Inequity & Racial Bias in Health Care [Barriers: Racial Bias, Inequity]

An article published on CaliforniaHealthline on March 9, 2023 entitled Black Patients Dress Up and Modify Speech to Reduce Bias, California Survey Shows, highlights inequity in health care. This article highlights personal stories about the experiences of those experiencing racial bias in health care. It starts with the following stories:

“A young mother in California’s Antelope Valley bathes her children and dresses them in neat clothes, making sure they look their very best — at medical appointments. “I brush their teeth before they see the dentist. Just little things like that to protect myself from being treated unfairly,” she told researchers.

A 72-year-old in Los Angeles, mindful that he is a Black man, tries to put providers at ease around him. “My actions will probably be looked at and applied to the whole race, especially if my actions are negative,” he said. “And especially if they are perceived as aggressive.”

The article points to research revealing the many types of activities that patients undergo in order to manage the racial bias they are faced with. “Many Black Californians report adjusting their appearance or behavior — even minimizing questions — all to reduce the chances of discrimination and bias in hospitals, clinics, and doctors’ offices. Of the strategies they describe taking, 32% pay special attention to how they dress; 35% modify their speech or behavior to put doctors at ease. And 41% of Black patients signal to providers that they are educated, knowledgeable, and prepared.”

Inflation and Housing Costs affect Health Care [Barrier: Cost of Care]

An article in NPR entitled High inflation and housing costs force Americans to delay needed health care, was posted today, March 10, 2023. The article states

“In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.

A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor’s office visits. Many didn’t take medications as prescribed.”

The article highlights personal stories that reveal the challenges for those who do not have health insurance in the United States. This is a challenge, worldwide, as our stories reveal.

Patient Burnout [Barriers: Cost of Care, Insurance, Health Care Professional Shortage, Physician Burnout]

This article in Time entitled “Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout” discusses the overwhelmed feeling patients experience when dealing with the US Health Care System. I hadn’t heard the term “patient burnout,” but it is a good way to describe the situation many patients find themselves in.

Unions for Health Care Staff [Barriers: Physician Burnout]

This article in Wired, entitled Doctor Unions Are Good for Your Health: Physicians across the US are unionizing, which can lead to better working conditions for health care providers and greater advocacy for patients, discusses the possibility that Health Care Staff Unions could help tackle some of the barriers to public health, specifically that of Physician Burnout. Improving the situation for physicians, improves the situation for patients. The article states “Unions boost life quality for house staff, which is critical in sustaining the health of young physicians and, in turn, the patients under their care. Persistently high rates of burnout signal that the system is inadequate in responding to house staff feedback for change. “

Primary Care Physician in Beverly Hills writes opinion piece on various Barriers to Public Health

An article in the LA Times written by a physician in Beverly Hills discusses many challenges that patients face related to barriers to public health in the United States. It states “It shouldn’t be so hard to get the right treatments to the people who need them. But money gets in the way.” He discusses the fact that both providers are in short supply and insurance poses barriers. He even discusses how costs are high for medicines.

Rates of congenital syphilis are skyrocketing in the US [Barriers: Access to Medical Care, Cost of Care/Insurance, Shortage of Medical Facilities]

An article from March 1, 2023 in CNN Health online entitled Rates of congenital syphilis are skyrocketing in the US. Here’s why, highlights the problem of congenital syphilis as a growing concern in the US. “Over the past decade, “there’s been about a 700% increase in the cases of congenital syphilis in the United States,” said Dr. Robert McDonald of the US Centers for Disease Control and Prevention’s Division of STD Prevention, Surveillance and Data Management.”

The article highlights the complicated causes, including Financial, shortage of medical personnel and facilities, and health literacy . “The reasons for this increase are complex and intertwined, starting with a lack of funding.” and “Next, there’s a shortage of qualified personnel…. One of the main roles of public health programs is messaging, getting the word out. Without staff and resources, awareness has been lacking.”

“Rates of syphilis are six times higher among Medicaid participants compared with people covered by private insurance and twice as high compared with those who pay their own health care costs, according to a recent study by the CDC.”

Death after Surgery More Likely for Black Men [Barrier: Access to Health Care]

An online article on CNN, entitled Among seniors, Black men more likely to die after surgery than their peers, new study suggests, suggests issues with inequities in health care access as evidenced in a recent study Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study. The article states “Among older patients, Black men may have a higher chance of dying within 30 days following surgery than their peers, according to a new study.” In terms of the cause, “Dr. Yusuke Tsugawa, the senior author of the study and associate professor of medicine at UCLA David Geffen School of Medicine” says that while “the study did not explore what could be driving the disparity but Tsugawa said that “several factors” could potentially play a role.”

“The structural racism may at least partially explain our findings. For example, Black patients living in neighborhoods with predominantly Black residents tend to live close to hospitals that lack resources to provide high quality healthcare,” Tsugawa said in the email. “It is possible that Black men in particular face especially high cumulative amounts of stress and allostatic load, which refers to the cumulative burden of chronic stress and life events, potentially leading to a higher death rate after surgery among this population.”

This highlights the barrier to public health of Location/Access to Quality Medial Care. Several of our stories, including Amaka, Jessica, and Halimah, also point to how the location of health care facilities impacts people.

Dementia Care Programs Need to Be Comprehensive & Accessible [Barrier: Cost of Care, Medical Literacy, Access]

An article in Popular Science published March 1, 2023, entitled Dementia care programs are not just for the patient: Medical care for people with Alzheimer’s is widely acknowledged to be fragmented and incomplete, discusses various barriers to public health. The article discusses the importance of “comprehensive dementia care,” which includes “coaches or navigators who help assess patients’ and caregivers’ needs, develop individualized care plans, connect families to community resources, coordinate medical and social services, and offer ongoing practical and emotional support.” The article states “Over the past decade, a growing body of research has shown these programs improve the quality of life for people with dementia; alleviate troublesome symptoms; help avoid unnecessary emergency room visits or hospitalizations; and delay nursing home placement, while also reducing depression symptoms, physical and emotional strain, and overall stress for caregivers.”

The need for these navigators was addressed in one of our stories as was the challenges with caregiving for this mother and for another mother. Navigators such as these, help to overcome the barrier when patients and the public need support in the area of Medical Literacy.

Medical Staff Shortage Following the pandemic [Barrier: Medical Staff Shortage & Burnout]

Another article highlights the Barrier to Public Health of Medical Staff Shortage and Burnout. This Fortune article, entitled The pandemic has irreversibly changed America’s health care system. Here’s why we will all be feeling the consequences of delayed care for years to come, states “A lack of funding and resources, along with rising anxiety, depression, and burnout, contributed to a mass exodus of frontline workers. More than half-a-million health care and social service employees left the industry each month in 2022 and more than a third of nurses say they’re planning to quit soon. The American Hospital Association penned a letter to the U.S. House of Representatives Energy and Commerce Committee and declared the shortages “a national emergency.” Staffing needs are as urgent as ever, with 16 million working-age Americans still struggling with long COVID-19, resulting in around $170 billion in lost wages annually. These staggering shortages and rising backlogs continue to limit the number of nonemergent procedures that can be performed.”

One of our stories also describes how Jessica experiences the shortage in primary care physicians in the US.

Care Givers [Barriers: Cost of care, Caregiver Burnout, Health Professional Shortage]

Another article highlights the challenges caregivers face when caring for people with illness.

The article in MSMBC, entitled Opinion | Bruce Willis’ latest diagnosis reveals an uncomfortable truth: Americans would prefer to not think about what happens if our minds and bodies start to decline. Caregivers don’t have that luxury.

The article states “Caregivers are confronted with the difficulties of learning how to give care to a loved one, which entails managing symptoms, navigating the complexities of the health care system, finding resources and taking care of themselves too. Some might think the easy answer is to hire in-home assistance. But while some families — like Willis’ — are resource-blessed, the vast majority are not.”

As the parent of twin babies who required intense care for over a year and a half after birth, I can relate to this excerpt about other caregivers with similar situations. The Nigerian mother of a child with autism also faces similar challenges.

In the US, the article discusses “Many of the difficulties for caregivers boil down to a lack of support. We are in the midst of a critical shortage of direct care workers, which seriously limits the alternatives for even the wealthiest.”

Another story highlights how another Mother in Nigeria with a child with autism, copes with constant stress and mental health issues stemming from the challenges she faces as a caregiver.

Care Work Crisis [Barrier: Health Care Professional Shortage, Care Work Challenges]

An article in Fortune entitled Nurses on strike are just the tip of the iceberg. The care worker shortage is about to touch every corner of the U.S. economy, discusses the challenges that careworkers in the US face. The article states “Thousands of nurses recently went on strike in New York City to push for better staffing as hundreds of nursing roles remain unfilled, stretching nurses to their limits. This staffing shortage hurts patients and reduces the quality of care. And while New York City is facing hundreds of unfilled nursing positions, nationally we are talking about a shortage of more than 200,000 nurses.”

“Care workers–physicians, home health aides, early childhood care workers, physician assistants, and more–face critical challenges as a result of America’s immense care gap that may soon touch every corner of the American economy.”

And, this issue affects people worldwide. One of our stories discusses how a mother of a child in Nigeria is forced to quit her job to care for her child who was diagnosed with Autism. Another mother of a child in Nigeria, who was also diagnosed with autism, experiences mental health issues.

The Caregiving Crisis impacts the economy too. Check out this article, Solving the $290 Billion Care Crisis, for more information and research. It states “It took COVID-19, a deadly global pandemic, for the US to wake up to the gaping fault lines in the “care economy.” What is the care economy? It is a vast ecosystem where families, employers, and institutions—from daycares and nursing homes to schools and hospitals—come together to support the young, the old, and the sick. This support is necessary for the functioning of a healthy society, and this work underpins every part of the economy. We can ignore it no longer.”

Read more: Care Work Crisis [Barrier: Health Care Professional Shortage, Care Work Challenges]

Barriers to Health Care for individuals with Autism

Two of our stories discuss the barriers to health care that a mother of a child diagnosed with autism faces in Nigeria.

A paper from March 2021 entitled Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood, discusses barriers to health care faced by families and individuals with autism. The abstract states “Most individuals with autism spectrum disorder (ASD)—a complex, life-long developmental disorder—do not have access to the care required to address their diverse health needs. Here, we review: (1) common barriers to healthcare access (shortage/cost of services; physician awareness; stigma); (2) barriers encountered primarily during childhood (limited screening/diagnosis; unclear referral pathways), transition to adulthood (insufficient healthcare transition services; suboptimal physician awareness of healthcare needs) and adulthood (shortage of services/limited insurance; communication difficulties with physicians; limited awareness of healthcare needs of aging adults); and (3) advances in research/program development for better healthcare access.”

More research needs to be done. Another study, Autistic disorder in Nigeria: profile and challenges to management, states “Autism represents one of the most common developmental disorders affecting children, but there are few reports on autism in African children.”