Battling Health Inequity

Racial and social disparities in healthcare are a deadly fact in the U.S., but local healthcare systems and practitioners are finding ways to make changes for the better.
Perspectives Healthcare

It’s important for the public to be aware that up to 80% of an individual’s health outcomes are determined not by their particular anatomy or family history, but by the economic and social determinants that shape their upbringing and lives from the earliest moments. People of color do not die earlier of chronic diseases because of “family history,” but because of repeated exposures to inequitable conditions — often for generations.

Dr. Jennifer Avegno, director of the New Orleans Health Department

There’s a reason why heads of state and the world’s wealthy elite come to this country for medical care. The United States is unparalleled when it comes to medical research and innovation. More Americans have received the Nobel Prize in medicine than Europe, Canada, Japan and Australia combined — despite their combined populations being more than double that of the U.S.

However, there’s a tale of two cities here. If you aren’t a world leader or a billionaire, consistent and quality medical care may be difficult for you to access in this country — and specifically, in this city.

The U.S. has one of the lowest life expectancies of high-income countries. Switzerland averages 83.2 years, while Americans average 77.3 — New Orleanians average 76.6 years. Studies show that more than a quarter of Americans — 27.2% of adults — suffer from a chronic condition. In New Orleans, four in 10, 41% of adults, have a chronic medical condition.

Those staggering statistics don’t mean Americans in general or New Orleanians specifically are more prone to disease or are necessarily unhealthier than people in other countries. Sure, we like to laissez le bon temps rouler and enjoy good, rich food, but these disparities illustrate that our healthcare system isn’t equitable. It isn’t fair.

And while these inequalities are distributed along income lines, they’re also deeply rooted in historical, racial divisions and biases that persist to this day.

“Healthcare in New Orleans, like the rest of America, is profoundly inequitable,” said Dr. Jennifer Avegno, director of the New Orleans Health Department. “People of color historically suffer higher rates of chronic and preventable disease, increased morbidity and lower average life expectancies.”

Avegno attributes these outcomes to generations of structural racism within healthcare systems and institutions, as well as economic and social inequities creating significant gaps in health determinants. She said a deliberate focus on dismantling health inequities at every step of care is critical to ensuring all New Orleanians have the chance to live long, healthy lives.

The science is also clear on this. Louisiana has the second highest rate of new cancer cases in the country, due in large part to the interaction between pollution and poverty.

“There is an absolute link between access to healthcare and cancer rates,” said Dr. Joe Ramos, director and CEO of Louisiana Cancer Research Center. “African Americans have the highest overall cancer mortality of any racial or ethnic group in Louisiana. Black women develop more new cases of triple negative breast cancer. The rates of prostate, cervical and colorectal cancer exceed that of the white population in Louisiana.”

In recent years, there has been a greater emphasis placed on health equity, likely driven by the problem receiving more exposure.

“As racial and social disparities in care have become better documented, and therefore undeniable, many healthcare organizations have implemented programs and processes to stimulate progress in this area,” said Dr. Mary “Toni” Flowers, chief diversity and social responsibility officer at LCMC Health.

Flowers sees the creation of positions like her own in health system C-suites as a step forward. She said healthcare organizations are acknowledging the value of the work of health equity and are providing experienced supporting staff to implement work plans to address and reduce existing inequities.

She notes, however, that it will take more than new roles or new programs to solve the problem.

“The most effective healthcare organizations gain the full benefits of proficient health equity leadership by integrating the work into operational strategic plans,” she said, “and not isolation of these efforts to peripheral community-based programming.”

The challenges of identifying all the structural and institutional ways that inequality is built into every part of healthcare are very real. Avegno said health profession school curricula are slowly addressing core drivers of unequal outcomes as part of their required education, and many hospitals and clinical practices are initiating diversity, equity and inclusion (DEI) initiatives to identify and break down barriers to appropriate care.

Without a sustained focus on the social determinants of health — like education, income, housing gaps and others at a broader level — however, progress will be limited.

One of the more direct, tangible ways inequity in healthcare is being addressed is through improving access to and with innovative medical technology. That includes large-scale analysis that can take the form of diversity and disparities dashboards that track disaggregated patient and employee data to identify and track patterns, trends and themes related to equitable experiences.

Using data to define problems and solutions is essential.

“There’s the old adage that you can’t fix what you can’t measure,” said Dr. Stephen Hales, secretary-treasurer at LCMC Health and past board chair at Children’s Hospital. “Sharing information allows collaboration in improving access and outcomes. Effective use of data lets us understand which strategies are most effective and gives us the tools we need to focus on preventive care rather than treating preventable conditions. Ultimately, that should be our goal.”

Health tech has traditionally been the privilege of the privately insured — services like telemedicine visits, remote monitoring systems, or assistive technologies to improve quality of life. By allowing Medicaid beneficiaries to access these programs — by making them reimbursable at a competitive rate, for example — the health tech gap could be bridged.

There are some early signs of this. An Ochsner pilot program using remote monitoring of Medicaid patients, for example, has shown real success, and some innovative health tech startups in the area, like TechPlug, are actively working to bridge the digital divide for underserved, vulnerable populations.

There’s also work being done by individual providers — the doctors and specialists who work with patients from marginalized communities.

“We’re seeing providers turn to subscription business models and create technologies that don’t require payment or approval from health insurances,” said Dr. Lana Joseph-Ford, founder and CEO of High Level Speech and Hearing Center. Ford said she’s started offering payment plans as a more “patient-centric approach” that makes it possible for people to access treatment they may not have otherwise been able to receive.

The bottom line is health equity won’t be achieved by one single solution. Health experts say it will take deliberate focus, painful reckoning, and a tremendous amount of work by everyone in the medical system and beyond to build a future where an individual’s race or ethnicity does not significantly determine their lifespan or likelihood of chronic disease.

For Avegno, the words attributed to Martin Luther King, Jr., say it best: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”


DID YOU KNOW? Life expectancy rates between citizens of traditionally underserved areas and citizens of more affluent areas of New Orleans can differ by as much as 26 years.