May 14, 2004

MGH forum addresses racial and ethnic differences in health care

It's a complicated health care subject that has a long history. For years, minorities have received lower quality medical care than whites in the United States. This difference — or disparity — in the health care experience and health outcomes was the topic of an engaging forum, sponsored by the MGH Disparities Committee, May 6 in the O'Keeffe Auditorium. A wide cross-section of MGH employees and staff from most departments overflowed the O'Keeffe Auditorium to hear guest speakers W. Michael Byrd, MD, and Martha H. Hill, PhD, RN, FAAN, both of whom were members of the Institute of Medicine (IOM) committee that produced the groundbreaking report "Unequal Treatment: Confronting Ethical and Racial Disparities in Health Care."

Byrd, who is an instructor and senior research scientist for the Harvard School of Public Health and a staff physician at Beth Israel Deaconess Medical Center, co-authored with his wife, Linda Clayton, a Pulitzer-Prize nominated book American Health Dilemma, which documents the African American experience in health care.

He led the forum with an in-depth look at the history of health care disparities, chronicling the phenomena from the early Greco-Roman period through the American slavery era up until the present day. "Disparities exist in many areas in our health care system," said Byrd. "They exist in areas such as service delivery, health insurance status, access, affordability, clinical encounters and quality of care. How did we get here? We have to look at our history, our culture and the structural development of our health care system."

Hill continued the presentation by focusing on the IOM report and the conclusions the committee developed. Hill, who is dean and professor at the Johns Hopkins University School of Nursing, is internationally known for her work and research into preventing and treating hypertension and its complications, particularly among young, urban African American men.

After conducting a literature review, the IOM committee found that disparities were consistent across a wide range of disease areas even when access and clinical factors were taken into account. They also found higher mortality rates among minorities and evidence of poorer quality of care. They discovered a variety of potential sources of disparities - such as cultural and language barriers, lack of stability in relationships between patients and primary care providers, and fragmentation in the health care financing and delivery systems.

The core challenge that the committee faced was answering the question: "How could well-meaning, highly educated health care professionals create a pattern of care that appears to be discriminatory?" Evidence suggested that bias, prejudice, uncertainty and stereotyping were contributing factors to discrimination in interactions between providers and minority patients.

The committee concluded the report with several recommendations to address these differences: increase awareness of the issue; create interventions in the health system; provide cross-cultural training for providers; collect more data and monitor progress; and conduct more research into the issues that cause disparities.

"It was a privilege to have Dr. Hill and Dr. Byrd discuss this important topic at the MGH," said Joan Quinlan, director of MGH Community Benefits and co-chair of the MGH Disparities Committee. "The MGH currently is addressing racial and ethnic disparities within our own community and is making progress through the hospitalwide Disparities Committee. This forum is one more tool to help our employees and staff better understand this issue."
The event was co-sponsored by the Department of Nursing, Community Benefits, Patient Care Services Diversity Steering Committee, the Multicultural Affairs Office, the Association of Multicultural Members of Partners and the Massachusetts General Physicians Organization.

Above, from left, Jeanette Ives Erickson, RN, MS, senior vice president for Patient Care Services and chief nurse; Winfred Williams, MD, director of the MGH Multicultural Affairs Office; Hill; Byrd; Clayton; Quinlan; and Brian French, RN, of MGH Patient Care Services.