Can the fight against healthcare disparities be won?

The summer before starting medical school I had the fortune of traveling to both Southeast Asia and Central America on humanitarian medical relief mission trips. I was initially exhilarated by the idea that I soon too will acquire the skills honed by the doctors, nurses, and other health care providers I was working with. The idea of mastering the science of healing had inspired me for so long, yet the vision was quickly becoming somber.

As a team, health care providers attended to patients from sunrise to sunset each day but the lines never got shorter. The patients just kept showing up, day after day and the lines were just as long as they were on the very first day. I was not disillusioned by what seemed like an endless amount of work, but rather by how a system had let down such a large number of people.

Patients showed up with a wide range of aliments. Some were extreme such as bone fractures over ten years old while others presented with mild and chronic cases such as hypertension and diabetes, most being diagnosed for the first time. Most showed up to see a doctor for the first time in their lives. I began to wonder if I was I destined for a career in medicine in which the lines never got shorter and the problems ailing patients only got worse. Worst of all, I questioned whether the overlying barriers to better health would ever be overcome.

Shortly after returning to the United States I started my first year of medical school. Within my first few patient encounters I began to witness some of the same barriers I saw patients experience in Southeast Asia and Central America, only this time in my own backyard. I was a first year medical with limited doctoring skills and little expectations so I began to do the only thing I was good at – listening.

What I heard were stories of patients waiting over six months to see a doctor for less than ten minutes, mothers having to decide between school supplies or a healthy snack for their kids, and families with multiple prescriptions wondering which medications they could afford and which they could skip this month because they did not have enough money for them all. These were just the stories from those who managed to get an appointment at one of the few safety net clinics available to the uninsured in our city. Thousands of other stories remain untold because patients either cannot afford or do not have access to a healthcare provider.

I have never questioned my decision to attend medical school but I often find myself questioning whether we, as healthcare providers, are fighting an unwinnable battle against disease and illness in the arena of politics we must all practice medicine in. Lack of access, poor quality, and affordability are issues that are present everywhere, but once again, I found myself wondering as I once did before starting medical school if the prospective healing touch of my colleagues and I will ever reach those that need it.

There has undoubtedly been a light at the end of the tunnel with the passage of the Patient Protection and Affordable Care Act (PPACA), the United States’ best attempt at universal health care coverage. Additionally, through an honors program at my medical institution geared towards medical students with a special interest in barriers and disparities in health care, I have become more knowable of the small army healthcare providers and policy makers advocating for change in the right directing. However, with every step forward it seems like we take two backwards.

Although in a limited capacity, I have sat in rooms full of powerful policy makers who make decisions that instantly affect thousands if not millions of patients. Most of them have never treated an infection, explained the complications of a chronic disease such as diabetes, or counseled a worried patient upon receiving a worrisome diagnosis. Often times, I was one of the few, if not the only person, in that room who had ever provided direct patient care, albeit in a limited capacity. Far to often we relay on those who are too far removed from the front lines of health care to make decisions about circumstances they have little understanding of.

I’ve often deliberated that if we cannot overcome access, quality, and affordability in universal health care at home, how could we ever do the same around the world? Was I destined for a career in which the lines never got shorter? Was I going to be forced to practice medicine in a system that placed the interest of everything and everyone before what matters most, the patient? I refuse to believe this will be the case but many first hand experiences have done little to reassure me we are headed in the right direction.

I arrived in Geneva at the end of May for my internship at the World Health Organization. Coincidently it was also the same week as the 66th World Health Assembly. I had the great fortune and incredible opportunity to listen to some of the greatest minds in global health such as Director-General Margret Chan and Dr. Jim Young Kim, president of the World Bank.

In her opening address to the assembly Dr. Chan highlighted the success in HIV treatment, now with over 9 million people in low- and middle- income countries receiving antiviral therapy while at the same time pointing out that not a single country has managed to turn around the obesity epidemic in all age groups. On the following day Dr. Young Kim did the same by reminding us that global life expectancy has reached 70 years, but also urging us to be the generation that delivers universal health coverage.

I have listened to reports updating the status of the millennium development goals and how we have met some while others are well in reach, how vaccines are being delivered to even the most deprived and remote areas in the world and even how patients themselves are working towards a safer way of delivering healthcare. All week the emphasis was on the success of our past work with a reminder of how much further we must push our current work. While there was an abundance of congratulatory spirits, I was most provoked by the urgency to precede further and set new goals while keeping the interest those who need our help most first in our minds.

Every generation of aspiring physicians assumes the responsibility of learning the science of caring for patients. Fiscal uncertainty, the rapid rise non-communicable disease, and the threat of reemergence of once combatable infections are only some of the circumstances that have dictated this generation to bear the burden of developing policies that create not only a system best for providing access to care but for also keeping patients healthier longer. I entered my medical training with doubt the fight against healthcare disparities would ever been won. Today I am certain we are well equipped with both the tools and the minds to be the generation that claims universal health care access, a significant reduction in health care disparities and the eradication of many diseases through immunizations. This fall I will be going back to my medical training eager to work towards these goals and rejuvenated knowing that one day the lines will start to get shorter, and patients will not only live longer lives, but healthier ones.

We know we have to influence people at the top, but it is people at the bottom who matter most.
– Dr. Margret Chan, Director-General, World Health Organization

Adrian Diaz is a medical student who blogs at M.D. under construction.

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  • Guest

    Two articles on “health disparities” in one day?

    We must have received our talking points from the pro-Obamacare propaganda machine today.

  • ninguem

    No, there will never be a solution to healthcare disparities, anywhere on the planet.

    Healthcare will always be two-tiered. Your job is to try to make sure that the bottom tier is something you will accept for yourself, or a loved one.

    • SBornfeld

      This is not a medical problem–it is a political problem. As long as people see medical care as a privilege and not a right, things will not change.

      • ninguem

        That’s right. Healthcare is a right.

        Dental care is the privilege.

        • Adrian

          Thanks for all your comments and thoughts.

          I would respectfully disagree that dental care is a privilege. Yes, there are certain aspects of dentistry (cosmetics) that can be considered a privilege just as in medicine. However oral health is just as important to overall health as any other component.

          • ninguem

            Clearly not picking up on sarcasm, are you?

            Speaking as someone who has spent lots of time in ER’s dealing with dental pain because their dentist won’t pick up the phone after hours.

        • SBornfeld

          Don’t be a dickhead.
          Thanks.

  • ninguem

    In French: Médecine à deux vitesses

    in German: Zwei-Klassen-Medizin

    In the UK: Postcode lottery

    The UK term can refer to socioeconomic disparities of all sorts of government services, of which healthcare is one.

    Google those terms, see that the problem exists all over. You do not get rid of the problem by adopting a German, French, or NHS model.

    Or any model for that matter.

    • SBornfeld

      Results count. We pay more and get less. Are you saying we cannot do better?

      • ninguem

        To you, I’m not saying anything. I’m making a direct response to the original post,

        “Can the fight against healthcare disparities be won?”

        The answer is “NO”, it has not been “won” anywhere, and never will. The countries that arguably have the systems that are supposed to be better than ours, still have disparities.

        The French have Medicaid, and upwards of a quarter of their docs refuse it.

        Kind of like our dentists, who shutter the doors if I sent them one.

  • Adrian

    I agree with your point about the US and the way it spends on health care. I hope my point did not come across as saying we are doing everything right or that a perfect system is near. Rather my point was that, while it is easy to become jaded and discouraged, my time in Geneva at the UN and WHO has certainly shun some light on plenty of good. I am not naive to think we will solve global health this decade or even this century but having an understanding of why change takes time and listening to some of the conversations that are taking place has certainly been inspiring.

    • SBornfeld

      Certainly I did not infer that you are at all pollyanna about this. I think that having a bit more of a global perspective may keep you from becoming a bitter old man like me. ;-)
      Best of luck in your career.