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Narrowing Health Disparities: One Health System's Efforts Toward Equity for Underserved Populations

Learning Objective
Explain the opportunity for health systems to work with communities to improve health equity
1 Credit
Abstract

Short Cutz is an unassuming hair salon in downtown Baltimore. It is not the typical place you might expect to get a flu shot or have your blood pressure checked, but it is in places like this—trusted, local businesses that are part of the rich fabric of community life—that Kaiser Permanente is having success closing the health disparity gaps that have long persisted among America's communities of color. Along this journey to close care gaps, researchers have evolved from thinking about health equality to pursuing equity. Health equality provides the same care to everyone.

Short Cutz is an unassuming hair salon in downtown Baltimore. Tucked into the corner of an aging block of row houses in one of Baltimore's toughest and most vulnerable neighborhoods, its windows are covered with security bars and “no loitering” signs are posted outside.

It is not the typical place you might expect to get a flu shot or have your blood pressure checked, but it is in places like this—trusted, local businesses that are part of the rich fabric of community life—that Kaiser Permanente is having success closing the health disparity gaps that have long persisted among America's communities of color.

Minorities are more likely to die as infants, have higher rates of disease and disabilities, and have shorter life spans. African American women have a higher proportion of advanced stage breast cancer at the time of diagnosis and have poorer outcomes; much of the disparity is attributable to lower screening rates and to health care access.1,2 It proves that “your zip code is more important than your genetic code.” Place matters, and a one-size-fits-all health care system is failing a good portion of Americans.

Kaiser Permanente has worked for years to close the disparity gaps between different populations and communities. From our beginnings as a health plan for World War II laborers and their families, we have served highly diverse communities with the mission to provide access to high-quality affordable and equitable health care to our members and to improve health in our communities. Although we care for nearly 12 million Kaiser Permanente members, we also are invested in creating healthier lives for the 65 million residents in the communities we serve.

We are deeply imbedded into each of our distinct communities and look for early opportunities to intervene and influence choices and other factors that contribute to high rates of disease. We provide care and service with cultural sensitivity and in the languages members prefer. Technology enables us to offer more choices to our members when deciding how they would like to interact with us, in person, by telephone, or via video appointments, for example. Online tools allow members to fill prescriptions, make appointments, e-mail their physicians from the comfort of home or via a mobile device. And although these conveniences are helping to improve health outcomes overall, we know that our minority members are less likely to use these tools. We have work to do to ensure these populations receive the benefits associated with telehealth.

Along this journey to close care gaps, we have evolved from thinking about health equality to pursuing equity.

Health equality provides the same care to everyone. Health equity levels the playing field by asking why some people are at greater risk of illness, injury, and death and reallocating resources and support to address those populations' unique needs.

Our work with Short Cutz is an example of the solutions that can arise when health care organizations partner with communities to reach people in their own neighborhoods and where they are most comfortable.

Nurses, physicians, and other clinicians are there regularly—as well as at several other local Baltimore barbershops and beauty salons—to talk to clients and neighbors about wellness and health and to offer free vaccinations and health screenings, including HIV tests, screenings for liver and kidney disease, blood sugar screenings, and more. Here is an opportunity for radiologists to practice population-, community-, and patient-centered care by explaining and promoting screening mammography. It is a natural fit because these community businesses are places where people feel welcomed and are already established informally as casual centers for people to talk freely about life in their city and neighborhoods. There is a relationship of trust between the businesses and their clients, so inviting our doctors and other medical professionals in to talk about wellness and to help people take care of their health can feel like a natural extension of that trust.

Partnering with additional organizations in these communities, we also offer nonclinical support, including fitness instructions, career counseling, job-placement services, and help signing up for health coverage under the Affordable Care Act. We are progressing from patient-centered care through family-centered care to community-centered care.

These and other unconventional partnerships around the country are helping us remove barriers to care and address the root causes of poor health and inequity that keep people and communities from reaching their full potential. We are seeing results.

Over the past several years, we have reduced disparities in hypertension control between African American and white patients by 71% and increased colorectal cancer screenings among Hispanic members by 20%. At the same time, we have improved results for all other populations, helping to close the gaps while raising the bar for everyone.

Of course, as long as people still die from colon cancer, heart disease, and other preventable illnesses, we still have work to do. Imaging screening for colorectal cancer and heart disease can advance the quality of care we provide in our increasingly diverse population and members.

We track some 250 ethnicities in our electronic health record system and now know the self-reported race, ethnicity, and preferred language for 90% of our members. We use that information to personalize care, target health disparities, and make sure we are meeting the unique needs of our members within racial, ethnic, and socioeconomic populations.

Understanding diverse neighborhoods and patients' backgrounds will be a core part of the curriculum at the new Kaiser Permanente School of Medicine, set to open in 2019 to 2020.3 We will train physicians to look beyond traditional medical settings and to address disparity issues. And we will recruit diverse talent, so that current and future physicians across the nation reflect our diverse populations, know how to address the conditions that cause health disparities, and know how to achieve greater health equity, so everyone has a fair opportunity to live a long, healthy life. Future radiologists we educate will play key roles in our physician-led integrated clinical and outreach team approach to providing care for our communities.

Good health is essential to the American ideal of life, liberty, and the pursuit of happiness. As health care professionals, we are obligated to ensure those unalienable rights are not compromised because of demographics, diversity, or socioeconomic status. We all should have an opportunity to thrive.

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Article Information

Copyright This content and the individual contributions contained in it are protected under copyright by the American College of Radiology.

To read more about imaging and patient-centered care, visit the Journal of the American College of Radiology.

Author Information:

Bernard J. Tyson, MHA, is Chairman of the Board and Chief Executive Officer of Kaiser Permanente.

References:
1.
Iqbal  J, Ginsburg  O, Rochon  PA, Sun  P, Narod  SA.  Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States . JAMA 2015;313:165–73.
2.
Curtis  E, Quale  C, Haggstrom  D, Smith-Bindman  R.  Racial and ethnic differences in breast cancer survival: how much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics?  Cancer2008;112:171–80. Google ScholarCrossref
3.
 Kaiser Permanente School of Medicine 2018 . Available at: https://schoolofmedicine.kaiserpermanente.org/news/. Accessed April 19, 2018.
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