The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t.
The U.S. lags behind other industrialized nations in many important health measures — partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious — but we’ll explore some of the best ones in this article.
U.S. results shoddy compared to global counterparts
The U.S. ranks dead last in life expectancy for men and second to last for women among the 17 wealthiest nations. Infant mortality in the U.S. ranks last among the most advanced countries in the world. And worse, among the 34 most developed countries, U.S. health care outcomes fell from 20th to 27th from 1990 to 2010.
The world’s richest economy scores dismally no matter which health care measures we examine.
Why so bad?
One reason the U.S. ranks so poorly globally is that health outcomes for certain racial, ethnic and socioeconomic groups fare so poorly domestically. African-Americans, Latinos and the economically disadvantaged experience poorer health care access and lower quality of care than white Americans. And in most measures, that gap is growing.
“Your health care depends on who you are,” according to a 2014 report from the Robert Wood Johnson Foundation, the nation’s largest philanthropy dedicated to health. “Race and ethnicity continue to influence a patient’s chances of receiving many specific health care interventions and treatments.”
The foundation estimates Latinos and African-Americans experience 30 to 40 percent poorer health outcomes than white Americans. This disparity leads not only to shortened lives and increased illness, but also costs the nation more than $60 billion in lost productivity each year.
Access to care remains a prevailing problem. From the most recent National Healthcare Disparities Report: 35 percent of Latinos and low-income individuals reported difficulties getting the care they need, compared to 25 percent of white Americans and 15 percent of high-income earners.
And while overall access has improved over the past decade, the rate of improvement across the U.S. has been slower for African-Americans, Latinos, and low-income individuals. For proof, look no further than in the treatment of these common conditions:
Diabetes, breast cancer, and heart disease
In low-income neighborhoods, patients with diabetes are ten times more likely to undergo limb amputation than those in affluent areas. Compared to white Americans, the rate of hospitalization for patients with diabetes is twice as high for Latinos and three times higher for African-Americans.
The death rate from breast cancer for African-American women is 50 percent higher than for white women. Racial and economic inequities in screening and treatment options contribute to this divide. In the U.S., 60 percent of low-income women are screened for breast cancer vs. 80 percent of high-income women. But even within the same economic stratum, white women have higher screening rates than African-American and Latino women.
We see the same variations revealed in the treatment of breast cancer. In over 80 percent of cases, women from higher-income households are treated with a combination of breast-conserving surgery and radiation. These less deforming approaches are used only 70 percent of the time among low-income women. The same pattern of inequity emerges among different races. African-American and Latino women on average undergo more radical breast cancer surgeries than white women.
Heart attack and stroke data are equally concerning. Not only do 25 percent of African-Americans have elevated blood pressure compared to 10 percent of white Americans, but black patients are 10 percent less likely to be screened for high cholesterol than white Americans. The result is higher rates of heart failure and strokes for African-Americans.
Among health care officials, there’s broad agreement that these inequities exist. There’s less agreement about the reasons for them or how to narrow the gaps.
Widespread challenges need creative solutions
The availability of health insurance has no doubt played a role in all of this. Before the implementation of the Affordable Care Act, African-Americans and Latinos were more likely to be uninsured than white Americans. Of course, a variety of other factors contribute to disparities in clinical outcomes. Among them: conscious and unconscious bias, limited access to healthy foods and inadequate community-wide health care resources.
Because the problem is multifaceted, the solutions must be, as well. The expansion of health insurance and coverage through the Affordable Care Act will help, creating much-improved access to free preventive screenings and services for all. Meanwhile, help in the form of creative solutions are coming from the community level.
For example, Better Health Greater Cleveland and the Greater Detroit Area Health Council are working to raise the rate of successful blood pressure control among African-Americans. The Crossroad Health Center in Cincinnati is tackling diabetes management in the Latino community. And Harlem Hospital made breast cancer screening free and added patient navigators to address the cultural barriers that limit residents from trusting or using the health care system. As a result, the hospital reports raising its five-year breast cancer survival rate from 39 to 70 percent.
Eliminating disparities has been a major priority for Kaiser Permanente for more than a decade. As CEO of The Permanente Medical Group, I’m proud of what we’ve accomplished for our nearly 4 million U.S. members. Today, Kaiser Permanente ranks in the top 10 percent nationally for all racial groups across a number of clinical areas, including cancer prevention, blood pressure control and the treatment of cardiovascular disease.
While there’s no one way to reach a solution, here are five approaches that have proven most effective in providing culturally inclusive care:
1. Using comprehensive electronic health records to measure, track and design interventions specific to the individual needs of our members. This allows physician leaders in Kaiser Permanente to measure progress, provide physician-specific feedback and learn from those who achieve the best outcomes.
2. Making this information readily available to all of our 8,000 physicians and rewarding those who achieve the best clinical outcomes.
3. Developing innovative, culturally appropriate health education tools for each segment of our diverse membership.
4. Investing in high-quality translation and interpretation services for our diverse membership. For the largest populations we serve, Latino and Chinese, we created bilingual, bicultural modules so patients can receive care in their preferred language.
5. Partnering with community organizations, leaders and churches to bring health care to all patients, especially those who can’t miss work or obtain transportation.
Applying these success factors nationally will require a broad commitment to eliminating the disparities that exist in U.S. health care today. The first step is recognizing these disparities exist and agreeing that it’s unacceptable for anyone to experience poorer health outcomes based solely on race, ethnicity, geography or income level.
Once we’ve acknowledged the problem, we need to ensure physicians have the necessary medical and cultural information required to provide exceptional care to all. Additionally, physicians need to be recognized and rewarded for closing the biggest care gaps.
We still have much to learn about the cultural barriers that prevent some patients from obtaining the best possible health care. But that alone won’t be enough to make a difference. We must agree that unequal care is unacceptable. Only then can we make all of the improvements our nation needs.
Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared in Forbes.com.