Speakers deliver speech about race in health care

Analicia Haynes, Senior Reporter

“Doctor, I just want you to treat him as if he were a white baby.”

That is what a grandmother told James Hildebrandt when he was training in emergency medicine at Bethany Hospital on the west side of Chicago.

The mother of the 2-month-old baby with a fever was in tears, he said, and would not look at him when the grandmother said this to him and asked him if he could also not experiment on her grandchild.

“She wasn’t being mean, she wasn’t angry with me, she wasn’t trying to insult me, she was really worried that I would treat that baby differently because of the color of his skin and that just hit me like a ton of bricks,” Hildebrandt said. “I was like, ‘My God to have to be afraid of that happening to you.’ She was afraid of what I was going to do, that I was going to experiment on the baby. It just broke my heart.”

The baby was fine, and Hildebrandt said that experience stuck with him for the rest of his life because for a while he asked why that family would think that.

“I was not equipped to understand those emotions I guess at that point in my life,” he said. “But it was something that really made me think and I guess it changed the way I look at things now.”

Hildebrandt, who is now the vice president of medical affairs at Sarah Bush Lincoln, shared this story and talked about several of his personal experiences dealing with race disparities in health care. He said he also told them to get the audience thinking about real life implications on what racial disparities in health care look like.

He was one of three speakers presenting a lecture Monday afternoon called “Race in U.S. Health Care.”

He shared his story to describe what “woke him up” as far as understanding what some of these problems are and how he was able to put myself in someone else’s shoes.

He also outlined studies and research highlighting the current state of race in health care and causes of those disparities.

Ozlem H. Ersin, dean of the College of Health and Human Services, and Doris Nordin, a campus minister at the Newman Catholic Center, were the other two presenters.

Ersin focused what she called the bigger picture of inequities in U.S. Health Care, outlining different studies and explaining the difference between disparity and inequity.

Nordin talked about her personal experiences within the Latino/Latina community in Charleston and identified problems that this group faces when trying to find necessary health care and the obstacles they constantly must overcome.

According to the Boston Public Health Commission website, health disparities are “differences in the presence of disease, health outcomes or access to health care between population groups.”

“Health inequities, on the other hand, are differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust. Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups,” according to the Boston Public Health Commission website.

Ersin said health inequities and health disparities are not the same. She said health inequities are layered onto health disparities, they are ideas that state there is something systematically wrong that is causing the health disparities. But she said the inequities are avoidable and are fundamentally unjust.

Ersin said the World Health Organization definition of health is the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

“That’s really important to keep in mind, so when we’re talking about health inequities in this country, we’re not only talking about everybody being free of diseases but also being able to live up to their full potential as human beings,” she said. “And when we say health care, we’re talking about an organized endeavor to maintain health and well-being as well as restore it when such is not evident.”

Ersin outlined three takeaways in her presentation. One of them was that in this country health inequities do exist, the second takeaway is that the way health inequities are measured in the U.S. are based on faulty ways of looking at individuals and trying to lump them into categories and buckets, and the third one is that inequity in health care is not a problem without a solution.

“We can do something about it, we can actually address inequities,” Ersin said.

She identified different examples of common health disparities in America and used numbers and data to paint the picture.

She said when a seminal report that came out in the Institute of Medicine in 2002, that was the beginning of when the health care system started paying attention to health inequities.

Hildebrandt referred to the same report in his presentation as well and said right now there are serious discrepancies between health care outcomes between minorities and whites in this country.

“In that report they said that these disparities cannot be explained by social factors, economic factors, geographic factors, in other words it’s not just because you live in a poor part of town and they don’t have enough doctors there. It’s not just because you don’t have insurance, it’s not just because you don’t have money or an education…those things don’t explain a lot of health care inequities,” Hildebrandt said.

He said these factors do not tell the whole story and that, according to the data found in the report, there is a racial aspect in inequities and disparities in health care.

But Ersin said before looking at inequities in U.S. health care, it is important to understand the demographic make-up of the U.S.

As of 2016, 60 percent of the U.S. population are white, 17 percent are Hispanic, 13 percent are Black, 6 percent are Asian and 4 percent are Other.

By 2050 the population is expected to grow by about 65 million people and there is expected to be a major demographic shift in terms of the make-up of the country, Ersin said.

“Our definition of what we mean by minority is going to be changing pretty soon if not already,” Ersin said. “When we talk about minority health or health inequities, what we’re talking about is a shifting picture.”

Ersin offered different examples of where disparities are seen in health care such as people with cancer between men and women and then between African American men and white men.

“When you compare males to females, you see that there is an inequity or a disparity or an outcome difference between females and males,” Ersin said. “Females seem to be doing better…but just on the surface, just by going by the numbers, females in this country seem to be faring better both in terms of real numbers and in terms of deaths from such cancers…there is a gender gap.”

Ersin then said that African-Americans, who represent 13 percent of the population, also suffer from more incidents of cancer than whites, which represent 60 percent of the population.

She also said, based on the data provided, that more black men die of said cancers than white men and women.

This was just one example of a health disparity that Ersin used. Another example was people diagnosed with diabetes.

She said that according to numbers from 2013 and 2015 15.1 percent of American Indian and Alaskan Natives are diagnosed with diabetes compared to just 7 percent of whites.

A third example was the level of education people receive. The more education people receive, the healthier they are.

“Another way to look at it might not necessarily be a race or gender lens but through educational attainment,” Ersin said. “Is that relevant to us at Eastern and this community? Absolutely. The higher our educational attainment is the more likely we are to be healthier and experience well-being.”

But, one of the most significant health disparities in the country is life expectancy.

In 1999 a Black male was likely to die, on average, seven years sooner than their female white counterpart, Ersin said.

“Currently the disparity between the highest life expectancy and the lowest life expectancy is down to four years. Is that acceptable? It’s not. In terms of life expectancy there’s a wide gap,” she said.

Hildebrandt also listed some other disparities including the fact that a Black woman is 22 percent more likely to die of a cardiovascular disease than a white woman or a black woman is 71 percent more likely to die of cervical cancer than a white woman.

But Hildebrandt said in 2010 the Institute of Medicine published another report that looked at how far America has come in fixing the disparities and inequities pointed out in the 2002 report.

“The answer is we’ve come a little ways, but not very far,” he said.

There are many contributing factors to disparities and inequities in U.S. health care and Hildebrandt said it is hard to try to figure it out why some groups in some areas get better treatment than others.

But one of the things that became clear in the study was that bias, prejudice and stereotyping account for some of the differences, he said.

“That’s part of the problem here and hurts me to say this but it’s true,” he said.

He said he tries to learn about his own biases and weaknesses, something he says is key to preventing disparities and inequities in health care.

“If you are aware of your biases then you can make sure that you’re not acting on them, that you’re being really careful to not allow yourself to treat people differently because that’s not what you really believe in. The better person does not believe in that,” he said.

Hildebrandt also said something like this has to be taught to medical professionals and to everybody.

“Without people realizing this and learning this we don’t have much chance of overcoming our problem with race,” he said.

Ersin also said the sources of health disparities are complex and rooted in historic and contemporary inequities and involve many participants at different levels.

However, she said there is hope in solving these inequities even though there is a “lot of work to do.”

“There’s hope but we cannot become complacent because there is a lot of work that has to be done,” Ersin said.

Analicia Haynes can be reached at 581-2812 or [email protected]