We’re All Created Equal—But Not When It Comes to Health
They’re called “health disparities.” It’s a fancy term that basically means some people get better healthcare, or are healthier to begin with, than others, thanks primarily to differences in economic and social status. For example, if you’re a black or Hispanic person in the U.S. and you head to the emergency room for treatment, you’re less likely than a white person to be given enough medication to control your pain.
And as TakePart reported in our recent series on the extraordinary burden faced by some Americans with cancer, if you are unlucky enough to get cancer and not have health insurance, you’re twice as likely to die of the disease.
Thankfully, there are some among us who aren’t satisfied to shrug their shoulders and say, “Well, I’m not sure what can be done.” One of those is Marshall H. Chin, M.D., M.P.H, F.A.C.P., director of the Robert Wood Johnson Foundation’s Finding Answers: Disparities Research for Change program, which is completely focused on finding, understanding, and eradicating health disparities.
For Dr. Chin, doing his job well starts with understanding all the ramifications of poverty: “When I think about disparities, I think about those who are at risk for poor health as well as common health conditions that cause a lot of harm,” he explains. “The most vulnerable are poor people. There’s an overlap between poverty and poor health.”
That’s nothing new, of course. So when considering where the nation should focus its efforts—with so many problems to be solved—Dr. Chin says there’s one big issue (literally): “In terms of the most common health conditions, the first is obesity. You don’t need to be a rocket scientist to see that; just take a look around and you see the population getting overweight,” he notes. “We’re seeing some schools with 30 percent or more kids overweight or obese. What this means for our nation is that we won’t have a healthy workforce,” he adds, drawing the link between excess weight and diabetes, high blood pressure, and stroke, among other conditions. “It all sort of feeds together,” he says. And HIV, a highly preventable condition, he says, remains an issue, with large disparities for minority women.
Rather than become overwhelmed by so many complex issues that relate not just to health but to socioeconomic status and race and ethnicity, Dr. Chin suggests focusing on a single issue where you can make a difference. His own work in Chicago has focused on lowering rates of diabetes and its complications among South Side communities, including bringing healthier food choices to “food deserts.” “A lot of poor neighborhoods have no access to fresh fruits and vegetables,” says Dr. Chin. “You can use your purchasing power by asking corner stores, even drugstores, to carry fresh produce.”
His own program, Improving Diabetes Care and Outcomes on the South Side of Chicago, co-led with Dr. Monica Peek, has partnered in Chicago with Walgreens. “We’re starting to put healthy food options in food deserts, discount the cost of healthy foods, and work with farmers markets in the area and nonprofits to supply coupons so people can get healthy food.” He says young adults are particularly great at taking action since “they are strongly aware of how important it is to live in a healthy environment and to live in a world where people can make healthy choices,” he adds.
Throwing your support behind efforts to support more and safer physical activity where you live can make a big difference too, he says. “The past [Chicago] mayor, Richard Daley and the current mayor, Rahm Emanuel, have both been strong advocates of bikes and are creating bike paths,” says Dr. Chin. “In my neighborhood in the past half-year they’ve created bike lanes, and the city will start a shared bike program like the one in Washington, D.C., and other cities.”
And Dr. Chin thinks social organizations, including outreach programs from churches and synagogues, are another way to get involved with support efforts aimed at healthier eating, increasing physical activity, facilitating screening (like mammograms), and the like.
Come this fall, when Americans will start to hear more about their state’s insurance exchange, the Affordable Care Act will make access to healthcare a lot easier for many more people. “The Act will help a lot, and it’s a very positive step,” says Dr. Chin, “But we still have a long way to go. You have to have access to care and you have to have access to high-quality care.” That means, in part, starting to tailor healthcare, both to the individual and to the community. “Oftentimes, patients are told that healthy eating is part of their treatment plan, but [as their doctor] I need to tell them how to adapt ‘healthy eating’ for their culture and family recipes,” he says.
“One of the big changes we’re starting to see in healthcare is the realization that if we’re going to reduce disparities and give the best quality of care, we have to look at what happens not only in the clinic and the hospital but also what happens in the community. 99.9 percent of living is done in the community: That’s where the action is for healthy living.”
What do you think should be done to help more people who really need healthcare get it? What else can we do to end health disparities?