Many people take it for granted that when they visit a doctor’s office, stop at a pharmacy or go to the dentist, at least some of the staff members will look like them. For some patients, it may not matter … much whether health providers resemble them by race, ethnicity or sexual orientation. But for others, diversity (or lack of) could determine whether they seek or shun the health care system. Read on as experts describe the consequences of the diversity gap among health care providers, researchers and leaders – and how greater inclusiveness is better for patients.
Lagging Life Expectancy
With persistently shorter life spans, black Americans are at a disadvantage, according to statistics from the Centers for Disease Control and Prevention. A breakdown by race and ethnicity from the Kaiser Family Foundation showed that in 2009, African-Americans had a life expectancy of about 74.5 years compared to nearly 79 years for whites, almost 83 years for Latinos and a high of 86.5 years for Asian-Americans.
Boosting the diversity of providers in the U.S. health care industry could be a tool for bridging the gap from shortest to longest life spans, says Dr. Douglas Garland Jr., trained as a health scientist and also a board member for the Association of Black Health Professionals, a recently formed interest and advocacy group.
The group’s mission is to increase the use of black doctors, pharmacists, dentists, nurses and others who work directly with patients. In addition to more recruitment and hiring of clinicians, the ABHP is advocating for employers such as hospital systems, both public and private, health agencies and pharmacy chains to expand black presence and build more diversity in leadership positions.
A recent study conducted by the association looked for a connection between states with a higher proportion of black Americans working in the health care industry and higher life expectancy trends. The early study suggests a correlation, Garland says, although the study does not show cause and effect.
From a patient’s immediate perspective, is it important to see clinicians who resemble them? “For the majority of Americans, the answer is no,” Garland says. “They should not pick a clinician who necessarily looks like them. That doesn’t have to be a prerequisite, shall we say? There are many people in American who get very great care notwithstanding the ethnicity of their clinician, be it a pharmacist, nurse, physician or any other clinical provider.”
But concerns about discrimination and mistrust of the health system exist, causing some people to avoid it altogether outside of dire emergencies. “There are Americans who are unwilling to engage in the health care system,” Garland says. “We believe that workforce diversity is one of the many tools that can help them re-engage, particularly the frequency they engage with the health care system at the appropriate time – preventively as opposed to waiting until the last minute.”
It’s not just about the hands-on providers with whom patients deal directly, but administrators and other staff members as well, Garland adds: “When patients walk into an institution and they see from top to bottom there are people who look like them, that helps promote trust and confidence in the system.”
If you want to see more diverse providers in health facilities serving your community, Garland suggests dropping a line to facility administrators and to your elected officials.
Mental Health Barrier
As a child psychologist, Dr. Alfiee Breland-Noble, an associate professor of psychiatry at MedStar Georgetown University Hospital, works with young people with mental health issues. In the realm of mental health professionals, Breland sees two especially salient gaps. One is the lack of diversity among those who conduct research in the treatment and prevalence of mental illness. On the clinical side, there’s a dearth of providers available to meet the needs of a diverse population.
Among teens, 11 percent have had a major depressive episode in the past year. African-American youth get less specialty care, have lower rates of treatment completion, spend less time in treatment and are less likely to get treatment specific to their mental health disorder, Breland-Noble told journalists attending a National Press Foundation conference on mental health in September.
As a federally funded researcher, Breland-Noble feels strongly about the need to increase the diversity of people who lead research along with patients involved in studies. “That’s where it starts with me,” she says in an interview. “If we’re going to have better treatment, we’ve got to have really strong research. If we’re going to have really strong research, we want it to be more generalizable. And to get there, we’ve got to bring more people into the fold. At the leadership level and in terms of who participates.”
Practitioners from any background can improve their cultural competence, says Breland-Noble, who has taught it. Cultural competence encompasses a few broad areas, she says. One is a knowledge base of different U.S. populations; for instance, the experience of Latino people depending on whether they’re of Caribbean, Central American or South American origin.
Awareness is another piece – how you view yourself in relation to other groups and your own personal experiences and biases. For African-American patients, faith is often part of the community, although it’s more significant for some than others, Breland-Noble notes. “As a provider, what is my experience and level of comfort in talking about my faith?” she says. “Am I comfortable sharing my own? Am I comfortable letting the patient share his or hers with me?”
Providers who are themselves part of a community probably have a head start relating to patients, she says. For example, an LGBTQ doctor could have personal experience coming out that another doctor might lack but could learn more about by talking to his or her colleague.
“You want a diversity of perspective and a diversity of experience,” Breland-Noble says. “That’s the best for patients. Patients don’t have to have, I think, somebody who looks exactly like them. What they do have to have is someone who’s willing to understand and who has taken the time to gain enough of a skill set that they’re open to working with people who are different from them.”