The Science of Eliminating Health Disparities

I'm checking-in at the 2012 Summit on the Science of Eliminating Health Disparities, which is focused on Building a Healthier Global Society by Integrating Science, Practice and Policy.  The summit has been rescheduled post super storm Sandy from December 17-19, 2012. 

A Woman’s Worth

In 1920 the 19th Amendment to the U.S. Constitution was ratified giving women the right to vote and it was unsuccessfully challenged a year later.  Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on race, color, religion, sex and national origin now has recent amendments including the Lily Ledbetter Fair Pay Act of 2009.

Today marks the 40th Anniversary of Title IX, The Education Amendments of 1972 another hallmark for girls and women across America. Meanwhile the Paycheck Fairness Act (S. 3220), that would extend the reach of the Equal Pay Act of 1963 and the Fair Labor Standards Act to close the gap male–female income disparity in the United States, has failed to pass the U.S. Senate. This is a story of generational as well generative progress. 

“The Best Countries To Be A Woman — and the Worst” New York Times article describes Canada's successful top ranking for “... policy mix giving women access to health care and opportunities and protecting them against violence made it more egalitarian than some European nations and the United States.”

The June 2012 issue of JAMA features an original contribution from a group of researchers led by Dr. Reshma Jagsi on gender differences in the salaries of physicians who lead major NIH endeavors at leading medical institutions across the the United States.  The results indicate a $12,194 paycheck differential favoring men, a shortfall for women. These disparities are often characterized through comparisons in productivity, which some conclude is justifiable.  The roots of this dilemma should be considered more closely. While  negotiation skills are a must for women in the professional workforce, systemic  disparities should be examined and addressed.

It’s worth noting that women’s paychecks are more likely to support children and families. The remarkable rise of women through the ranks of business, academia or medicine has some common stumps that can be overcome with leadership and fortitude for the future.  Educational achievement as well as economic opportunity represent significant pathways for progress among girls and women.  Our success is the success of our nation with diversity and inclusion at it’s heart as well as prosperity.

Matters of the heart

My sketch of the human heart during first year anatomy.

She whispered to me with bulging eyes of urgency, “something is not right, I’ve been in pain all night.” Her chief complaint was chest pain.  She had a routine work-up and some care with little relief.  The news came that all of her test results were normal.  Her body appeared tense, she looked panicked and afraid.  At bedside, the attending suggested endoscopy offering that her pain may be related to a gastrointestinal condition.  I introduced myself immediately as a medical student and quickly advocated for a cardiologist consultation. I mentioned that a few months prior she had been rushed to this hospital by ambulance with what had been determined as idiopathic ventricular fibrillation. The attending shook his head, he started moving toward the nurse’s station and I followed behind.  He reviewed her case with me again and then he shouted, “endoscopy” then I said “cardiology consult.” I left quickly without waiting for a response because I was trembling with fear.

As I sat outside trying to figure what my next steps would be, my phone rang and it was the nurse, she said that the attending had agreed to the cardiology consult. I returned to our house to care for my grandmother, in the absence of my mom she had no caregiver.  In the afternoon the cardiologist called me to express his concern with mom’s condition. He recommended, pending insurance approval that she be transferred to another hospital (the one that I had told her to go in the first place) for more tests and further observation.  This hospital did not have a full cardiology service and would be closing for good within next 72 hours.

Mom was transferred that night, additional test results showed significantly block coronary arteries. Early the next morning she had cardiac catheterization to open her blocked blood vessels. After a short hospital stay in she returned home. 

For a medical student learning to observe in clinical settings is a skill that comes with practice, time as well as teaching.  Furthermore, bearing witness involves seeing the whole patient taking aim at focus beyond the chart to examine the situation. The recently released book by Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care (Harvard University Press, 2011) offers the following:

“...the race and sex of patients [influences] physicians’ decisions about whether to refer patients for catheterization...If you were black, the report (Schulman et.al) concluded, you were less likely to be referred.  If you were a woman, you were also less likely to be referred.  And if you were a black woman, you were especially less likely to be referred.”

While some have criticized Dr. Schulman’s research as “exaggerating the disparities” inequalities in treatment and care are demonstrated in his efforts providing evidence for the need to improve health care as discussed in the report  Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare by Brian Smedley et. al.  As an African American woman who is a physician-in-training, I’m glad to witness good medicine as well as mom’s progress.

Cross-posted  at KevinMD.com

Our world and families in the days ahead

Today in America you have a 50% chance of living beyond 100 years. Those who are aging and living well make this mark with survival stories of resiliency by allowing the power of hopefulness to help them with setbacks in life, they overcome stress with success.  Another  key is having a network of care and love from families, friends and supportive communities. We need our families and beloved communities for long and healthy lives.

The United Nations set May 15, 2011 for the observance of the International Day of Families with a theme of "Confronting Family Poverty and Social Exclusion." It’s a call to recognize that families around the world are vulnerable especially given the persistence of violence, poverty and the uprising of natural disasters in an already unstable and unbalanced climate.  From my view convening a global or national dialogue on family requires a look beyond strategies of war, approaches to economic market stability or business as usual in search of policies and practices that mobilize resources to value, connect, unify and empower communities and families who are interconnected by blood lines across generations and living together, in close proximity through relationships and/or sharing physical location.  What’s the challenge?

“Social exclusion is often at the root of the problem. Discrimination and unequal access to social services deprive families of the opportunity to plan a better future for their children. Certain types of families are at particular risk, including large families, single-parent families, families where the main breadwinners are unemployed or suffer from illness or disability, families with members who suffer discrimination based on sexual orientation, and families living in urban slums or rural areas. Indigenous and migrant families, as well as those living through conflict or unrest, are also on the front lines of marginalization and deprivation.”  

Secretary-General's Message for 2011

The aftermath of earthquakes in Haiti and Japan show people struggling to find their children and other family members.  In Haiti the rising levels of cholera puts families and communities at risk for illness that without access to clean drinking water, nutrition and health care increases preventable deaths. In a technology meets volunteerism equals innovation, crisis mapping has helped bring response teams with resources to critical areas of the world.  A website and portal www.Ushahidi.com helps users “call for help” using mobile devices via email, sms and tweets to map locations of distress based.  Many countries like Hait don't have a 911 response system. Volunteers around the world have helped to develop the sophisticated system using Facebook, Twitter and Google maps with people on the ground to reconnect some children and families when geography seemed to be an impossible barrier. A vivid example showing the power and possibility of connection, for families around the world.

The recent devastation of tornadoes and floods in southern and mid-western parts of the United States have left many families homeless, disconnected and grieving the loss of loved ones.  Who will help them heal?  In her book, The Warmth of Other Suns” author Isabell Wilkerson tells the migration stories and now more so the return of African American families to their southern roots, which perhaps still remains tied to the search for relief from discrimination and racism. Yet, remarkable and significant progress has led to stunning diversity in America visible in neighborhoods, schools and the workplace, but also shows clear evidence of inequity at the cost of lives, comprising health and society. Here we have to continue the dialogue to realize for better outcomes for the future.

What can we do to strengthen our families?  We can take on acts of empathy, compassion and love without delay.