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  ITOR'S COLUMN EDITOR'S COLUMN
 HEALTH CARE
HEALTH CARE DISPARITIES
ED
Health Care Disparities (HCD) - this term has been with us for many years. It is a term that many of us physicians not only have heard, but also have gone to seminars and conferences about it. There we have learned more about HCD and what it entails. It is now in the spotlight for the State of Michigan, and it has new ramifications for practicing physicians. Those more closely aligned with HCD can bear witness to the challenges it involves and the dif- ficulties with getting real traction on it. Efforts aimed at tackling this multi- faceted problem have resulted in many lessons learned, but it also has been recognized that there is much more that can and needs to be done. The HCD problem sheds light on the fact that it takes more than a singular strategy to confront the problem, and much more work will be needed to change the trajectory of this problem over time. The COVID 19 pandemic mortality sta- tistics function as a symbolic flashlight shining into the darkest crevasses of health care services and delivery. This is especially poignant because of the high percentage of mortality among African Americans infected with this disease. This is a national, state and local problem. There appears to be a significant divide between perceptions of how health care is thought to be offered and delivered and what the data actually shows.
In her June 3, 2020 article entitled, “Health Inequality Actually Is a “Black and White Issue,” Jordyn Imhoff of the University of Michigan Health writes “The second paragraph of the Declaration of Independence states clearly: All men are created equal. But does this hold true for all people in 2020?”
In the same article, Melissa Creary PhD, Assistant Professor of health man- agement and policy at the UM School of Public Health, wrote, “While it’s true that African Americans have higher rates of hypertension, diabetes and obesity, all risk factors for worse outcomes from COVID-19, I think public health practitioners would say it’s not the fact that they have these diseases that’s causing the higher death rate --because people of all races, classes and creed have these diseases.” Also, “It’s the fact that we see an undeniable bur- den of disease in the African American population. It’s this disproportionate amount of disease that is worrisome. The underlying issue as to why we see so many of these conditions is actually attributed to structural inequity.”
A May 23, 2019 research article in JAMA Oncology entitled Association of Black Race with Prostate Cancer–Specific and Other-Cause Mortality by Robert T. Dess MD, asked the following question, “Is black race associat- ed with worse prostate cancer outcomes after controlling for known prog- nostic variables and access to care?” In the findings of this study, black race was not associated with worse prostate cancer specific mortality outcomes in men with newly diagnosed non-metastatic prostate cancer treated within health care systems that have standardized access or within a standardized treatment approach with follow-up. In contrast, within the Surveillance, Ep- idemiology, and Ends Results (SEER) cohort, black race was associated with multiple socioeconomic barriers to quality of care.
In September 27, 2018, the Commonwealth Fund featured an article enti- tled In Focus: Reducing Racial
Disparities in Health Care by Confronting Racism Compared with whites by Martha Hostetter and Sarah Klein. The article states “Members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. They also have worse health outcomes for certain conditions. Black mothers die from pregnancy-related complica- tions at three to four times the rate of white women. And while maternal
DISPARITIES
 6 Detroit Medical News
Third Quarter 2020
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