During the National Congress of Student Members held here as part of the 2017 AAFP National Conference of Family Medicine Residents and Medical Students July 27-29, delegates adopted a handful of resolutions that addressed health equity for all Americans.
Emmeline Ha, of the George Washington University School of Medicine and Health Sciences in Washington, D.C., testifies about a resolution she co-authored that asks the AAFP's Center for Diversity and Health Equity to support new data collection methods to identify demographic subpopulations.
A number of other resolutions also received a thumbs-up from students, including measures on lifestyle medicine, electronic health record (EHR) system interoperability and teen pregnancy.
These and other resolutions students adopted are not yet AAFP policy; they will now move through the AAFP's policymaking channels for review, referral and, when appropriate, further action by AAFP leaders and the AAFP Congress of Delegates.
Health Equity for All Americans
Several resolutions adopted during the student congress on July 29 addressed equality in health care, including equal representation in the research that drives allocation of government health care resources.
- During the 2017 National Congress of Student Members held in Kansas City, Mo., delegates adopted a handful of resolutions that addressed health equity for all Americans.
- A number of other resolutions also received a thumbs-up from students, including measures on lifestyle medicine, electronic health record system interoperability and teen pregnancy.
- Students also considered, but eventually rejected, a measure to combine the student congress and the National Congress of Family Medicine Residents.
Delegates adopted a substitute resolution that asked the AAFP's Center for Diversity and Health Equity to create a public statement of support for changes to data collection methods that identify subpopulations and better acknowledge and address health disparities. The measure also called on the AAFP to advocate amending and expanding the White House Office of Management and Budget's Race and Ethnic Standards for Federal Statistics and Administrative Reporting(www.whitehouse.gov) to better reflect U.S. demographics.
Supporters of the measure testified in a July 28 reference committee hearing that current standardized race categories (American Indian or Alaska Native, Asian, black or African-American, Native Hawaiian or other Pacific Islander, and white) and ethnicity categories (Hispanic or Latino and not Hispanic or Latino) don't adequately include people of Middle Eastern or North African descent or those of combined racial descent.
"The Middle East and African populations are categorized as white, even though their experiences are quite different and unique," said co-author Emmeline Ha, of the George Washington University School of Medicine and Health Sciences in Washington, D.C.
The authors also pointed out that subpopulations within racial groups face disproportionate health disparities. "Homogenized data on Asian-Americans may appear comparable to Caucasian whites. But when you look at Southeast populations such as Cambodians and Laotians, they have considerably lower rates of insurance access, median household income and education status and are misrepresented," Ha said.
For example, according to an HHS data analysis(aspe.hhs.gov) from the 2010 U.S. Census, about 18 percent of Asian-Americans and Pacific Islanders are uninsured. However, uninsured rates for the subgroups of these populations vary considerably, including rates of 6.6 percent for Japanese-Americans, 10.9 percent for Filipino-Americans, 11.8 percent for Asian Indian-Americans, 13.4 percent for Chinese-Americans, 16.7 percent for Native Hawaiian and Pacific Islander-Americans, 19.8 percent for Vietnamese-Americans, and 25.5 percent for Korean-Americans.
Co-author Linda Ataifo, also of the George Washington University medical school, spoke about her Nigerian heritage and how being Nigerian is different than being African-American.
"The health outcomes of Nigerian-Americans, specifically those who have prostate cancer, tend to be worse compared to African-Americans," she said.
Ataifo also said the division of health care resources is a fundamental part of improving equity. If those resources aren't reaching the subgroups that need care, then the funding is misallocated.
Keanan McGonigle, of the Tulane University School of Medicine in New Orleans, explains a resolution he co-authored asking the AAFP to use its resources, population health knowledge and political influence to advocate for the Medicare for All model.
"I think this resolution helps us to better understand the subpopulation needs in specific communities and how to better prepare and provide the care that they need," she said.
Medicare for All
After extensive reference committee testimony, delegates also adopted a substitute resolution that asked the AAFP to use its resources, population health knowledge and political influence to support the Medicare for All model.
Original resolution co-author Keanan McGonigle, of the Tulane University School of Medicine in New Orleans, said the Academy should advocate for improved and expanded Medicare coverage for all Americans.
"This would be a more equitable health care system than the one we have currently," he said. "Medicare is a uniquely American system of health care provision with lower administrative costs, higher quality and better outcomes than a lot of private insurance options. So, expanding it from the 65-and-older population to all Americans would be beneficial. And with the AAFP's focus on primary care and health equity, a single-payer option goes hand-in-hand with those goals."
Other testimony asserted that the Medicare for All model would benefit patients by simplifying the health care system and ensuring all physicians are considered "in-network," including those in rural areas.
The reference committee noted in its substitute resolution language that at the request of the 2016 AAFP Congress of Delegates, a report from the Board of Directors on single-payer health care will be presented to the 2017 Congress of Delegates in September.
Stephen Supoyo, of the Icahn School of Medicine at Mount Sinai in New York, N.Y., testified in support of the resolution. He said family medicine is the future of medicine in the United States and called on the AAFP to act accordingly.
"Since we will be a central part of the health care workforce, and since our patients will look to us as leaders, and thereby look to the AAFP as a leader on this issue, I believe we should be at the forefront on this issue," he said. "If we don't act now, we will be left behind."
Finally, the student congress adopted a resolution asking the Academy to recognize health care as a basic human right -- not a privilege -- for every person.
Co-author Kale Flory, of the A.T. Still University-Kirksville College of Osteopathic Medicine in Kirksville, Mo., said the idea that everyone deserves access to primary care should be supported by most AAFP members.
"So, I'm here to ask the Academy to publicly declare health care a human right, and use this framing for future advocacy, as this is much more impactful when advocating for our patients," he said.
Students also adopted measures that called on the AAFP to
consider incorporating more lifestyle medicine resources into the Academy's website, presentations and workshops at conferences;
advocate for legislation to mandate EHR interoperability through a simple and secure interface; and
communicate to appropriate government entities, including Congress and HHS, opposition to budget cuts to the Teen Pregnancy Prevention Program(www.hhs.gov).
One final note of interest: One of the three student reference committees recommended adopting a resolution that called for combining the National Congress of Student Members and the National Congress of Family Medicine Residents. Supporters of this move said forming a unified body to vote on resolutions would increase efficiencies for both groups and also provide opportunities for mentorship between residents and students. In the end, however, the measure was voted down by student delegates.
The resident congress considered a similar measure, with residents delegates ultimately adopting a substitute resolution calling for consideration of a limited number of joint student-resident resolutions at a joint congress session.
Related AAFP News Coverage
2017 National Congress of Family Medicine Residents
Residents Vote to Protect Patients, Push Physician Wellness
2017 National Conference: Day Three(storify.com)