Diversity among doctors drives trust in health care

— Black History Month gives us the opportunity to reflect on the countless examples of the contributions that African-Americans have made to build our country. By celebrating these pioneers who helped shape America, we are inspired to overcome adversity and realize the positive change we, too, are capable of enacting in areas where inequity still persists. Black health is one such example where much has been achieved, but much more can be done to secure positive health outcomes in the black community.

We know that on virtually every measure of health, African-Americans fare far worse than their white counterparts— from diabetes to heart disease to infant mortality. These disparities can be explained by myriad and co-influencing factors, including a lack of access to affordable healthcare, nutritional education and safe spaces to exercise.

A less apparent, but equally troubling, reason for unequal outcomes in black health is a strong sense of skepticism— even mistrust— in physicians, in medicine and in the healthcare system in general. The impact of the Tuskegee syphilis study, a four-decades-long clinical trial in which African-American men, unaware of their condition, endured the disease for the purpose of medical observation, still looms large on the black consciousness, perpetuating a culture of wariness that has lingered for generations.

Mistrust in medicine is particularly pronounced among African-American men many of whom enter the healthcare system only after their conditions are severe or life-threatening.

A 2011 study by the University of North Carolina at Chapel Hill found that black men who self-identified as “highly mistrustful” of healthcare were more than twice as likely to delay check-ups and cholesterol screenings, and three times more likely to delay a routine blood pressure screening, than those who were more trusting.

Distrust, skepticism, fear— these beliefs are intensely embedded in the history of black healthcare, but they are ones we must overcome if we are to truly improve the health of our families and communities. Today, too often, a lack of trust can become a huge liability, even a death sentence, for black patients.

I became a healthcare professional, because I saw my family members, friends and neighbors plagued by diseases that could have been prevented, if they had taken a proactive approach to their care. While it’s important to acknowledge that African-Americans’ relationship with the healthcare system is complex, our community cannot afford to remain disengaged in these matters.

That’s why all of us must take a hard look at the barriers that prevent African-Americans from achieving health equity and commit to an effort to reclaim black health and wellness.

On the part of individual members of the black community, that means not only taking advantage of the coverage opportunities provided by the Affordable Care Act, but also taking a hands-on approach to health— one that seeks out care in a timely and accountable fashion and works to nurture a positive culture of health in our families, churches, neighborhoods and cities.

On the part of healthcare providers, this work will require a new standard of care that recognizes the unique needs of minority populations and designs a care strategy around what works for each individual patient. Working with physicians at our facilities, we are learning that when we actively engage the patient in his or her care, we’re better able to build meaningful, long-term relationships that lead to better health outcomes. This personalized care approach is proving vital in earning trust and improving the health of the African American community.

Representation also matters when it comes to building confidence in healthcare in minority communities. Black Americans make up 13 percent of the population, yet they account for barely four percent of practicing physicians nationwide. What’s more, is that studies show relationships between patients and physicians of the same race or ethnic background are characterized by higher levels of trust, respect and patient satisfaction.

It’s clear that more needs to be done to encourage African-Americans to pursue medical professions and ensure the proper supports are in place to nurture diversity in the field.

As we remember and reflect on black history— the bad and the good, the darkness and the light— there is no better time than now to commit to actions that will make our community healthier and stronger. And it begins by working together to break down barriers, real and perceived, to the care we need and deserve.

Patricia A. Maryland, Dr. PH, is the President of Healthcare Operations and Chief Operating Officer of Ascension Health.

For communities of color, the fight against diabetes is far from over

— Recently, the Centers for Disease Control and Prevention (CDC) announced the rate of new cases of diabetes in the United States declined by about 20 percent from 2008 to 2014. This represents the first sustained decrease in diagnosis since the disease emerged as a major threat to public health over the course of the past two decades. But the fight is far from over, especially for communities of color.

While the CDC report is good news regarding an overall decline in diabetes rates, it did not acknowledge a significant change in prevalence among the African-American community, which continues to be far more vulnerable to the disease than other racial and ethnic groups.

Consider the data: Black adults are about twice as likely to have diagnosed diabetes as non-Hispanic White adults. They are also twice as likely to die from the disease. What’s more, African-Americans are more than three times as likely to suffer from health complications related to diabetes, such as lower-limb amputation and kidney failure.

It’s clear that the African-American community is shouldering an unequal burden when it comes to diabetes treatment, prevention, research and education. And so the CDC’s announcement—while welcome news—does not signal that the fight against the disease is over. There is more work to do to not only overcome the diabetes epidemic, but also eliminate the healthcare disparities that disproportionately plague our community.

To do that, we must redouble our efforts to create a culture of health in African-American communities—one that removes the stigma of seeking care and helps our neighbors and family members access the opportunities provided under the Affordable Care Act. Healthcare.gov is now available for the open enrollment period through January 31, 2016, and taking advantage of the options available today is the first step our community can take to reclaim Black health and wellness.

But coverage alone isn’t enough to guarantee better health outcomes for African-Americans. Healthcare providers have a responsibility to deliver inclusive, quality care that considers the needs of the whole patient. That means providing patients with relevant, reliable information that empowers and engages them to make choices for a healthier life.

The truth is that all healthcare providers should strive to provide an environment where no one is excluded—where everyone has access to compassionate, personalized care and the opportunity for better health regardless of their struggles or station in life. And that’s the right model for all providers. Because we must get to know our patients on an individual, holistic level—not prescribe a one-size-fits-all approach—if we intend to truly improve their health outcomes.

Finally, our policymakers, civic leaders and all who have a stake in the health of our community must address the social determinants that influence and widen the diabetes equity gap. For years, we’ve known that diabetes can be prevented and managed with healthy lifestyle changes such as exercise and good nutrition. But it’s difficult to go for a run around the block when you live in a high-crime neighborhood. It’s challenging to find fresh fruits and vegetables when you live in a food desert. We must marshal our communities around the policies that affect our environment’s ability to support a culture of health and wellness.

Diabetes has been—and will continue to be—a major public health issue in the U.S. We’re making progress in the fight against the disease, but we need to do more to address the disparities felt by the African-American population. With a focused effort from members of the Black community, policymakers, civic leaders and healthcare providers to create a culture of health, deliver compassionate, personalized care and advance the policies that make healthy lifestyles viable, I am confident we can curb the diabetes epidemic for good, for everyone.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer for Ascension Health.