Written by Anneliese Lapides ’24
Like many other institutions in the United States, inequities in healthcare result in disproportionate disparities affecting marginalized groups. The COVID-19 pandemic is a perfect example: According to the CDC, death due to COVID-19 is 2.1 times higher among Black or African American people compared to their white counterparts1. Hospitalizations due to the virus are much higher in non-white groups: 5.3 times among Native Americans, 4.7 times among Black/African Americans, and 4.6 times among Hispanic/Latino individuals1. The current pandemic sheds light on an already existing problem: Societal structures have made the system beneficial for those it was built for. This can hurt the trust people have in the healthcare system, which may lead to less healthcare utilization, and thus worse outcomes—creating a vicious cycle.
And what about those who are unable to access healthcare in the first place? The National Center for Health Statistics reports that as of October 2020, 32.8 million people under the age of 65 do not have health insurance2. Without insurance, care is very costly, sometimes so much so that people must choose whether to spend their money on healthcare or other basic needs. As medical professionals, we vow to care for community members, but there is an underlying tone of “only if you can afford it” based on the way insurance and the healthcare field is structured. Health has become a commodity; we can even say that profit has become a priority in a system that is meant to prioritize people. And while many in the field do their best to increase access and affordability, the truth is that healthcare as a whole is not treated as a human right—leaving individuals without insurance and those in marginalized groups without access to equitable care.
How can we, as physicians, work to change this system? We learn the intricate anatomy and physiology of the human body, but we take care of people. When we remind ourselves to value the humanity at the core of our chosen profession, we will be best equipped to take a stand for our patients. Part of that responsibility to them is working toward making the system better for them. We are not policy makers, but we can have an impact on their decisions and how they reform the structure of the healthcare system.
How do we advocate for our patients who are negatively impacted? It is easy to say that we will do this, but it takes effort and time to take actionable steps to right the wrongs particular groups have experienced and to improve moving forward. Therefore, it is crucial that physicians are consciously working toward this goal. We get close to our patients; we see them and their families at their most vulnerable moments; we learn about their personal lives—the good and the bad. We observe first-hand what policy makers don’t see. Being a physician comes with societal privilege and prestige; people respect physicians and think of them as experts. So, with that privilege, policy makers may be more likely to listen to us and enact changes based on our calls to action.
Physicians are part of the patient’s team. Thus, the role of advocate is not really an additional one, but one that is and should be incorporated into the responsibilities we vow to follow through on. When we advocate for our patients and for positive systemic change, we can achieve:
- Moving toward truly equitable care for all people. Eventually we can establish a system where health disparities do not exist and adverse outcomes do not impact marginalized groups due to cycles of systemic oppression and discrimination.
- Moving toward truly accessible and affordable care, thus the realization of health as a human right. It is up to physicians to put this value into their practices, which can translate into effective healthcare policy. Bringing awareness to the issues is a first step, but changing policy brings about the much-needed solutions, such as increased mobile clinics, preventative care initiatives, health education programs, increased physician practices in areas of need, etc.
- Building relationships of trust. Mistrust in the healthcare system can arise for many different reasons, including but not limited to: experiences of prejudice or discrimination, lack of quality care in the past, denial of care because lack of insurance. If people feel like the system is working against them, their health—both physical and mental—is negatively affected. Physician advocacy can work to mend those past relationships and build a strong foundation for new ones.
The first step is to be accessible physicians and consciously aware of what steps we can take to make the system more equitable in our day-to-day practice. A second step is actively advocating for change. We cannot stand by and let the system take advantage of those we vowed to serve. We can love the field of medicine while still acknowledging its flaws and striving to improve it. Just like personal growth is a positive, aiming to do better and to be better at the institutional level is a reflection of valuing the core intention of medicine.
- National Center for Immunization and Respiratory Disease, Division of Viral Disease. (2020, August 18). COVID-19 Hospitalization and Death by Race/Ethnicity. Center for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
- National Center for Health Statistics. (2020, October 10). Health Insurance Coverage. Center for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/health-insurance.htm