Race can be an uncomfortable topic, so let’s talk about it.

September 11, 2017

Ferguson. Philando Castile. Charlottesville.

These events make clear the long legacy of racial injustice remains present in our country. Race can be an uncomfortable topic, but we must be willing to address it if we are to achieve a more equitable, just society.

As the leader of a foundation dedicated to improving the health of all Connecticut residents, I see the impact of this history as Connecticut confronts the disparate health outcomes in the state.

Connecticut is one of the healthiest states in the country. We can be proud of this, but must also be conscious that there is more to the story: People of color do not share the same positive health indicators white Connecticut residents enjoy. For example, in Connecticut:

  • Blacks are more than twice as likely to die from diabetes as whites. The death rate from diabetes among Latinos is more than 50 percent higher than for whites.
  • Blacks and Latinos are more than four times more likely than whites to be hospitalized for asthma.
  • Babies born to black mothers are nearly three times more likely to die than babies born to white mothers.

National research has shown that people of color face different treatment in health care. A recent study of children with appendicitis found that black children are less likely to receive pain medication for moderate pain or to receive opioids for severe pain. Multiple studies have found that black patients are far less likely than whites to receive cardiac catheterization to treat heart disease.

These differences exist not because providers are racist or hospitals don’t care, or because patients are not compliant. Rather, they are the result of years of policy, systems, and structures. For example:

  • Many interventions and treatments are based on research that did not include people of color.
  • The lack of funding for face-to-face interpretation in health care means that many patients who are not fluent in English are unable to fully communicate with their medical providers or understand doctors’ instructions.
  • Unconscious biases on the part of health care providers can lead to disparities in how much time they spend with a patient or whether they attribute a patient’s problems to noncompliance.
  • There is little systematic collection, stratification, and utilization of race, ethnicity, and language data that could identify patterns that lead to disparate outcomes and help identify solutions.

The question is, what are we going to do about it?

This is the work of the foundation. Although health care is personal, delivered one patient at a time, and patient advocacy is critical, we can’t “fix” these problems patient by patient, family by family. That’s because as soon as one patient is doing better, there will be a line of others facing the same problems.

Instead, we must look at structures and systems that create the conditions that have left us with an uneven playing field. It is up to all of us to improve the health care system so all can get through the door and be heard by their provider.

This means ensuring equity in health care coverage. While only 5 percent of white Connecticut residents are uninsured, 11 percent of Hispanics lack coverage.

It means ensuring that all Connecticut residents have a way to get comprehensive health care from a provider they trust. Black residents are twice as likely as whites to have no primary care provider, and Latinos are three times as likely.

It means shifting the focus of our health care system from one that pays doctors and hospitals for the number of tests, visits, and treatments they provide, to one that focuses on patient outcomes and rewards those who can help their patients stay healthy and out of the hospital.

Together we must strive toward an equitable health care system that provides opportunity for all to thrive. This is not a zero-sum game; rather, the changes that will lead to a more equitable health care system will benefit us all.

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