Underserved Populations Struggle with Poverty, Disparities in Health Care

As Denise Rodgers, M.D., of Newark, N.J., stood in front of a standing-room only crowd and launched into her delivery of the Stephen Jackson, M.D., Memorial Lecture here on July 30, her message was clear: Poverty, health disparities and health care disparities go hand-in-hand in America's underserved communities. Her solution came in the form of a challenge to America's future family physicians.

"I'm here to shamelessly promote working in underserved areas," said Rodgers.

The speech, titled "Family Physicians and Health Care for the Underserved," was featured at the AAFP's 2010 National Conference of Family Medicine Residents and Medical Students.

Rodgers, an expert on health care disparities, currently serves as EVP of academic and clinical affairs at the University of Medicine and Dentistry of New Jersey in Newark. She is a past president of the Society of Teachers of Family Medicine and a former residency program director at the University of California, San Francisco, General Hospital.

Rodger's lecture was front-loaded with facts and figures designed to put a face on America's medically underserved populations. She then showed audience members how certain minority populations in America -- most notably blacks, Hispanics and American Indians -- face not only reduced access to medical care but poor health outcomes, as well.

Rodgers pointed out that blacks and Hispanics topped the list of minorities living in poverty in the United States in 2008. "To be poor in America means to be at significant risk of poor health in America," she said, reminding her audience that the top two goals of the Healthy People 2010 initiative were to increase quality and years of healthy life and eliminate health disparities.

"Healthy People 2010 is coming to an end, and we're not close to meeting those goals," Rodgers lamented.

She compared 1986 and 2006 mortality statistics that focused on those same minority populations to highlight the sluggish progress. In 1986, Rodgers said, an HHS task force report on black and minority health listed the top six causes of excessive mortality as

"Disparities in health outcomes persist in all (those) areas 25 years after the report was written," said Rodgers.

She continued with statistics on health indicators for black Americans. "Pause for a moment and look at the significant increase in death rates for homicide, infant mortality and HIV/AIDS," said Rodgers. "Imagine if we saw these death rates in the white population."

Rodgers also touted the passage of health care reform as a means of providing coverage for 32 million previously uninsured Americans, and she reminded her audience that the legislation commits hefty resources to rebuilding America's primary care workforce. It also provides funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas.

"In working with underserved populations, substantial strength and resources exist in our communities," said Rodgers. "There are many partners in the community to work with us to improve the health status of everyone. It's important that we not feel that we have to do this alone."

However, she noted, "Health care disparities are about us. They originate in the way that health care providers fail to provide quality health care to some patients."

Rodgers told the young physicians and physicians-in-training in the audience that family physicians "are the heart and soul of the delivery of health care." And she encouraged them to help build up the communities in which they will practice by asking their patients to turn off their TVs, go outside and meet their neighbors.

Rodgers closed her presentation by taking a few questions from the audience.

The first question drew the most poignant response from Rodgers.

"If you're in the majority population, how can you best serve minorities?" asked a voice from the audience.

Rodgers responded: "My experience as an African-American woman is when I go into a room with an African-American patient, there is an extra smile that says, 'Oh, I'm really glad to see it's you.' There is an assumption that, as an African-American woman, I can relate or that I'm somehow going to do a better job of taking care of my African-American patients."

Rodgers continued the story. Earlier in her career, at a practice in the Bronx, her patient population included a large number of individuals from Puerto Rico. Those patients greeted Rodgers with the same welcoming smile when she entered the exam room, she said, but their smiles quickly faded when they heard her less-than-fluent Spanish.

"Our patients are just like us. They have preconceived notions based on appearance," she said. "What we look like has very little to do with who we truly are. If we deliver competent, compassionate health care, we can overcome how we look to our patients in a heartbeat.

"At the end of the day we can overcome all obstacles that our patients bring to us … first and foremost by seeing them as human beings."