NKF keynote speaker discusses racial disparities, how to eliminate these in health care
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BOSTON — The keynote speaker at the National Kidney Foundation Spring Clinical Meetings discussed racial disparities in the United States and how physicians can change their practices and political behavior to achieve health equity.
“COVID-19 had a huge impact on the United States population in general, but Blacks, Hispanics, American Indians and Pacific Islanders have had an age-adjusted death rate that is at least twice as high as that of whites,” David R. Williams, PhD, MPH, professor at Harvard University, said during his presentation.
These disparities have led to a decline in life expectancy at birth between 2019 and 2020 overall, but this decline was seen most prominently for Black and Hispanic individuals, he said. Williams noted there has been no decline of this magnitude since 1944.
Drivers of disparities
“Income, education, occupational status or wealth is a powerful predictor of variations in health,” Williams said, “and there are large gaps in socioeconomic status in the United States.”
According to a study that evaluated data from the U.S. Census Bureau in 2018, for every $1 a white household earned, Black households earned $.059, Hispanic households earned $0.73 and American Indian households earned $0.59. Williams referenced another study regarding wealth that revealed that for every $1 of wealth a white individual has, a Black individual has $0.10, a Latino individual has $0.12 and individuals of other races have $0.38.
Additionally, data show African Americans with a college degree and with the longest life expectancy of the group have a shorter life expectancy than white individuals with a college education, white individuals with some college education and white individuals with just a high school education.
Therefore, Williams said a strong driver of racial disparities in health care is racism. As he said in a previous lecture that Healio covered, desegregating neighborhoods will also reduce racial disparities in health because where one lives is a driver of opportunity and leads to the other drivers of disparities. By eliminating segregation, disparities in income, education and health would be erased, according to studies Williams referenced.
What can be done
If physicians listen to patients and communicate without racial bias, not only will they find better health outcomes, but they will also build trust with their patients, Williams said. This can also be achieved by diversifying the workforce to meet the needs of all patients. Similarly, Williams said physicians must do what they can to ensure health access for all.
In addition to changing practice management and becoming involved in policy, Williams referenced some hospitals that are creatively eradicating disparities.
While Boston Medical Center built a rooftop farm to give back to its local community and provide better nutrition for its patients, Loma Linda University Health built a $68 million education clinic and dedicated a top floor to a “gateway college” to lower unemployment rates and provide job skills for high school graduates, Williams said. The gateway college offers medical certificates to students.
Similarly, Williams used Rush University as an example of what an academic center can do. To reduce the life expectancy gap between neighborhoods in its community by 50% by 2030, Rush University initiatives have included projects with high school students to bring community members into health care, projects to support local businesses and incentivize employee volunteer programs.
“We need to build a science base that will guide us in developing the political will to address the racial and social inequities,” Williams concluded. “There is no political will, there’s no desire to make a change, if we don’t feel the pain – if we don’t sympathize with individuals.”
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Williams DR. Understanding and effectively addressing inequities in health. Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.
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