The New York Times, National Public Radio (NPR), ProPublica, The Washington Post,
US News & World Report, Time, Newsweek, Essence —
they’re just a few of the media outlets that have recently done stories regarding apparent racial bias in health care.
The stories frequently zero in on disproportionately high rates of maternal mortality among black women, about the health care they received.
Dr. Mario J. Gaspar de Alba
, an associate professor of pediatrics at the UNLV School of Medicine as well as its associate dean for diversity and inclusion, is a strong supporter of the decision by the Institute of Medicine of the National Academy of Sciences to call for more studies looking at discrimination and prejudice in medicine.
“It is an area that deserves more study,” notes de Alba, who says he saw disparities in health care delivery as a Hispanic growing up on the US-Mexican border in El Paso, Texas. “Evidence shows racial bias in health care exists. Fortunately, at the UNLV School of Medicine, from Dean (Barbara) Atkinson on down, there is a commitment to diversity so we’re better able to serve our community. We want to have diverse faculty and medical students who represent and understand the nuances of our very diverse community. We do a lot of community engagement and community service where our students work alongside of, and come into contact with, people who don’t look like them. Our curriculum takes diversity into account.”
In its stated mission, the UNLV School of Medicine makes a commitment to “serving the health care needs of our diverse urban community.” Twenty percent of the charter class of medical students is Latino, eight percent African American —
ethnic backgrounds medically underserved in Las Vegas. Women make up a majority of the class.
What the effect of racial bias in medicine has ultimately been on patient care remains unclear, Alba says. A 2016 study published in the Proceedings of the National Academy of Sciences found disparities in pain management may be attributable in part to racial bias. That study, which surveyed 222 white medical students and residents, found that a distressing 40 percent of first year medical students and one in four residents thought black patients had thicker skin than white patients.
Another 2016 study published in the American Journal of Gastroenterology found black patients were 20 percent less likely to die or have major complications if they received treatment at a racially diverse hospital. The study’s author said the “underlying hypothesis” of the study “is that hospitals and providers that treat more minority patients have higher levels of cultural competency.”
“Any institutional lack of respect for, or understanding of any specific group, will lead to sub-optimal health care and poorer health outcomes,” de Alba warns.
Social inequities have long been pointed to as reasons for the shorter life spans of minorities, including less access to healthy food, clean water, health insurance, and good medical care. That differential access, which can lead to chronic conditions such as obesity, diabetes, cardiovascular disease and high blood pressure, makes having a baby more dangerous.
Yet the recent media attention, often detailing federal statistics showing black women are three times more likely to die from pregnancy-related complications than white women, also suggests that part of the reason for the disparity is that doctors dismiss the legitimate concerns and symptoms of black women, regardless of their social economic status.
In 2017, during a joint reporting venture by NPR and ProPublica, reporters who talked to 200 African-American mothers found that a constant theme was the feeling of being disrespected and devalued: “Over and over, Black women told of medical providers who equated being African women with being poor, uneducated, noncompliant and unworthy.”
In the April 15, 2018 edition of the New York Times Magazine, writer Linda Villarosa showed how Simone Landrum, an African-American, had her health concerns ignored prior to giving birth to a stillborn child.
De Alba says the UNLV School of Medicine’s commitment to diversity in educating future physicians can be seen in several ways.
“Implicit bias training helps all of us understand subconscious biases created by environment and media that affect how we act and interact with others, especially under high stress situations in which we are more likely to rely our our mind’s automatic (subconscious) processes,” he says.
A problem-based learning curriculum can build possible discrimination into the medical issue at hand, de Alba says. “We’re not teaching in a lecture format,” he says. “It’s not a one time thing.”
De Alba says the medical school is working with K-12 school systems to better ensure that there is a pipeline of incoming medical students which look like the Las Vegas community. Dean Atkinson, he says “understands how important focusing on diversity is if we are to be successful. Her desire is to have a medical school in which diversity is valued and an integral part of our culture, not just a monthly lecture.”
Fortunately, de Alba says, more attention is now being given to diversity. “I honestly don’t recall discussing or being trained in diversity topics when I started residency in pediatrics 15 years ago... I believe medical educators are more keenly aware of the diversity of our country and the importance of training a diverse workforce to improve health equity for everyone. Health equity improves health care care outcomes: a driving mission of medical education.”
Diversity, de Alba stresses, isn’t just about race and gender. “Diversity,” he says, “should be thought of as race, gender, culture, educational experiences, family, work history, essentially everything contributes to who a person is and how they work and live. Everyone has their own ‘story’ and path they took to get to where they are. This is what truly makes us diverse. If we can tap into that diversity, there is no limit to what we can learn and how we can grow as individuals and as a school of medicine.”