San Diego Forum Examines Role Of Race In Medicine

Today is world AIDS Day and African-Americans are a racial group that is most affected by HIV it seems a perfect time for this panel. There's a public forum going on today which tackles the issues of racial disparities in healthcare and their effects of racism on health. To talk about it we have Dr. Camara Jones President of the American Public health Association an expert on the subject. We also have Dr. Edith Mitchell President of the American medical Association and Rodney Hood, a doctor in private practice in San Diego. He has 35 years plus of experience and is President of the San Diego-based multi-health -- cultural health foundation. Welcome -- welcome all of you to the show. This is a very impressive panel I will say. Would start off. I'm looking at some of the studies here and when it comes to medical outcomes, racial disparities -- they don't seem to have changed dramatically over the last 50 years. I think this country has changed rather dramatically. What would you say is causing all this? Why haven't we changed quick Will I will take a shot of that. I think that the difference we see in health outcomes, the fact that like babies die twice as often in the first Uriel of life as white babies and Latino have more obesity and liability -- diabetes. All these health disparities have a deeper root cause that we haven't addressed. Which is racism. Differential treatment and the different life experiences of people of different ethnic groups in this country. That's why we are actually -- people are are afraid to say the word racism. When you say it, the first thought is I am not racist. Why are you calling me a racist? So were having this discussion this evening to talk about racism, not as an individual character flaw or moral failing or psychiatric illness. Is a system of assigning value aced on race that unfairly disadvantages some individuals and communities. And unfairly advantages other communities through the waste of human resources. Trying to get a deeper root cause. 50 years ago we might've been dealing with overt racism. People who have these thoughts and beliefs and didn't say them out loud. Now it's much more pernicious. Beazer believes that are still in grade in the system and people. Dr. Mitchum, there had To have been improvements in medical care over the last 50 years. When we think about Medicare, Medicare was established 50 years ago and there are certainly have been improvements in overall survival as well as care of various diseases and conditions. However, the differences, between the survival and outcome improvement that have occurred in the Caucasian population are certainly far fewer in minority populations. Not only in African-Americans And other minority populations as well. There can be a lack of access to care, there can be even cultural bias in terms of healthcare institutions. So it's eliminating all of those factors that contribute to disparities. Dr. Hood, you are a local physician. Have you experienced this first hand in your practice quick I've been in practice in San Diego for almost 40 years and health disparities here in my practice and throughout the country throughout the 40 years. Unfortunately, do we have certainly seen some improvement if you read the data really hasn't changed. One of the focus -- focuses of a multi--- multicultural foundation is to address the issue of health equity. We use the term health disparities and health equities. Health disparity is really just the difference and health outcomes and status between various groups. Racial groups, ethnic groups age etc. Health equity is dealing with the unnecessary and unjust outcomes based on other factors. We had -- we heard poverty is one, where you live is another, your lifestyle is another -- what is not discussed enough is race in racialism and discrimination in the health system. Is well-documented over many years. How do we know it's simply not various factors -- one group is more inclined through -- to a certain illness than another. Is not these external factors but the system itself is not working. In 2002, we released the unequal treatment report showings quality of care received within the healthcare system even if you're in the same system. Everyone in the VA and covered by Medicare or Medicaid. But that panel also recognize differences in quality -- happening by race and access. Big thing we don't deal with are the differences in the conditions of our lives. So living in different neighborhoods -- it is set Dess it doesn't just so happen, people of color are poor or they were tend to live in more impoverished neighborhoods than white people. How does that happen to be? So then you get outside of what happens outside the healthcare system. You to baking policies. You get into history and the fact that this country was founded by the taking of the land from American Indians in the near genocide of those people and putting them onto reservations. You talk about the role of enslaved Africans and their progeny who built this country over centuries without being able to get wealth. Even though people like to say, what is happening today, what is someone eating or not eating today? You have to look at structures and history. So what are we talking about when someone enters the medical system. You are pollution and maybe you have, African-American and you have a teenage boy Dashwood some of the things as an African-American you might encounter in the system, that if you are a 15-year-old Caucasian boy, you might not have the same experience? If you are a 15 role Caucasian boy if you are walking away from a police officer and carrying a knife, you would not be shot 16 times. Are not talking about what is happening just in the healthcare system [ Indiscernible - multiple speakers ] And the healthcare system, my wife is a nurse practitioner -- everyone says they want to help in the healthcare system. So let me tell you what the data shows. She talked about the Institute of medicine study unequal treatment. In that they looked at studies that looked at African-American Hispanics going to be ERT treated for bone fractures and pain. African-Americans and Latinos got less pain medications than whites but the same diagnoses and being treated by the same physicians. There's a study in cardiovascular disease published in the New England Journal of Medicine in which they looked at treatment of cardiovascular disease and interviewed a lot of physicians who made the correct diagnosis, but when it came time to intervention, they recommended less effective treatment for African-Americans than whites. So the literature is full of that. What we believe is that this is not necessarily a conscious decision on the part of the physician. At the subconscious decision. And what is encouraging about that, is that as physicians became aware of this subconscious bias, they could change. Also there are studies in cancer patients, in lung cancer -- large study done at the Massachusetts General Hospital in Boston where patients with stage I lung cancer were evaluated according to race in the kind of therapy they were recommended and received. It was very clear that African-Americans received far less surgery and were recommended surgery far less frequently than others. So it's very clear that there may be subconscious or conscious bias. But certainly biases that are related to the care received, the access to care and therefore the ultimate outcomes. Is widespread and well-documented. Is the President of the American health Association, it is very clear to us that health is not created only within the health sector. It's very important for us to acknowledge these differences in quality of care. It's very important for us to acknowledge the differences in access to care. We have to talk about the differences in our everyday lives that are making some individuals and community sicker than others in the first place. That is where the most important impact of racism happen. Why is it that the schools in some neighborhoods are not as good as the schools and other neighborhoods? What we have residential segregation in the first place? I think we have to achieve -- achieving health equity will involve three things for this nation. Big principles. I know people are thinking big think -- big principles -- recognizing and rectifying historical injustices and providing resources according to need and recognizing individuals. Summit comes to the healthcare system, we are talking part of this is we simply don't have enough physicians in African-American neighborhoods? Whitey keep going back to the healthcare system? Is not just within the healthcare system. The reason is because that's what the form is about. I see what you're saying. There other including preventive care. Preventive care involves nutrition. And so in certain segregated nickel -- neighborhoods. There might not be access to fresh vegetables, fruits and therefore, the opportunity lost for preventive health. Access to pharmacies and access to physician offices for preventative health. So an example is, I'm also the President of a medical group called multicultural medical group. The past three years we had a grant that was from innovation. What we did was identify the top utilizer's of the health system. We put together local intervention team. The issue was to keep the modern -- to them out of the hospital to save money. We were very successful. We found that what what was Them -- what kept them out of the hospital and well, wasn't the clinical medical intervention cop at the social intervention. Helping them to overcome the social barriers. The issue of look -- lack of food, transportation, literacy -- not understanding the system, learning how to navigate the system. So you have groups of folks who are stuck in this culture who we call noncompliant. Really what it is is a lack of resources. When you help them with resources, you can help their health get better. I want to be able to get this in before the end of the section. Today is world AIDS Day, African Americans are disproportionately affected by HIV. Why is that? Do have a solution here? So there are multiple factors and we actually have just completed a consensus panel yesterday on AIDS in this country. It is well recognized that there are approximately 1.2 million individuals in the country suffering from AIDS and HIV disease. About 500,000 are African Americans. For many, it is a cultural problem in terms of the causes and contributors to HIV. Others -- lack of access to care. Not interested in care and tell the individual is sick. So therefore, the preventative strategies that we know about in preventing HIV and AIDS, and also the early 30 -- therapeutic interventions that allow for long life in patients with HIV disease, are ignored. For many, the expense of leaving a day of work to attend a medical institution. Therefore lack of access to care. Fewer individuals with insurance that will therefore allow them to receive the care. So there are multiple factors contributing to the excess disparity and excess burden experienced by African-Americans from HIV disease and AIDS in this country. Was people enter the healthcare system, as part of this is that there are fewer African-American doctors in the system? Certainly fewer than the population as a whole. When you get to the Hispanic community, the disparities are even wider of East in the state of California. That's correct. If you consider that in the United States, 12.9% of their community is African-American, yet only 3.9% of physicians in this country. While there have been many avenues to try and increase the number of doctors in minority communities, most of those effects have allowed for some individuals to join me provider experience, but not enough. So yes, we need more doctors who are more likely to go back to the communities to practice. How do we do that? In California you cannot use race as a criteria. Their step -- several states have gotten this area. Be seen a decline in the number of minority students entering medical schools at the same time period. So how do you turn that around? Cost is one area. Many medical students complete their medical training with range of $250,000 that. And for many -- $250,000 debt. Many cannot think about that amount of expense and the long-duration of study. So it is expensive. Yes that to. I also think that getting back to this evening at 6 PM you will hear Dr. Jones as well as a panel of other experts who will be sitting there. We will have Jamaal Miller who is the deputy director of the office of health equity at the state. We will actually have a medical student -- African-American medical student talking about her experience and the research she is doing. We are expecting a dozen or more students to come. We are actually setting up what we call, mentoring of the students to support them. These are medical students and premedical students and those that want. We need to develop a pipeline to engage them early and encourage other students to follow that track. That will be the final word. The town hall is racism -- left the cure began. It is happening at the Jacob Center for innovation at Euclid Avenue in San Diego. Is sponsored by the Multicultural Health Foundation and national and community partners. You can go to KPBS.org for more details. Of anything my guess Dr. Rodney Hood and Dr. Camara Jones. Thank you for being here.