For racial care divide, building trust may be key


This week, I wrote up a couple of stories on ethnic disparities in clinical outcomes that simply made my skin crawl. And that's after years of writing up stories on how Hispanics and African-Americans have gotten the short end of the care stick for a number of years.

One statistic that stood out in particular: A new study concludes that among patients with liver problems who were studied, 73.8 percent of whites were evaluated for a liver transplant, compared to a shockingly low 8.6 percent for blacks. Look at genetic, social and risk factors all you want--that's simply a terrifying number suggesting a staggering difference in care.

Then today, I summarized a survey--conducted among predominantly African-American population in Baltimore--which suggested that in that community, distrust of the medical system runs high, and that worse, consumers often suffer for that distrust by failing to get needed care.

Obviously, there's at least some connection between point A (worse outcomes among ethnic minorities) and point B (massive ethnic mistrust of the healthcare system). What I wonder is why more health policy planners aren't focusing on rebuilding this missing trust.

There are certainly neighborhood outreach initiatives--including one program tapping trusted neighborhood women to convey safe-sex and childcare information to younger females--but much of public health work seems to focus on analyzing socio-economic barriers to obtaining care.

Don't misunderstand me, I believe it's critically important to understand socio-economic barriers to care, including transportation costs, level of education on health issues and community support for self-care. But when you already know that mistrust of the healthcare system is rife in many ethnic communities, it seems to me that that's a very good place to start making changes, first and foremost. After all, it's extremely difficult to shift someone's socio-economic status, or cause them to adopt new health behaviors, even if you offer them juicy rewards. (Decades of experience has taught us that.)

Trust, on the other hand, is a matter of putting your own integrity and willingness to help on the line: to meet people where they are, help without judging, listen to their concerns whether you feel they're off-base or not, tap into credibility enjoyed by community leaders and more. Those may be generalities, but concrete programs can be built around principles like these. If we want to get people in ethnic communities stirred up to help find and close these gaps in care, the best way is to engage them, and engagement takes trust.

If I, with my education and in-depth understanding of the health system, sometimes feel bullied and pushed around by emergency department staff or specialists--to name two pet peeves--I can only imagine someone coming into these situations who feels they're out of the loop, misunderstood and worst of all, being patronized. If I were them I might bypass doctors as often as possible, too.

Let's get going on the racial disparities problem by getting to the people who are being harmed and giving them a voice. Hey, it can't hurt, and it very well might help. - Anne

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