No easy solution to eliminate health care disparities


There are no easy answers for finding out the key to eliminating health disparities and several factors might help lead to the reason why such inequities exist.

“In the public health, I think we realize now that eliminating health disparities or achieving health equity will take work on multiple levels including [with] the individual, the community or neighborhood, the health care system and policy levels,” said Dr. Cheryl Holt, a disparities expert and co-director of the population science program at the University of Maryland Marlene and Stewart Greenebaum Cancer Center. “We recognize that almost everything impacts health including factors such as poverty, education, employment and where a person lives.” “With that, eliminating health disparities will take work on all of these levels.”

In 2014, Dr. Holt, who is also associate professor of behavioral and community health and co-director of the Center for Health Behavior Research at the university’s School of Public Health, joined internationally recognized molecular epidemiology of breast and prostate cancer investigator Dr. Joanne Dorgan in leading a new research program that focused on issues of cancer epidemiology, prevention and disparities at the Greenebaum Cancer Center.

The program brings together investigators with a range of expertise including cancer disparities, tobacco control, molecular epidemiology, genetics and genomics of pain, as well as other disciplines. It includes investigators from the School of Medicine and School of Nursing on the UMB campus as well as researchers from the School of Public Health in College Park.

While numerous reports continue to suggest that certain policies at medical facilities create barriers for minority patients, Dr. Holt says she isn’t sure that is the case.

“I am aware that certain facilities have in their mission to serve patients in the Baltimore area which includes a significant proportion of minority individuals, for example, the Greenebaum Cancer Center,” she said.

As a result of a long documented lack of trust that minorities tend to have toward physicians, Dr. Holt noted that trust does play a key role in health care. She says it could also play a larger role in helping to reduce disparities.

“Trust is an important issue and it is part of the health disparities or inequities picture. There are legitimate, historical reasons why people may not trust doctors, hospitals and [other] institutions,” she said. “It is important today that people become advocates of their own health care. Find a regular doctor that you feel comfortable with and remember that you are the consumer and you can change doctors if you don’t feel you are getting good care.”

It’s also important that patients educate themselves about their condition so they are more informed on the choices made, Dr. Holt said.

Taking a family member or companion to a medical appointment should also be considered and can prove helpful in many instances, she said.

“There can be culture or language differences that make for challenges in the health care setting. There can be limited health literacy among the patients, which makes it difficult for people to access and interact with the health care system even when they do have insurance,” Dr. Holt said.

The medical research also shows racial and ethnic minority patients tend to receive a lower quality of care than non-minorities.

“In some cases, there may be bias, even unintended or unconscious bias on the part of the providers treating people who in many cases are different from them,” Dr. Holt said.

With the implementation of the Affordable Care Act, the White House has repeatedly noted that there has been a closing of the disparities gap. However, only time will tell if that assessment holds.

“I think it may be that people are enrolling and accessing health insurance. However, in the overall big picture, it is going to take more time to determine the impact on health disparities,” she said.