February 11, 2022, 3:38 p.m. — Recently, I was discussing health equity with some of my fellow AAFP Board members and was surprised to hear that there are people in their communities who question them about whether health disparities actually exist in our country. And in the last few weeks, there have been groups publicly protesting work aimed at establishing greater equity in health care, especially for communities of color.
I am a little taken aback. I’ve been practicing for more than a quarter-century, and I’ve seen the effects of health disparities first-hand. We know that they exist, and we know why they exist. This week, the AAFP reiterated our support of health professionals who are working to resolve these health disparities.
The COVID-19 pandemic is perhaps the best example we have that shows the impact of health inequities on underserved populations and marginalized populations. Dozens of studies have shown that health inequities can have an overwhelmingly negative effect on the well-being of communities of color.
Race, ethnicity, social standing, income level or ZIP code should not be the determining factors of how healthy we are or how long we are going to live, but for many people, that’s exactly what those factors do.
Family physicians are the key to better patient care for the American public. We are on the front lines of driving the conversation and moving the needle on health equity for all of our patients. Through the work of the AAFP’s Center for Diversity and Health Equity, which includes advocating for health in all policies, our Academy is working hard to help address health disparities and social determinants of health.
Striving for health equity isn’t easy and it often requires us to confront our own biases. We all subconsciously have some, so the first step is becoming aware of them and in turn not allowing them to cloud our patient interactions. This can be quite uncomfortable because none of us want to admit we have any biases.
There is an example of my own bias that I like to use because I think it is one that many of us as physicians can relate to.
I opened my practice in August 1995. I practice in a small town in eastern Virginia located on the Chesapeake Bay. It’s small enough that I know most of the residents. I went to school or church with many of them and some of my patients used to see my father.
Several years ago, a new patient came into the office. I hadn’t met him before, and the patient chart didn’t provide a whole lot of information other than he was a white male with chronic back pain. Before I even opened the door, I assumed he was a person suffering from a substance use disorder looking for an opioid prescription.
And upon opening the door, what I saw further added to my assumption. The patient was covered in tattoos from head to toe. After speaking with him for a few minutes, I quickly realized that I had subconsciously misjudged this person and the situation.
He explained that he’d been struggling with chronic back pain for years after a work injury, and while medication brought him temporary relief, he didn’t want to be reliant on drugs to be pain free. He was looking for a longer-term solution to attain comfort. He has been a patient of mine ever since that visit, and we have been able to successfully address his chronic pain without medication.
I remind myself of this situation often because it reinforces the importance of taking advantage of the resources the Academy provides for us to learn about and address implicit bias and social determinants of health to strive toward greater health equity for our patients and our communities.
This is what health equity is about. It’s about putting aside preconceived notions based on the way someone looks or something we see in their chart before even meeting them. It’s about having hard conversations with ourselves as well as with people who are different than us. It’s about understanding that each of our patients is an individual with unique needs and offering support to help them achieve/maintain their health.
Health disparities and health equity are complex and difficult topics, but that doesn’t mean we should avoid them and give up. It’s hard work, but I see the passion — and compassion — in our members’ eyes when these issues come up. I see the efforts they are making, working on their patients’ behalf and trying to understand how they can make a difference in their patients’ lives. I want you to know that the AAFP has your back, and that we’re working hard to support you along the way. The Academy plans to continue its work on advancing health equity throughout 2022 and in the years to come.
As we observe Black History Month, I ask that we all take a moment to reflect. We know that much progress has been made in addressing health disparities and improving health equity, but we must also acknowledge that much work remains to be done. We need to keep the conversations going, and take advantage of the tools the Center for Diversity and Health Equity provides, such as the EveryONE Project and implicit bias training resources. Together, we can achieve health equity for our patients, communities and country.
Sterling Ransone, M.D., is the president of the AAFP.