How Best To Address Healthcare Disparities?

While there has been increasing attention on Healthcare Disparities  and more centralized thinking on how to address these disparities, the problem still remains.  In New York City a recent conference marked the launch of the NYC Coalition to Dismantle Racism in the Health System.

Doctors Council is part of this group whose goal is “to equip health professionals (in all sectors: community health activists/CBO, social work, public health, medicine, health policy, academic medicine) with the tools to address racism and eliminate inequities in the health system in NYC.”

But intention is not enough.  Recent work has focused on overturning assumptions, however well meaning, about ending disparities and basing reform on the real evidence of what works.

In this post we want to highlight a recent article in HealthAffairs “Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care” by Dr. Margarita Alegría.

Dr. Alegría and her colleagues address three mistaken assumptions about how to eliminate disparities in the delivery of behavioral health.  They “posit that the persistence of disparities in behavioral health services is partly due to the planning of service delivery systems without consideration of research findings and, consequently, with faulty assumptions.”

To that end, they list 3 mistaken assumptions about ending disparities in behavioral health:    “The first mistaken assumption is that a universal approach to improving access to care by itself will reduce disparities in behavioral health services.”   “ The second mistaken assumption is that the planning of behavioral health service delivery addresses minority patients’ preferences.”   “The third mistaken assumption is that evidence-based interventions are readily available for uptake in settings that serve diverse populations, with a trained workforce prepared to offer them.”   While all 3 assumptions seem to embody common sense, evidence does not bare it out.  They conclude “Strategies to increase the availability, accessibility, and quality of behavioral health care for racial/ethnic minorities work best if they also address social determinants that affect health care (emphasis added). A systematic commitment at the levels of policy, health care delivery, and community practice could create real and lasting improvements in behavioral health status for all Americans.”   The impact of healthcare disparities on our patients is something we see every day and the need to address social determinants of care is a growing realization of doctors.    We have previously written in earlier blogs about health disparities as well as social determinants of care.  How do you see the interconnection?  What are your thoughts about how best to address healthcare disparities in general and in particular to behavioral health?  Let us know.

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