FROM THE PRESIDENT by LEWIS HARGETT , MD
Health Equity : Physicians Doing Their Part to Even the Playing Field
Physicians promote good health and wellness for patients . We spend years in medical school and post-graduate training to diagnose , treat illnesses / injuries and manage the health care of patients . The initial goal is to treat the immediate disease process . However , the ultimate goal is to make the patient “ whole ” and back again to a state of “ good health .” But what does “ good health ” mean ? According to the World Health Organization , the definition of good health is , “ A state of complete physical , mental and social well-being and not merely the absence of disease or infirmity .” This definition infers that patients can recover from a specific disease or infirmity but there are other factors outside the medical treatment plan that can affect the health care outcome . Physicians may not be aware that some patients experience obstacles to receiving health care . The “ whole person ” or “ patient-centered ” concept must be considered , not just the specific disease treatment plan .
The Centers for Medicare and Medicaid Services ( CMS ) defines health equity as “ The highest level of health for all people , where everyone has a fair and just opportunity to attain their optimal health .” Often there are barriers outside medical treatment that affect the patient ’ s ability to attain optimal health . These barriers or obstacles are called the social determinants of health . They include race , ethnicity , disability , sexual orientation , gender identity , socioeconomic status , geography , preferred language , etc . All of these disparities present challenges for the patient to achieve a state of “ good health .” Again , health equity can be achieved when the “ whole patient ” is considered and not only the specific disease process .
The social determinants of health listed above not only affect good health , but they also affect one ’ s longevity . On average , one ’ s lifespan is often determined by where they live . The Louisville Metro Department of Public Health and Wellness ( LMPHW ) Health Equity Data Dashboard review dated Jan . 31 , 2024 , showed there was greater than a 15-year difference in life expectancy for residents who live in the West End of Louisville ( 65.4 years ) vs . residents that live in the East End of Louisville ( 81 years ). Issues such as race , living in the West End ( predominately African American ) vs . East End ( predominately white ), income , education , access to healthy food , access to medications , reliable transportation , housing , etc ., all contribute to the differences in one ’ s life span . In view of those factors , environmental conditions where people are born , live , learn , work and age can affect one ’ s state of health and quality of life .
As a physical medicine and rehabilitation ( PM & R ) physician , I have encountered some inequities in health care due to language and cultural barriers . My goal is to provide quality health care for all patients to regain the highest level of physical and mental functioning based on their disability . In PM & R , a multifaceted team approach has been beneficial to addressing the barriers outside of direct medical treatment . Today , cultural and language barriers are common disparities . For example , I am reminded of a Hispanic patient that was admitted to my rehab inpatient service following an acute stroke . English was not the patient ’ s primary language , and an interpreter was needed . Hence , communication between the patient and the rehab team to include doctors , nurses , therapists , dietary , case-manager , etc ., was a potential obstacle in his recovery . However , several of the patient ’ s family members were fluent in Spanish and English . Also , there was a rehab nurse fluent in Spanish and English . A family member was encouraged to be present for the health care providers and during therapy sessions to serve as an interpreter when needed and provide support for the patient . During the patient ’ s hospital stay , the disparities of culture and language were addressed by all of the health care providers involved in this patient ’ s recovery . The patient was subsequently discharged home in an improved condition . All of the strategies used helped address the language and cultural barriers to maximize better health care services .
What can we as health care providers do to address the health disparities that prevent many patients from attaining a state of “ good health ”? First , we must be aware that health disparities exist , and they must be identified . Once identified , specific actionable goals should be established to address the disparities . Then , direct interventions and referrals should be made to the appropriate agencies and hospital services to address the disparities . Consequently , disparity factors will be eliminated or minimized , and the patient can be on the road to better health outcomes .
In conclusion , all health care providers are encouraged to be more aware and educated on the social determinants that affect patients ’ access for health care outside of direct medical treatment . Heath equity can be achieved when quality health care is customized to meet patients ’ circumstances and individualized needs . Then , there
is a better opportunity for patients to achieve “ good health .”
Dr . Hargett is a physical medicine and rehabilitation physician in private practice . He is also Treasurer of the National Medical Association .
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