DIVERSITY & INCLUSION
RECOGNIZING RACIAL INEQUALITIES TO PRACTICE
BETTER MEDICINE AUTHOR Kathryn Vance
After a year of civil unrest met with a global pandemic , the
Greater Louisville Medical Society saw an opportunity to educate members on the impact of racial injustices in and on the medical field . In partnership with the Lexington Medical Society and the Health Enterprises Network , on Jan . 14 GLMS hosted the first of three seminars in a new series entitled Racial Inequality in Medicine , featuring speaker Dr . Karen Krigger , MED , FAACP , AAHIVM ( S ).
DEFINING PUBLIC HEALTH TERMS
Dr . Krigger first defined some of the most commonly used , and often misunderstood , terms used in looking at public health inequities .
Equality : Each individual or group of people is given the same resources or opportunities .
Equity : Each person has different circumstances and is allocated the exact resources and opportunities needed to reach an equal outcome .
Health Equity / Inequity : Health equity occurs when everyone has the opportunity to be as healthy as possible . Health inequity occurs when people have a lack of equal access to the needed resources to maintain or improve health outcomes .
For example , equality is that with a certain MCAT and interview score , you will gain entrance to medical school . Inequity is that some medical students have relatives who can offer them private tutoring sessions in an anatomy lab . She explained that according to the Centers for Disease Control and Prevention , “ Equity is a process and equality is an outcome of that process .”
Health disparities also affect the quality and availability of care for many people . These are preventable differences in the burden of disease , injury , exposure to violence and opportunity to achieve optimal health , that are experienced by socially disadvantaged populations . Health disparities are influenced by factors of race or ethnicity , gender , education or income , disability , geographic location , sexual orientation and more . “ These health disparities are directly related to the historical and current unequal distribution of resources ,” said Dr . Krigger .
Black , immigrant and low-income neighborhoods here and across the state have for decades been subjected to Redlining . Redlining is the systematic mapping of neighborhoods to grade them as undesirable for investment , as places less desirable / safe to live . These grades are often very low , thus eliminating access to mortgage insurance or credit and affecting zoning decisions .
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While redlining was “ officially discontinued ” in 1951 , the impact of disinvestment resulting from redlining , with reduced access to and acceptance from leading lenders , is still evident in Louisville and across the country today . This can be seen in refusal to provide delivery in certain areas , business loan denials regardless of credit-worthiness , and dropping property owners from insurance coverage altogether , based solely on zip code . These practices have resulted in poorer , overcrowded housing and exposure to more severe levels of air pollution , which can contribute to a variety of chronic diseases .
Food Deserts describe poor accessibility to sources of healthy food , as measured by distance to or number of grocery or produce stores in an area . Dr . Krigger noted remarkably that Louisville is considered a food desert in all areas except the Northeast .
“ If you take a trip from the medical school , down Broadway to 46 th Street , and count the number of fast-food joints and compare them to the number of opportunities to purchase groceries and fresh fruits and vegetables , you ’ re going to have a rude awakening ,” she said . Family income , vehicle availability and public transportation also affect access to those healthy food choices . The consequences of these food deserts are numerous , but most certainly put people at a higher risk of diet-related diseases such as obesity , diabetes and cardiovascular disease .
RECOGNITION OF HEALTH OUTCOME DIFFERENCES BETWEEN AMERICANS NATIONALLY , STATEWIDE AND LOCALLY
In all communities , social determinants of health dictate a person ’ s access to care and can be either positive or negative to a person ’ s health outcomes . The five social determinants of health are neighborhood and built environment , health and health care , social and community context , education , and economic stability . These determinants can be found in social norms and attitudes ( discriminations , racism ), exposure to crime and violence , socioeconomic conditions , residential segregation , language / literacy , the “ digital divide ” ( access to mass media and emerging technologies ), culture and so much more .
Housing instability and unemployment are key drivers of poor financial stability . In a 2019 report from the National Alliance to End Homelessness , the Black population in the US had a greater percentage of homelessness than the general US population . A Bureau of Labor Statistics study also showed that Black Americans face nearly double the unemployment rate of that of white Americans .
Issues crucial to educational equality include enrollment in