How to Address racial disparities in health care

Challenges and Solutions Essay
Introduction
The problem of racial disparities in health care is an issue in global health that needs to be addressed (Wheeler & Bryant, 2017). One of the reasons it is only superficially discussed, however, is that the legacy of maltreatment of the black population at the hands of health care professionals is one that has yet to receive its long overdue attention (Freimuth et al., 2001). Barriers to care in poor communities persist largely because of the socio-political and economic influences that keep these communities poor in the first place (Saraceno et al., 2007). Solutions to these barriers may be forthcoming in limited ways, but for the most part, the issues remain. Two programs working to establish equity in health care are The Society for Diversity in the Biomedical Sciences and the Racial Equity Resource Guide. This paper will describe these two programs; discuss their target populations, location, purpose, and objectives; and describe the features of the programs that aim to improve health. It will also evaluate the programs in terms of (1) effectiveness, (2) acceptability, and (3) sustainability. Finally, it will make recommendations for how each program can improve.
The Society for Diversity in the Biomedical Sciences
Description
The Society for Diversity in the Biomedical Sciences focuses on the target population of African Americans, American Indians, and Latinos, with the purpose being to increase their representation in the sciences related to health and the environment. It is based in Houston, TX, and the features of the program that aim to improve health include the possibility of networking with other professionals in the field, the provision of mentors to support education and training, career development resources, research opportunities, and partnerships in the biomedical sciences. Internships, workshops, and news updates are all made available to members of the program.
Evaluation
In terms of effectiveness, it is unclear to what extent the program has had any success. It is relatively new, having just been established in 2016. Its social media is not up to date; its Facebook page has not had a new posting since 2017. Its LinkedIn activity is even older. None of this suggests that much activity or progress has been made by the program. There is no documentation of success in terms of achieving any of the stated goals put forward in its mission statement.
In terms of acceptability, the program’s approach may be appropriate in theory, but in practical terms, it is not a great approach because of some of the problems of simply reaching the target population in the first place. These problems are even identified by the program on its own webpage, yet the program does not offer much in the way of understanding about how to address the challenges. For instance, some of the problems causing low numbers or underrepresentation of minorities in the biomedical sciences field include: little to no access to teachers or mentors, poor basic skills as a result of inadequate education and training in primary and secondary schooling, lack of family or community support for this type of progress, low high school completion rates, poor college retention rates, lack of knowledge or interest in STEM careers, fear of student loan debt, priorities determined by more pressing matters such as employment and obtaining necessary resources for daily life. The program does not explain how it is helping to address these challenges but rather only points them out and then notes that it is offering a summer symposium for interested learners. But what good is such a symposium going to be if the target population is faced with the barriers described above? Therefore, it is safe to say that the program is not using very effective means of addressing the problem at the root level but rather only providing opportunities for those of the target population who have already managed to get moving in the right direction. Thus, more could be done to address this matter.
In terms of sustainability, it does not appear that the program has long-term viability; although there is no data available on its financial state, the program is made up of loosely-knit individuals who either volunteer their time or are depended upon for sharing their experiences with young learners. There is no endowment; it relies on a non-profit status to attract donations. No news items of blog posts have been made since 2017. None of this indicates sustainability in the slightest.
Recommendations
As Saraceno et al. (2007) point out, barriers have to be removed before progress can be made. The barriers preventing the program from achieving success with the target population include all those described above as well as the issues stemming from the legacy of harm experienced by the black community at the hands of the health care industry (i.e., the Tuskegee syphilis experiments, etc.). In order for this program to succeed, it needs to start addressing those barriers first and foremost—and then it can begin to provide the education, training, mentoring, and other supports offered currently. Issues of poverty, history, social justice and education at the lower levels first have to be addressed and solved before this program can really begin to have any effectiveness. However, as Farmer (2005) notes, it means that the system of power has to be challenged head-on, otherwise there will be no real changes.
Thus, the program should start seeking ways to drum up support for impoverished communities of the target population. That support can come in the way of financial support, educational support, or socio-political support. The important thing is that some form of support be directed to the families and communities so that the root problems can be addressed. Those problem areas have to be focused on first. The program is making the mistake of focusing on higher education challenges, and this does nothing for the individuals who never make it that far. Their own access to education and health is limited and those limitations need to be removed.
The program would do far more for the advancement of health for the target population by addressing the issues that prevent the target populations from finishing school, from having access to care, and from rising out of poverty. The power structures and issues of systemic racism that exist in the US must be addressed through the collaborative work of law enforcement, legal representatives, legislators, community leaders, activists, lobbyists, and legislators. The program should be working with these individuals to help the target population achieve greater outcomes for themselves and for the field of health science.
Racial Equity Resource Guide
Description
The Racial Equity Resource Guide is a resource designed to support project America Healing, which launched in 2010. The target population consists of majority white populations in the US that might not realize the disadvantage to which ethnic minorities in the US have been subjected. The purpose of the program is “to put the belief in a false human hierarchy based on physical characteristics and the racial and structural inequalities it creates behind us, by first putting it squarely in front of us” (Racial Equity Resource Guide, 2020). To that end, the program’s main feature is the America Healing project, which “is a strategy for racial healing toward racial equity, and is designed to raise awareness of unconscious biases and inequities to help communities heal” (Racial Equity Resource Guide, 2020). The Racial Equity Resource Guide is designed to be a “comprehensive and interactive racial equity resource guide that includes practical resources including articles, organizations, research, books, media strategies and training curricula aimed at helping organizations and individuals working to achieve racial healing and equity in their communities” (Racial Equity Resource Guide, 2020).
Evaluation
In terms of effectiveness, the program aims to help close the racial equity gap. While the Guide itself was only created in 2014, the effectiveness of it has not yet been measured with any quantitative analysis. Its goals are, nonetheless, to reduce racial inequity and thus reduce several gaps in society, such as the income gap, the education gap, and the achievement gap. More information is required to understood the value of the resource guide as is—but the Guide does provide individuals and institutions with the ability to identify several organizations and experts on specific topics and use the materials they have to raise awareness about the racial equity gap.
In terms of acceptability, the program does provide an appropriate approach to the issue it is attempting to address. Its focus is to raise awareness about racial inequity in a population most likely to be ignorant of it and most likely to be in a position to do something about it. Its method is to make available for distribution papers, articles, websites, lectures, talks, organizational experts and more so that proper channels can be opened up and the literacy on racial inequity improved in the target population.
In terms of sustainability, the program is funded and supported by the W.K. Kellogg Foundation. This is a very wealthy foundation and it should be able to sustain the needs of the program without difficulty for the foreseeable future. As there are no substantial costs involved in the program, other than the linking of materials and the maintenance of the network of resources, the program is not viewed as one that is particularly costly.
Recommendations
Recommendations for the program are that in order to improve its effectiveness, it needs to partner with local school districts, the local organizations, Fortune 500 companies committed to sustainable issues of community life in the US, and other organizations that can make a difference. Raising awareness should not be dependent upon individuals making information available one person at a time; rather, the program should look to expand its influence by focusing on diversity and inclusivity issues that are so important to major corporations in the US and leveraging that emphasis by turning it into a conversation about racial inequity.
The issue of racial inequity is not going to be solved simply by passing out reading materials. It is something that is going to need active teachers and educators imparting their understanding to others—whether they are students in secondary education or in colleges; workers in an organization; or members of a community. As Farmer (2005) shows, the pathologies of power have to be addressed in a proactive manner, and that means facing them directly and in truth. Barriers to raising awareness can come in many forms, as Saraceno (2007) notes. The problem, however, is that these forms can be within the structures and systems of society itself. Therefore, overcoming them and increasing knowledge of the problem of racial inequity can be a bit more challenging than simply handing out materials and inviting speakers to give a conference on a topic.
What the program should do is to work with legislators to promote a bill that would require the Department of Education to ensure that public schools teach about racial inequity. Starting with the young population is the way to guarantee that the future community has this information ingrained in them and that they will take steps to address the issues once they inherent the reins of power. The other recommendation is that the program create leaders who can engage in activism within communities and collaborate with leaders, organizations, churches, businesses, schools, and so on, to promote the information that the program provides. In doing so the various ideas and resources made available through the Guide will be spread far and wide and distributed across the board instead of to one specific sector: the wider the seed or net is scattered, the more likely the program is to reap the bounty.
These steps will help to make the program more effective in terms of reaching a wider audience and increasing knowledge on the subject. That in turn can promote increases in things like access to care, access to education, and access to opportunity for marginalize or underserved populations. Increasing health is the ultimate goal and that depends upon increasing awareness.
References
Farmer, P. (2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press.
Freimuth, V. S., Quinn, S. C., Thomas, S. B., Cole, G., Zook, E., & Duncan, T. (2001). African Americans’ views on research and the Tuskegee Syphilis Study. Social science & medicine, 52(5), 797-808.
Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., ... & Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370(9593), 1164-1174.
Wheeler, S. M., & Bryant, A. S. (2017). Racial and ethnic disparities in health and health care. Obstetrics and Gynecology Clinics, 44(1), 1-11.