The Health Disparities Podcast

Researcher Shreyasi Deb, PhD, MBA, became interested in health disparities when studying economics, and has since applied this perspective to understanding public health. At the American Academy of Orthopedic Surgeons, Shreyasi is looking at the positives and negatives of bundled payment models and the unintended policy consequences around value-based care. Are some patients already experiencing inequity and exclusion? Can we address the unique socioeconomic and multiple comorbidity aspects of each patient in a post fee-for-service world by spending more on social services? With Bill Finerfrock.

When an accomplished surgeon sees his own father struggle with arthritis, he knows there are some structural problems in play. HSS surgeon Dr. Michael Parks shares some insights into the processes behind health disparities (or health differences as he prefers to say). Why do some people steadily progress through the steps of intervention, but others languish? What role does race and gender play? Dr. Parks also discusses why the WHO sees health disparities as a social injustice, and why a new bill sponsored by Congressman John Lewis is so important to health equality. With Bill Finerfrock.

Tammy Huff, MD discusses how rural health disparities are driven by many logistical challenges in remote and underserved areas, where limited public transport and hospital closures make access to care increasingly difficult. Bundled payments may be adding to these challenges by asking providers to carry more risk. Low health literacy, high medical co-morbidities and risk factors such as tobacco use are more prevalent in these rural areas, making many patients care management more complex. Are these factors increasing disparities by making surgeons more cautious about proceeding with procedures? Can different payment models mitigate these problems? With Bill Finerfrock.

Deborah Coplin-Hall, MS, RN and Carla Harwell, MD discuss how nurses have been at the forefront of screening patients for social determinants for decades, only now are social determinants and cultural competency being taught, structured and systematized. Deborah describes some important progress being made with health disparities, such as increasing the minimum wage in her city of Buffalo, NY, and she explores the impact of gentrification on communities of color. Deborah has successfully married her work as a nurse with an active role in the church, where strong emphasis on engagement in personal health has been integrated with faith-based activities. She also discusses countering “the brush off” by asking physicians the right questions and making sure care providers fully listen and respond to patient concerns.

Brigham and Women’s nurse Sasha Dubois, MSN, RN discusses how racial segregation, gentrification, and displacement in her native Boston can create “healthcare access deserts” that fuel health disparities, even in an area where there are a number of high-quality hospitals. Establishing medical homes in the communities where patients are is one approach that Brigham and Women’s is implementing, together with centers that focus on understanding and managing multiple co-morbidities by integrating factors such as social determinants into care plans and health records. Sasha is an expert in Magnet designation, a driver for excellence which raises standards of care and encourages a more patient centered approach. Magnet also emphasizes the importance of cultural competency, unconscious bias, and understanding disparities. With Dr Carla Harwell.