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A bright, fair health care future is inclusive

A bright, fair health care future is inclusive
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The milestone of 250,000 deaths in this country due to the COVID-19 pandemic deserves no accolades. 

Even more, sobering a statistic is that one in 875 Black/African Americans and one in 1,275 Latinx Americans have died from COVID-19. This is compared to one in 1,625 white and one in 2,100 Asian Americans. 

These numbers might seem surprising on the surface, but the proportion of people affected by chronic medical conditions such as cardiovascular disease, diabetes, and lung disease are similar. Who treats these patients matters. 

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While 13.4 percent of the U.S. population is African American and 18.5 percent of the population is Hispanic and Latinx, among active physicians, 5.0 percent identify as Black or African American and 5.8 percent identify as Hispanic, according to the Association of American Medical Colleges

For our patients' health and to improve equity in our health care system, it is imperative to have more representation of underrepresented minorities as physicians and other health care providers.  

In my Chicago cardiology clinic recently, where typically 60-70 percent of patients are Black or Latinx,  an 85-year-old woman with coronary artery disease and chest pain symptoms greeted me with, “You know what, doc, I’m so happy to see someone like you. Someone who looks like me. I have been trying to find a Black cardiologist for so long because it makes me feel more comfortable and I know that I can trust you to take care of me.”

It causes concern to wonder how many other minority patients feel this way or how many others delay essential evaluation and care because of the mistrust they have in the medical system that often does not seem to reflect them.

A recent poll by the Kaiser Family Foundation and The Undefeated showed that only 6 of 10 Black adults trust their doctor to do what is right compared with 8 of 10 white people. Additionally, 7 of 10 Black people believe that the health care system mistreats people based on race, which is actually an increase from 56 percent compared to a poll from 1999.  

As simple as it sounds, having health care providers who look like or have similar backgrounds to patients can almost single-handedly instill a sense of trust and lower so many intangible barriers for patients.

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As a practicing physician for close to a decade in primarily urban and underserved areas, there is a significant sense of distrust and skepticism that people in these communities have for hospitals and health care workers, which, given the history of this country’s treatment of minorities, is not unwarranted. 

Perhaps most notoriously, the Tuskegee Experiment between the 1930s and 1970s sought to study the natural history of untreated syphilis by intentionally withholding treatment in infected African American men. 

As Harriet Washington illustrated in Medical Apartheid, the ripple effects from this and other abuses from the medical community are still felt in people's minds and hearts today. 

As a result, it is common for underrepresented minorities to avoid seeking preventative health services and participate in research studies that provide potentially life-saving therapies. Ultimately this can result in decreased adherence to medical therapies for chronic conditions, poor patient-physician interactions, worse outcomes and even physician burnout. 

Increasing the number of traditionally underrepresented minorities in health care is essential in this quest to repair the relationship between these communities and the hospitals that aim to serve them. There is still a long way to go as the percentage of underrepresented minority graduates from medical and nursing schools remain disproportionately low. Among recent medical school graduates, 6.2 percent were Black/African American and 5.3 percent were Latinx students. While relatively higher, the minority nursing population is also below 10 percent in each group.  

The value of mentorship and providing opportunities for young, underrepresented minorities to gain exposure to this career field is critical but is often severely lacking for many reasons. 

The administration needs to be more intentional about investing time and resources to create structural opportunities to bridge this gap. There needs to be more than creating committees, announcements and posters. 

Partnering with local middle schools, high schools and colleges to create sustainable pipeline programs providing education and mentoring to students from these underrepresented backgrounds would lower the barriers for entry into the health care professions that often deter young people. 

Additionally, there should be more of an effort to work with local businesses to create consistent outreach programs in the form of health fairs and seminars that would improve the visibility of health care workers in the surrounding communities and help to decrease the level of distrust that people feel towards the medical establishment. 

There has to be more action than creating diversity positions within the leadership or mandating racial sensitivity education that sometimes feels reactionary and performative, especially in the current social and political climate. Gestures are appreciated but do not always translate to tangible changes. 

Organizations, such as the I Am Abel Foundation in Chicago and Minority Males in Medicine in Maryland, have created avenues for high school and college-aged students to network and engage with health care professionals like never before and serve as models on how to create this change. 

As one of the 19-year-old male students mentioned after one of our recent sessions, they said they would often feel intimidated to reach out to physicians for shadowing or research opportunities because of the uncertainty of how they would be received. But seeing someone who looked like them provided a sense of comfort and confidence that they could succeed in this career path.  

Certainly, many social, economic, philosophical and historical layers impede the movement towards true health equity in this country. Nonetheless, every person deserves the best medical care possible, especially in these times. 

While many of these systemic barriers seem insurmountable, the goal of improving diversity in health care, and by extension, improving access to care to minority communities, is possible with more of a concerted effort by educational institutions and hospitals that proclaim to value diversity. 

A future with a health care workforce that truly reflects the diversity it touts and that this country regularly prides itself on is fair and bright indeed. 

Brian Clark, MD, is a practicing cardiologist at Rush University Medical Center with expertise in treating cardiovascular diseases. He is a Public Voices Fellow through The OpEd Project.