Cultural Issues and Health Disparities Studied
What are the causes of racial and ethnic health disparities? Harvard Medical School researchers recently documented disparities in the outcomes of diabetes patients with the same physician. Despite the assumed equal treatment provided, blacks showed worse outcomes than their white counterparts for standard measures of diabetes control.
The study looked at 6,800 patients being treated by at least one of 90 primary care physicians at Harvard Vanguard Medical Associates sites in eastern Massachusetts.
Lack of attention to cultural issues may explain some of the differences. The study authors (Sequist et al) offer this as the explanation: “Racial differences in outcomes were not related to black patients differentially receiving care from physicians who provide a lower quality of care, but rather that black patients experienced less ideal or even adequate outcomes than white patients within the same physician panel. ... Physician-level variation in disparities was not associated with either individual physicians' overall performance or their number of black patients with [diabetes].”
In a New York Times interview, Dr. Sequist explains how a lack of tailored culturally competent care may lead to disparities:
“It isn’t that providers are doing different things for different patients,” Dr. Sequist said. “It’s that we’re doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren’t being met.”
For instance, he said, counseling black or Latino patients with diabetes to lower their carbohydrate intake by cutting rice from their diets may not be a realistic strategy if rice is a family staple.
“We may be listing fruits and vegetables that are part of one person’s culture but not another,” Dr. Sequist said. “We’re not really giving them information they can use.”
Recommendations to remedy this disparity include greater attention to cultural and socioeconomic differences that impact patient behavior, such as diet. The abstract and complete article are available in the current issue of the Archives of Internal Medicine.