DAYNA BOWEN MATTHEW PROFESSOR UNIVERSITY OF COLORADO LAW SCHOOL COLORADO SCHOOL OF PUBLIC HEALTH CENTER FOR BIOETHICS AND HUMANITIES POVERTY RACISM DISPARITIES OBESITY ASTHMA INFANT MORTALITY Ø LACK OF ACCESS TO LEGAL REPRESENTATION Ø BARRIERS TO INTEGRATED HEALTHCARE Ø UNCONSCIOUS RACISM IN HEALTHCARE DELIVERY THE COLORADO HEALTH EQUITY PROJECT RWJF Survey -‐ 85% of MDs indicated “unmet social needs are directly leading to worse health for all Americans” and ninety-‐ﬁve percent of physicians serving paSents n low-‐income, urban communiSes that ‘paSents’ social needs are as important to address as their medical condiSons. Colorado Health Equity Project: Sample Case Health Issues: Warts, Cancer, InfecCon, Depression Unmet Legal Needs: Lost beneﬁts, unsanitary housing Family of three lived for 25 years in bug infested trailer paying $700/month, Medicaid and disability payments terminated and health care deferred. CHEP enforced adult protecSve service, social security, and beneﬁt laws to move family, reinstate beneﬁts, and obtain disability raSng allowing son to work. Family resumed medical treatment, self-‐ suﬃciency, and recreaSon. INTEGRATED HEALTH CARE INTEGRATED HEALTH CARE What is unconscious bias? on unconscious bias Source: Schulman Kevin A, et al. NEJM. 1999;340-‐624. EVIDENCE THAT BIAS IMPACTS HEALTH CARE •  Schulman: Race and sex of a paCent independently inﬂuence how physicians manage chest pain –  CriSque of Schulman Study: •  RelaSve chance of referral used risk raSos rather than odds raSos therefore results somewhat overstated probabiliSes –  “We doubt that lower uFlizaFon rates observed consistently among black paFents reﬂect an eﬀort to provide more appropriate care to these paFents.” Literature Review •  Alexander R. Green (2007) –  Physician discriminatory treatment due to implicit bias not to intenConal racism –  As MD pro-‐white implicit bias increased, so did likelihood of treaSng whites and not treaSng blacks with thrombolysis for CAD RECOMMENDATIONS RECOMMENDATIONS •  Reform Reimbursement Policy •  Community Advocacy and EducaSon •  Provider Training and IntervenSon •  Broaden our Range Of SoluSons Difference Matters A Resource on Diversity Identity, and Communication By Brenda J. Allen, PhD http://www.differencematters.info Just Medicine: A Cure For Inequality In American Health Care By Dayna Bowen Matthew, JD