(UN)EQUAL TREATMENT FOR ALL

Health disparities explained
By Erin Pagel

Health disparities are preventable differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that are experienced across populations. Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status and sexual orientation. Health disparities are often identified along racial and ethnic lines, in that African Americans, Hispanics, Native Americans, Asian Americans, Alaska Natives and whites have different disease and survival rates.

To learn more about health disparities and understand what we can do to impact the issue locally and beyond, we spoke with Dr. Tejinder (Tej) Khalsa, a general internist and assistant professor at Mayo Clinic and medical education consultant for the World Health Organization (WHO), about health disparities impacting Black, Indigenous and people of color (BIPOC) broadly and in our own community. Khalsa is of Northern Indian background, was born in Britain and married into an African-American family. She now calls Rochester home and is a champion for closing the gap in health disparities. Khalsa first felt the real sting of health disparities (something she’d previously only learned about in textbooks and studied as a researcher) when her Black mother-in-law was given substandard care when hospitalized for abdominal pain. Khalsa and her father-in-law stepped in to advocate for her care.
“It was a nightmare,” says Khalsa. Seeing this unfair treatment fueled her passion for addressing disparities with her own practice, her work with WHO and her research and academic efforts.

AREAS OF DISPARITY

Health disparities in the United States impact and hurt both white people and BIPOC, though the latter are disproportionately harmed. Disparity exists in preventive care, chronic condition management, cancer screening, detection and treatment and nearly every other health event. 

“People of color from historically marginalized groups face poorer health in almost every way,” says Khalsa. “Black people, Native Americans and Native Hawaiians all get sicker sooner than white people, have more aggressive progression disease and die sooner.” Analysis of 2014 data indicates that if white Americans were their own country, it would rank 34th in the world for life expectancy. If Black Americans were their own country, it would rank 96th.

Khalsa notes, “One of the most alarming health care disparities for women relates to maternal and infant mortality. The U.S. has the second-highest maternal and infant mortality rates among 31 comparable, high-resourced countries. All families, regardless of color or race, are at risk.” And still, “Black women are dying from preventable pregnancy-related causes at three- to four-times the rate of white women, while Black babies are dying at twice the rate of white babies,” adds Khalsa. 

The ongoing COVID-19 pandemic brings its own disparity. BIPOC bear the heaviest burden at every stage, including risk of exposure, access to testing, severity of the illness and death and getting sick and dying of COVID-19 at rates higher than whites and higher than their share of the population. Black, Latinx and American-Indian people are experiencing hospitalizations at rates four-and-a-half to five-and-a-half times higher than non-Hispanic whites. 

WHY DISPARITIES STILL EXIST

Though real progress has been made in addressing some disparities, reasons for ongoing prevalence of others are rooted in the constellation of factors both inside and outside hospital doors. Access to care, financial concerns and cultural differences all play a part in ongoing disparities. Disparity has deep roots in racism and slavery, Indigenous women and Black women alike having been treated as less than human throughout much of our history. Beyond overt and deliberate racism, BIPOC experience discrimination as a result of implicit bias and a system that encourages racism. “It takes 100 milliseconds to judge someone based on race,” says Khalsa, “and studies have shown that 70% of us, doctors included, have anti-Black bias.”

Khalsa shares, “Structural racism denies Black women equitable access to the social determinants critical to health. Examples include job discrimination, low-resources housing, being paid less for the same work and lacking inheritable wealth because of the legacy of slavery. These are very powerful factors that accumulate as toxic stress in the bodies of Black women, contributing to a biological weathering effect that threatens their health.”

ADVOCATE AND ADDRESS DISPARITIES

In 2019, world leaders adopted a United Nations declaration on universal health coverage. However, it remains a political challenge in the U.S. “It’s time to get involved and engage with our elected officials to lift this initiative into law,” says Khalsa. “We can’t have people in our country dying because they are poor.” 

Address disparities with “knowledge, compassion and action,” says Khalsa. “Every one of us needs to build our knowledge, expand our circle of compassion toward people who are different than us and move into action. We can overcome our own implicit bias and advocate for others who are different from us or missing from the conversation.”

Khalsa says we can transform our everyday interactions with enhanced intentional kindness. “We are at a critical point of reckoning in our nation’s history. We are dealing simultaneously with the COVID-19 pandemic, the centuries-old racism pandemic, an economic crisis and a political crisis. We are suffering with profound grief, loss and rage. Yet we all have the power and potential within us to be part of the transformative healing we need. Fill yourself with knowledge and compassion, then intentionally see the person in front of you as part of your own family. Treat them intentionally with kindness. And keep pushing—push yourself to do more for justice, and push your elected officials to do the same.”