Pharmacists: Fight Racial Disparities in Health Care

The novel coronavirus disease 2019 (COVID-19) pandemic, coupled with recent protests in the United States, have inspired pharmacy organizations to take a stand in support of and pledge to racial equality in health care.

Today, the American Pharmacists Association is promoting a #PharmacistsFightingRacism campaign to bring together pharmacists in the common goal of eliminating racism and the effects it has on quality of care and the health care system.¹

The campaign comes after several national pharmacy organizations, including NCPA, ASHP, the American Association of Colleges of Pharmacy, and more, issued a joint statement on the issue of racial inequality in health care, highlighting it as an “urgent priority.”²

“Adding to the challenges of the global pandemic of COVID-19, which disproportionately impact communities of color, there is a greater public health crisis plaguing our country: racism and discrimination,” the statement said.² “People of color and other marginalized groups experience a continuum of systemic racism, discrimination, and injustices that result in ongoing health inequities created by numerous factors impacting social determinants of health.”

Identifying Disparities in Health Care

Many studies through several decades have shown that minorities receive less than ideal or standard medical therapies for illnesses such as cardiac disease, asthma, kidney disorders, and mental illness. Research has also pointed to the fact that minority status, in addition to other social determinants of health (SDOH), indicate a lower level of care and poorer quality of care.³

A study that invited the IOM Group on Racial and Ethnic Disparities to answer the question, “How could well-meaning [health care providers] provide inequitable care to minority and non-minority patients?” found some of prevalent shortfalls in health care related to providing care to minorities.³

The study pinpointed 2 concepts that some studies suggest are present in the medical field: the culture of medicine and the “medical gaze."

The culture of medicine and the medical gaze that medical students learn both prioritize efficiency and progress on a patient’s ailment; distractions from this streamlined goal, including “socially complex problems” may be seen as derailing to some physicians, who are constantly pushed for efficiency. Minorities may be seen as being “difficult to manage” due to stereotyping, but also due to SDOH and other existing disparities that affect minorities in the United States.³

B. Lee Green, PhD, vice president of diversity and strategic communications at Moffitt Cancer Center, supported the idea that professional socialization affects this behavior in health care. “An entire set of studies have shown that poor and minority patients are treated differently when they enter the health care system. They may not be given the same level of treatment that non-minorities receive, and [may experience] unconscious bias,” Green told Drug Topics® in an email.

Though medical schools in the United States have increasingly incorporated curriculum related to diversity and cultural competence, and students are encouraged to engage in caring for poor and underserved populations, these curricula have not adequately addressed racism in health care. Researchers support this to be the case, since racial and ethnic disparities continue to persist despite these programs.³

For example, the financing of health care coverage, type of health insurance, and accessibility to government programs, as well as lack of coverage, contribute to health care disparities.³

Minorities tend to be underinsured or have no insurance, Green explained. That limits access to necessary care and treatments. And when they do access the health care system, it is often too late, and they’re likely to receive a late or advanced diagnosis, which is harder to recover from.

Representation in Health Care

Increased minority representation and participation in the health care system has also shown to address racism and discrimination in health care. A recent study presented at the American Society of Clinical Oncology (ASCO) 2020 Annual Meeting explained that a diverse health care workforce improves the following:⁴

• Patient outcomes
• Treatment adherence
• Quality care
• Existing health disparities
• Patient-physician trust
• Patient satisfaction
• Learners satisfaction
• Innovation and creativity

The study also showed that the areas of hematology/oncology rank as number 8 in their percentage of underrepresented minority (URM) physicians, with 9.98% of those practicing being a URM: 3.8% are African American, whereas 6.1% are Hispanic/Latinx. Endocrine is ranked #1, with 17.47% of practitioners identifying themselves as a minority. According to the study, there have recently been decreasing trends in Hispanic/Latinx representation in hematology/oncology.⁴

In pharmacy, data show that the number of minorities in the field of pharmacy are increasing, but industry experts still characterize the overall numbers as low.⁵

“The way the system is set up, a lot of students of color are not exposed to the pharmacy field or connect with professionals that look like them,” Ahmed Ali, PharmD, owner of Othello Station Pharmacy in Seattle, Washington, said in a previously-published article in Drug Topics® on minority representation in pharmacy.⁵ “Pharmacy is a very unique environment and sometimes you have to be connected with one to understand what a pharmacist does and what a career looks like.”

Green similarly encourages improving the pipeline of minorities who enter into the health and medical field. Not only do many patients like to see health care providers who look like them, but minority physicians and health care workers would have a considerable understanding and appreciation for issues related to minority health, therefore able to create a positive impact.

Disparities Amid COVID-19

In a video interview with Drug Topics®, Devin English, PhD, assistant professor at Rutgers School of Public Health, explained that the inequities amid the COVID-19 pandemic reflect a health care crisis already in action.

“What we're seeing with COVID-19 is completely predictable, policies like redlining and systematic disinvestment have led to racial segregation that we see in black and Latinx communities today. Now, this matters because we know that your zip code often determines whether you have high levels of pollution and overcrowding, and whether you have access to quality health care and economic opportunity. Right now, Black and Latinx communities, where there are additional disproportionately high levels of pollution and overcrowding and low levels of access to health care and economic opportunity; there are also high levels of COVID-19 related risk factors,” English explained.

These risk factors include conditions like asthma, as well as the inability to socially isolate or socially distance because their job is essential amid the pandemic. Black and Latinx communities are then making up huge percentages of COVID-19 deaths.

English recommends increases in testing and clinical care in Black and Latinx communities. “We should match our treatment and our care to where the need is the highest,” he said.

A new study from the Baltimore-Washington, DC area found that COVID-19 rates were 3 times higher in Latinx individuals than rates in any other racial or ethnic group.⁴ Researchers echoed the call to action: something needs to be done about these disparities.⁴

“It is clear that the systematic exclusion of this population from health care services has contributed to the disparities we see today,” said Kathleen R. Page, MD, associate professor of medicine at the Johns Hopkins University School of Medicine, and a study member who cared for many of the patients. “This pandemic has taught us that we are all interconnected. At the very least, we must engage with communities early and provide language and culturally appropriate information and services, removing as many barriers to care as possible.”⁴

Key Next Steps

Though the COVID-19 pandemic and recent protests have turned a spotlight on racism inherent in the health care system in the United States, there is still a long way to go. Green sees the next steps including the need for holding health care providers accountable for creating equitable outcomes, taking into account the systemic, and sometimes hidden influences, that work their way into and flow through health care.

“COVID-19 basically highlighted long existing health disparities for minority communities. It is shining the light on the fact that we have a long way to go in addressing [this issue]. We have certainly made progress, but there are a lot more efforts that need to be undertaken to address health disparities,” Green told Drug Topics®.

References:

1. American Pharmacists Association. We Stand in Unity. Accessed June 25, 2020. https://www.pharmacist.com/pharmacistsfightingracism
2. Pharmacy Organization Unite to Take a Stand Against Racial Injustice. News Release. Pharmacist; June 23, 2020. Accessed June 24, 2020. https://www.pharmacist.com/sites/default/files/audience/Pharmacists_RacialInjustice.pdf.
3. DelVecchio Good M, Good BJ, Becker AE. The Culture of Medicine and Racial, Ethnic and Class Disparities in Health Care. National Academic Press (US); 2003. https://www.ncbi.nlm.nih.gov/books/NBK220349/.
4. Velazquez AI, Leibrandt R, Duma N, et al. Trainee and workforce diversity in hematology and oncology: Ten years later and what has changed? J Clin Oncol 38:2020 (suppl; abstr 11000).
5. Loria K. Minority Representation in Pharmacy. Drug Topics. February 12, 2020. Accessed June 25, 2020. https://www.drugtopics.com/view/minority-representation-pharmacy