Factors that Decrease Inequities in the Healthcare System

Does healthcare inequities exist for minority populations and the poor in the United States?

The family of Thomas Eric Duncan thinks so. They are upset about the “unfair” medical care he received at Texas Health Presbyterian Hospital in Dallas, Texas. Mr. Duncan was from Liberia. He was the first person to die of Ebola in the U.S. after being infected with the Ebola virus.

Mr. Duncan’s nephew, Joe Weeks, told ABC News he felt Duncan had “unfair” medical treatment. Mr. Weeks suggested that Mr. Duncan did not get the same treatment being given to Ebola patient Ashoka Mukpo, in a Nebraska hospital. He did not cite the differences in care.

Although hospital officials told the family they were capable of managing Mr. Duncan’s care, the family questioned why Mr. Duncan was not moved to Emory University Hospital, where two American health workers had been successfully treated following an infection with the Ebola virus while in Liberia. Mr. Weeks said the family was also frustrated that Mr. Duncan was not given donated blood from Ebola survivors to pass on their antibodies of the virus to Mr. Duncan. The hospital officials told the family “that the blood wasn’t a match.”

The jury is still out regarding the facts surrounding Mr. Duncan’s case, and the major snafu that occurred when he initially went to the emergency room for care, but was released and sent home with treatment from antibiotics, thus culminating in his death.

What can we do, in the meantime, as healthcare professionals to ensure that all patients perceive the quality of medical care they receive as being excellent, regardless of their race or economic status?

The racial and ethnic health inequities don’t just reflect income. More African American, Native American, Latino and Pacific Islanders are in poor or less fair health than whites at practically every income level (although recent Latino immigrants report better health).

Ethnic differences highlight the need to further examine social support, socioeconomic status, access to care, and cultural factors to guide future health-related quality of life (HR-QOL). Health includes physical, mental, and social realms.

On the individual level, this includes physical and mental health perceptions pertaining to health risks and conditions, functional status, social support, and socioeconomic status. On the community level, HRQOL includes resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.

HRQOL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups.

The evaluation, diagnosis, treatment, and management of medical conditions will result in significant positive outcomes when there is a clear pathway regarding the objectives to promote healthy behaviors. The implementation of transparent programs and intervention services along with proper allocation of resources is necessary to close health care gaps and decrease priority disparities.

In addition to HRQOL elements, the cultural competency of health care workers is important, and includes five factors that influence health communication.

  1. Behaviors or the manner in which health care workers conduct themselves through their actions and responses with patients from varied demographics. Is the healthcare worker tolerant and attentive or standoffish and impatient?
  2. Language or methods used to ask questions and receive answers for the purpose of exchanging information in a clear and concise manner, which can be understood and recognized by all parties involved. This is extremely important for the purpose of providing medical care and treatment intervention. Does the healthcare facility have a language interpreter for patients that may speak English as a second language so that thoughts and ideas may be conveyed and received properly?
  3. Customs-Is the healthcare worker trained to recognize actions or ways of behaving that are common and traditional among people in a particular group. For example, it is a custom in some religious groups to never leave the woman alone with a male that is not her relative. Does the healthcare organization or facility make concessions for this?
  4. Beliefs or feelings of being sure that someone or something exists or that something is true. Does the healthcare organization have an Imam, priest, and rabbi present for patients and their loved ones who are spiritual believers seeking spiritual guidance and comfort from a ‘Higher Power?’
  5. Perspectives or mental thoughts, feelings, and emotions within and about the environment. Is there a meeting of the minds during the initial contact? Is the communication and explanation process regarding medical treatment between the patient and their family with the hospital staff comprehended? Are next steps going forward understood?

Clearly, these factors are important for achieving accuracy during triage and during the continuum of medical care. The takeaway from the events that transpired in Dallas, Texas is that if healthcare disparities are present, they will often result in suboptimal care, misunderstandings, the potential threat of legal action, and a public relations nightmare.