life. And I was fortunate to know the importance of early detection, but a lot of people in the community just don’t realize the importance.
Ms. Mohan: “Heart disease is the leading cause of death in the United States and the risk of heart disease death differs by race and ethnicity. The US African-American population have a greater burden of cardiovascular events. Can we talk about the factors that lead to this disparity?”
Dr. St. John:
“One of the ways to answer this question is to quickly tick through what are the risk factors for heart disease. And what I tell my patients every day is a risk factor is simply anything that increases the likelihood or the chance that you get a particular disease. So as you mentioned, high blood pressure, high cholesterol, smoking, diabetes, sedentary lifestyle, family history which we touched on already. These are some of the main risk factors. There are others and some less common. Each of those things, or many of them, are things that you have to measure.
“So, what I tell patients every day, you just can’t know what your blood pressure is without measuring it. You simply can’t guess what your cholesterol is. So, you really have to know your numbers. And that’s a mantra that we try to tell patients. You have to have some way of finding out where your blood pressure is and then interfacing with someone in the healthcare profession to help you make sense of that.”