One prominent doctor called it the greatest risk to health. Another called it a threat to national security. U.S. Sen. Richard Blumenthal called it a scandal. The topic at a town hall meeting in Hartford Tuesday wasn’t cancer, radiation or any other medical concern that frequently makes headlines. It was health disparities, the well–documented but less-often discussed differences in life expectancy, rates of chronic disease, infant mortality and other health outcomes that are linked to social, economic and environmental disadvantages. “In 2011, the greatest health risk is health care disparities,” said Dr. L.D. Britt, president of the American College of Surgeons.
Britt spoke as part of a meeting presented by the Curtis D. Robinson Men’s Health Institute, a part of St. Francis Hospital and Medical Center, and Tuskegee University. Earlier in the day, the two organizations formalized a research relationship aimed at advancing research in prostate cancer.
The Men’s Health Institute, founded by Robinson, a businessman and prostate cancer survivor, provides education and testing for prostate cancer and free surgery and treatment to men who don’t have insurance or cannot afford the care. As part of the collaboration, the Men’s Health Institute will send Tuskeegee tissue samples from African-American patients for research.
The link between the collaboration and health disparities is not insignificant. Prostate cancer disproportionately affects and kills African-American men, but influential studies of the disease have involved primarily Caucasian participants, making some doctors skeptical of applying their findings to African-American patients. Tuskegee is known as the site of the infamous U.S. Public Health Service study of untreated syphilis in black men, during which researchers withheld treatment from men who had never given informed consent for the research. It’s often cited as a source of mistrust in the health care system among minorities.
During a panel discussion, experts spoke of a wide range of causes for health disparities, including a lack of access to health care, lack of insurance, low health literacy and a failure of hospitals to make eliminating health disparities a top priority. They also cited other factors not directly tied to health care, like the availability of supermarkets in an area and racism.
Research has found that health insurance is a significant factor in health disparities, with racial and ethnic minorities less likely to have health insurance than the rest of the population.
But panelists noted that having insurance doesn’t eliminate the problem. Dr. Wayne Rawlins, national medical director for racial and ethnic equality initiatives at Aetna, said disparities exist within the insured population. Others said that having insurance doesn’t necessarily mean it’s easy to get an appointment with a doctor.
Dr. Joxel Garcia, president and dean of Ponce School of Medicine in Puerto Rico and a former assistant secretary of the U.S. Department of Health and Human Services, said the U.S. is the only nation in the G8 and G20 where health is not a fundamental right.
“We have the right to bear arms. The poorest person in this nation can buy a gun,” he said. “And we don’t have health as one of our constitutional rights. Think of that.”
Britt said the “elephant in the room” is health literacy. Health care providers must make sure that patients understand the treatment being recommended and know how to take care of themselves, he said. Even people with insurance often don’t get the care that’s recommended for them.
“Half of the care recommended, people don’t do,” he said.
Other panelists pointed to factors outside the health care system that affect health, including education and housing. Garcia said the best predictor of a child’s health is the education level of his or her parents.
Hartford has just one or two big supermarkets, Rawlins said, making it difficult for people who don’t live near them to buy fresh fruits and vegetables. He noted that West Hartford and Glastonbury have a fraction of Hartford’s population but more supermarkets.
And Robinson pointed to another problem: racism. Disparities don’t just exist in health care, he noted.
“We have to realize there’s racism in this country,” he said.
So what can be done about it?
St. Francis President and CEO Christopher Dadlez said hospitals must make eliminating disparities a key priority. He said he’s embarrassed for hospitals, which he said have not done a great job taking on health disparities.
“It has to start at the top,” he said. “The board rooms at hospitals have to accept that health care disparities are a priority.”
Dadlez pointed to the increased focus on quality and patient safety over the last decade at hospitals across the country, which he said occurred after all hospitals bought into it as a major priority. Equity in health care has to become a key priority for every hospital in the country, he said.
Dadlez said hospitals also must identify the needs in their communities and learn what barriers people face in accessing care–things he said hospitals don’t know. Through the Men’s Health Institute, he said, the hospital is learning how to become integrated into the community and improve access.
“But we’re just learning this, and we need to apply that,” he said.