Why do disparities in medical care persist? | The Excerpt
On Sunday’s episode of The Excerpt podcast: Earlier this year, a study published in The Lancet Child & Adolescent Health journal found widespread racial and ethnic disparities in medical care, treatment, and health outcomes across all pediatric specialties. That there are healthcare inequities in America that disproportionately affect marginalized communities isn’t news. But why do these disparities persist? Dr. Ayla Stanford, author of “Take Care of Them Like My Own: Faith, Fortitude, and a Surgeon’s Fight for Health Justice,” joins The Excerpt to discuss the current state of access to care in the U.S.
Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.
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Dana Taylor:
Hello and welcome to The Excerpt. I'm Dana Taylor. Today is Sunday, August 18th, 2024.
Earlier this year a study published in the Lancet Child and Adolescent Health Journal found widespread racial and ethnic disparities in medical care treatment and health outcomes across all pediatric specialties. That there are healthcare inequities in America that disproportionately affect marginalized communities isn't news, but why did these disparities persist?
Here to discuss the current state of access to care in the US is Dr. Ala Stanford, author of "Take Care of Them Like My Own: Faith, Fortitude and a Surgeon's Fight for Health Justice." Thanks for being on The Excerpt Dr. Stanford.
Dr. Ala Stanford:
Thank you, Dana, for having me.
Dana Taylor:
Let's start with the book. Why did you feel compelled to write it?
Dr. Ala Stanford:
In my life, I am a pediatric surgeon by training. I've seen things on both sides of the scalpel, if you will, regarding health inequities in our country. Being a child raised in North Philadelphia in an impoverished city, there were certain expectations, or lack of expectations people had of me because of my socioeconomic status. But then, once I became a surgeon, there were things that I saw play out with the care being delivered, and I felt like I could use my life to tell a story on somehow how preconceived notions are incorrect and how if we all had a better understanding of one another, how that would equate to better health outcomes for everyone.
Dana Taylor:
You mentioned the Heckler Report in your book. That 1985 report led to the establishment of the Office of Minority Health at the US Department of Health and Human Services during the Reagan administration. What did we learn from that report and have healthcare disparities significantly improved since?
Dr. Ala Stanford:
We should all be indebted for Secretary Heckler, Margaret Heckler for putting that report together. What it said was that the color of your skin is the reason why you will live a certain amount of years in the United States. And, bluntly put, that if you're a Black man or a Black woman in America, you can live anywhere from 5 to up to 10 years shorter than white Americans in the United States. That much of that has to do with systemic bias. And this was evidence-based, this was not an opinion. This was not what someone thought. This is what the data supported. And unfortunately, when you look at that data from 1985 and you compare it to 2024, there have been strides but not as great as one would've liked to have seen.
Dana Taylor:
Overall, are we seeing progress in addressing the big six health issues: cancer, cardiovascular disease and stroke, substance misuse and abuse, diabetes, unintentional injuries, infant mortality? Are we moving ahead on any of the big six?
Dr. Ala Stanford:
Let's talk about cancer, for example, and I'm going to use two that are prevalent in Black communities, breast cancer for women and prostate cancer for men. That has touched me in my family.
Black men, the standards that are created for Black men with prostate cancer come from studies with predominantly white men. And so, when Black men are diagnosed, the disease is often later and it's often more advanced. And so, some of the basic treatment strategies cannot be employed because it's already spread throughout their body. There are no screening guidelines for Black men when they are both genetically predisposed to have higher incidences of prostate cancer.
Black women, when they are diagnosed, have a less invasive form of the disease, but they're more likely to die from it. So often that stems from, okay, you have a diagnosis, how quickly can you get in to see your doctor? How quickly can you have that ultrasound, the MRI and/or the surgery scheduled? How easy is it for you to get to your follow-up appointments and so forth? And so, as clinicians, I believe it's our responsibility for whatever we recommend for a treatment for a patient, that we help facilitate that through patient navigators, through involving community to make sure that patient gets what they need.
Dana Taylor:
What role does employment status play when looking at healthcare disparities between different socioeconomic groups in the US?
Dr. Ala Stanford:
I won't say it's everything, but it's up there. It's up there with health, employment and health. Because if you can't feed your family, that is stress. If you have a low paying job that doesn't pay you to be off from work, you can't get to an appointment. If you have a job that does not give you healthcare or it gives you minimal healthcare, the co-pays for that, the co-pays for your medication, the co-pays for surgery can be astronomical. And so, when you have to decide between food or shelter, a roof over your head for your family, then lots of times your health is not what is made a priority.
And Dana, one thing I think I need to make sure I mention and I talk about this a bit in the book is it's not just impoverished Black people at all, or Brown people, or Latinx. You can also be affluent and educated with insurance and have poor health outcomes. And for me, during COVID, the people who were calling saying they were being turned away from hospitals and clinic spaces to get tested and vaccinated were friends of friends of mine who had multiple degrees and good health insurance that were being turned away.
Dana Taylor:
Dr. Stanford, you wrote about your aha moment during the COVID-19 pandemic and the narrative around comorbidities in Black communities. What do you think was left out of that conversation?
Dr. Ala Stanford:
What was left out of that conversation was access. Yes, some people had diabetes, or hypertension, or obesity, absolutely. But when they came to their provider, most of whom were closed, the primary care docs, so you only had the ER of the hospital and they were told to go home and wait until they were sicker, wait until they had more symptoms, or come back with a referral from your doctor that they couldn't get because their docs were closed, or they didn't have because they didn't have a primary care provider. It was that adage of telling someone to pull themselves up by their bootstraps and they didn't have any boots. And so, when people reached out to me, what was being said was it was their chronic health condition, but I knew that the real reason was access, access, and access. Reasons one, two, and three.
Dana Taylor:
How do housing and environmental factors contribute to an increased risk of illnesses like asthma in certain communities?
Dr. Ala Stanford:
Environmental justice is real. I can say through the Assistant Secretary of Health and Health and Human Services, that is now an initiative and priority. And so, when people say, "Oh, Black children have more asthma because their parents smoke more," that's not true. That's a subjective narrative that you have to dispel with objective data. So if you look at the American Lung Association, you'll see that Black and white Americans smoke at the same level, about 16%. However, white children have a much less incidence of asthma than Black children. And a lot of that, to your point, is where they live. It's the housing.
Dana Taylor:
I was going to ask, how can improving education impact health outcomes? What's missing here?
Dr. Ala Stanford:
As people say, when you know better, you do better. Being educated, and it doesn't have to be a formal education. It doesn't have to be medical school and law school and all of that but nowadays, you can search anything on the internet. So what you are having a symptom of and what condition you're going for that you need to have read about it before you come and have your list of questions. So when the doc says, "Anything else before I leave? "Thanks for asking, doc. Absolutely. I have some questions about this. Can you print something out for me on it?" "Oh, well, you can look it up online." "Well, I can't look it up online." "Oh, you can print it out." "Actually, I can't. Could you print it out for me so I have something to follow when I get home?" And so, education definitely leads to better health outcomes because you can advocate for yourself.
Dana Taylor:
What would an equitable healthcare system look like in America? What should individuals expect in terms of accessibility and quality of care?
Dr. Ala Stanford:
It would be that your provider had a shared Experience. Doesn't even have to be the same ethnicity. Although we do know in black communities that having just one Black doctor in a community, in a county improves health outcomes, just one. So number one, it would be representation.
Number two, you would have a patient navigator. And a patient navigator is someone who knows your business, who knows that you don't have a car, knows that you might need transportation to get to your appointment. And so, rather than the critique being she never makes her appointments and she's non-compliant, that patient navigator can facilitate you getting to all of your appointments.
Number three would be we would be able to create our screening strategies based on the percentage that you see in certain populations. For example, colon cancer, breast cancer, and prostate cancer and heart disease for that matter in Black communities. And that those types of conditions that you're being treated for, you could go in and just be seen period.
Number four is that if you are taking care of patients period, that it is integrated into your education that you learn about people from different backgrounds. Now, is it part of medical school education? Absolutely. But I feel like it is more an afterthought as opposed to being intentional and a primary course of study. I believe it should be a primary course of study like anatomy is a primary course of study in medical school.
Dana Taylor:
Can technological tools such as diagnostics, now made possible by AI, speed up efforts to close the healthcare inequity gap,
Dr. Ala Stanford:
You have to make sure that the people that are designing the AI and feeding that source data are from diverse backgrounds. Otherwise, the information that spit out is unfortunately going to be the same biased information that came from that individual. And so, like everything, diversity is a strength. It improves everyone's life, but we have to be cognizant of the digital divide and everyone does not have that access. And so, while certain people are progressing, there are some that are not going to be able to jump on that train with that technology, and we cannot leave those folks behind.
Dana Taylor:
Dr. Stanford, you spent more than 20 years providing healthcare as a surgeon. What led you to leave the operating room?
Dr. Ala Stanford:
So Dana, what led me to leave the operating room was I realized that my skills were needed more literally in a church parking lot than in the OR. And to date, we took care of over 100,000 people and counting with direct care, and that's more than I ever operated on one patient at a time.
For a lot of folks, it's like, what do I want to be when I grow up? I want to be a journalist or I want to be an entrepreneur. And for me, I only ever wanted to be a surgeon and a pediatric surgeon, but I now realize that perhaps my education, and my training, and the platform that I created for myself allowed me to be poised, and prepared, and ready when the pandemic hit. That I could use all of that academic knowledge, and doing community service, and being on mission trips, taking care of folks in Hollywood, all of those things together allowed me to be prepared for the opportunity as it presented.
And I still keep my board certification up. Who knows? I may go back. But right now, I know that I'm having more significance and more impact with my mind and my voice than just with my hand as I was in the operating room.
Dana Taylor:
Thank you so much for joining us. Dr. Stanford.
Dr. Ala Stanford:
Thank you, Dana.
Dana Taylor:
Thanks to our senior producer Shannon Rae Green for production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@usatoday.com.
Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.