Consequences and the Financial Burden of Healthcare Disparities and What Can Be Done

Editor’s Note: MSSNY member Paniz Parvar, MD, submitted this article. If you are a member and would like to contribute an article for consideration in our newsletter, please contact us at [email protected].

“Babies born just six subway stops apart in New York City face a nine-year difference in life expectancy.” This finding comes from a 2015 map developed by researchers at Virginia Commonwealth University in association with the Robert Wood Johnson Foundation and the NYC Department of Health and Mental Hygiene. According to their research, life expectancy in New York City varies from 85 years in neighborhoods like Tribeca and Murray Hill to just 76 years, barely 4 miles away in East Harlem, and even down to 75 years in Brooklyn’s Brownsville and Morrisania in the Bronx. Looking only at this map, one can make the assumption that inequalities in health stem from inequalities in our societies.

One definition of health disparities by the CDC is the occurrence of diseases at greater levels among certain population groups more than among others. The different populations are described by factors such as race or ethnicity, gender, education or income, disability, geographic location, or sexual orientation.

Health disparities and injustice in societies are preventable through reasonable action, and the lack of prevention and our inability to address it efficiently is resulting in a higher number of deaths and diseases, particularly among underprivileged populations. Based on data from the New York State Department of Health, mortality rates in the city of New York in 2022 were 822.6 deaths per 100,000 for Black non-Hispanic populations and 588.9 for white populations. This means approximately 233 more Black individuals per 100,000 are dying each year only in New York City than they would if they had the same mortality rates as white populations.

As delivered in their final report in 2008, by the Commission on Social Determinants of Health—established by the World Health Organization (WHO) in 2005 to address the social factors contributing to ill health and health inequities—“social injustice is killing on a grand scale.” It is a matter of life and death in the literal sense. Therefore, recognizing, understanding, and taking action to address the injustices and the disparities is the responsibility of all of us, not only as healthcare workers but as members of society.

Moreover, it would be difficult to overlook the financial consequences of such injustice and disparities in healthcare. Even though discussing the economic impact of decreased life expectancy or reduced years of working life may seem like a less empathetic approach, it conveys the feeling of looking at human value in the context of productivity and economic utility. As Kate E. Pickett and Danny Dorling mention in The Marmot Review of Health Inequalities, speaking about “maximizing capabilities” sounds more like the language of economics and not social epidemiology or progressive public health. But it remains an effective and practical way to capture the attention of those in charge—the decision-makers and the corporate shareholders.

According to a 2023 clinical review published in JAMA and funded by the National Institute on Minority Health and Health Disparities (NIMHD), health disparities in the United States exist due to factors such as race, ethnicity, and levels of education. The researchers estimated the economic burden of these disparities by analyzing excess medical care costs, lost labor market productivity, and premature deaths. In 2018, health inequities among racial and ethnic minorities were estimated at $451 billion, while those associated with lower educational levels amounted to $978 billion.

Throughout the years, numerous efforts have been made to improve and address the inequities, both on a large scale and within local communities. The WHO Commission on Social Determinants of Health tried to impose action by focusing on three core principles: improving conditions of daily life, addressing the inequalities in the distribution of resources, and developing a workforce that is well-trained and knowledgeable in social determinants of health. In the next section, we will explore actions and steps that individuals can take in their daily practice as providers or healthcare workers to do their part in addressing and reducing injustices in healthcare.

Becoming Conscious of Unconscious Bias

Oftentimes, the way a patient is treated when they first come into contact with the healthcare system or facility—whether it is by the security at the door or by the receptionist—can have a lasting effect, following the patient through their entire healthcare experience. According to a 2015 report published in JAMA Internal Medicine by the American Medical Association, white Americans, on average, spent 80 minutes waiting for or receiving care, while Black Americans spent 99 minutes and Latinos waited 105 minutes for the same care. With face-to-face time with the doctor being nearly identical in all populations, this data suggests minorities are spending more time in waiting rooms or engaging with administrative parts of medicine.

Furthermore, when patients do see the doctor, the existing unintentional biases may lead to different management and treatment plans for individuals with similar symptoms and diagnoses. For example, based on the studies, white patients experiencing heart attacks were more likely to undergo aggressive medical procedures or receive common guideline medications compared to their Black counterparts.

Becoming aware of the unconscious biases that result in such differences in treatment and management of different populations, especially as frontline healthcare workers, is the first crucial step in addressing the disparities in our day-to-day practice.

Understanding That at Times, Spending More Time with Some Patients Than Others Is Essential for Equity

There are times when a healthcare provider and a patient come from different cultural backgrounds and speak different languages, requiring the presence of a third-party translator. In these instances, it may feel as though twice as much time is being spent with one patient compared to a similar patient who can communicate with the provider in similar languages.

However, dedicating extra time to ensure clear communication and providing the same level of care and attention to all patients is what truly brings equity and ensures we are doing our part in delivering justice in healthcare.

Looking at Diversity and Inclusion in a New Light

It is no secret that oftentimes, sharing the same backgrounds with our patients and having more similarities will help us understand and communicate more effectively with people under our care. What we will argue, however, is that shared backgrounds are not just limited to language and culture; they could also mean similar personality traits and preferred methods of communication.

That is why diversity in the healthcare workforce should not be limited to inclusions of different races, genders, or cultures; it is important to include people with a variety of personalities and characteristics. The assumption that certain personalities are best suited for specific roles risks excluding members of the community who may be uniquely equipped to connect with patients on a deeper level, in a way that is unachievable to someone with more traditionally common approaches. For example, a more introverted doctor may better understand and communicate with a patient who shares similar dispositions and ways of expression. Recognizing the value of diversity in personalities, as well as demographics, can help us create an inclusive healthcare environment where all patients feel seen and understood.

As Dr. Martin Luther King Jr. stated at a press conference before his speech at the second convention of the Medical Committee for Human Rights (MCHR): “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.” Health disparities do not arise overnight. They are the result of historical injustices and unequal distribution of resources. Addressing these disparities is tied to confronting the broader injustices existing in our societies. By recognizing our role and taking meaningful action, we as healthcare workers can help bring us closer to a future where equitable healthcare becomes a reality for all.