For more than 40 years, healthcare professionals, public health advocates, and healthcare strategists have been discussing health inequities that consistently and disproportionately affect groups of color in the United States. Despite growing awareness of these disparities, however, limited progress has been made, according to Lakesha M. Butler, PharmD, BCPS, Diversity and Inclusion Coordinator, Southern Illinois University Edwardsville.
Delivering the John G. Kuhn Keynote Lecture at the 2021 Hematology/Oncology Pharmacy Association conference, Dr Butler discussed the impact of racism on social determinants of health and identified strategies to dismantle structural racism in pharmacy.
“We have a lot of work to do to dismantle the hundreds of years of structural racism that is still impacting our minority patients today,” she said.
More than 80,000 minority patients in the United States die annually because of health disparities, Dr Butler said. Blacks are 3 times more likely than non-Hispanic whites to have kidney failure, she said, and black men have a more than 30% greater risk for prostate cancer compared with white men. Black patients also receive less treatment for pain and have higher rates of obesity compared with whites.
Instead of focusing on an “individualistic” ideology that suggests that poor health outcomes are predominantly the result of poor choices, Dr Butler encouraged the examination of social determinants of health, including physical environment, health behaviors, clinical care, and social/economic factors.
“The social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” she explained.
Examples of social determinants of health include the availability of resources to meet daily needs such as safe housing, local grocery stores, transportation, parks, playgrounds, and sidewalks to walk and exercise. Other examples include access to educational, economic, and employment opportunities, as well as access to healthcare services. Social norms and attitudes, such as racism and discrimination, are also a part of social determinants of health.
All these factors contribute to patients’ mortality and morbidity rate, along with the health status of groups. In fact, the combination of socioeconomic factors and physical environment makes up approximately 50% of the determinants of health outcomes, Dr Butler said, which poses a challenge to the attainment of equitable opportunities for all.
“According to the county health rankings model, differences in physical environment, social, and economic factors exist in minority groups,” said Dr Butler. “These differences are rooted in structural racism that still manifests today.”
Structural racism, Dr Butler explained, is the normalization and legitimization of historical, cultural, institutional, and interpersonal dynamics that routinely advantage white Americans while producing cumulative and chronic adverse outcomes for people of color.
“I believe that we have continued to perpetuate racism, because we have not dismantled it to understand why it’s still occurring,” she said. “We need to identify the root problem to be able to fix it.” Dr Butler suggested that oncology pharmacists take the following steps to dismantling structural racism in cancer care:
- Recognize and believe that racism is structural and systemic
- Understand how the social determinants of health affect patients, and educate yourself
- Discover and identify personal biases, and how those biases show up. “We should approach our patients from a standpoint of cultural humility,” said Dr Butler. “As healthcare providers, we have a wealth of medical knowledge, but our patients know themselves better than we could ever.”
- Move from being a bystander, to an ally. “We must actively oppose racism, not just in word, but in action and deed,” said Dr Butler. “Wherever we see injustices occur, it is imperative that we speak up and speak out.”
- View patient encounters with an equity and trauma-informed care lens
- Engage minority individuals as shared stakeholders
- Revise organizational policies and practices to be equitable.
“As pharmacists, we took an oath to make sure that we provide the best care to all patients,” Dr Butler said. “However, because of historical structural racism, historical oppression, and historical marginalization, some patients are experiencing disproportionately negative health outcomes.”
“We have to be intentional, and be aware of that, so that we can ultimately attain that level of health equity and provide optimal care for all patients,” Dr Butler concluded.