January 14, 2022
3 min read
Dhaliwal reports no relevant financial disclosures. Please see the policy paper for all other authors’ relevant financial disclosures.
Health care professionals must take action to create policies to address racial inequities with health care access, equity in the workforce and diversity in clinical trials, according to a policy perspective from the Endocrine Society.
In an article published in The Journal of Clinical Endocrinology & Metabolism, researchers outlined various strategies the endocrine community can take to reduce disparities and eliminate racism in endocrinology, with the goal of advancing equity across all facets of health care.
“Our goal is to raise awareness within the endocrine community on the glaring issue of racism in health care, and empower and engage all involved — patients, health professionals, educators, learners, researchers, policymakers and leaders — to take responsibility for our part in it and make deliberate efforts to eliminate racism and, more importantly, prevent entry of racism at all levels of the socioecological system,” Ruban Dhaliwal, MD, MPH, research physician at Massachusetts General Hospital and member of the Endocrine Society’s Advocacy and Public Outreach Core Committee, told Healio. “Beyond declarations, the Endocrine Society makes a clear commitment to address racism in health care and strongly supports the scientific, educational and clinical efforts of members to improve the health of all people.”
Racism in clinics, workforce and research
Dhaliwal and colleagues discussed how racial disparities are present in nearly all facets of health care. In clinical care, traditionally underrepresented groups are disproportionally affected by endocrine conditions. American Indian, Latinx (gender-neutral alternative to Latino/Latina/Hispanic) and Black people all have age-adjusted prevalence for diabetes of greater than 11%, whereas the prevalence of diabetes among white people is 7.5%. Access to care is also an issue due to implicit biases toward racial minority patients.
“Minority groups encounter challenges in access to quality medical care,” the researchers wrote. “Implicit bias, stereotyping and prejudice have hampered progress toward equitable health care for all patients. Data show that the implicit biases of clinicians toward racial/ethnic minority patients impede their ability to provide effective care.”
Another issue is the endocrine workforce does not reflect the patient population in the U.S. Only 3.3% of U.S. endocrinologists are Black, 7.1% Latinx and 0.1% American Indian, whereas according to the 2010 U.S. Census, 13% of Americans are Black, 18.5% Latinx and 1.3% American Indian. Additionally, the researchers noted members of minority groups also have undue uncompensated additional duties in terms of salary and rank.
There is also a lack of diversity in clinical trials. The researchers wrote that minority groups are significantly underrepresented in clinical research studies, an issue that has been ongoing in endocrine research. One of the biggest hurdles for improving diversity in trials has been a lack of diversity among clinical research coordinators.
Steps to eliminate racism
Creating an equitable health system requires a concerted effort from all members of the health care community, according to the researchers. One major strategy in eliminating racism is through education, both at an individual and organizational level.
“Building an antiracist health care system requires an ongoing commitment from all members of the health care industry,” the researchers wrote. “Health equity will not become a reality by simply working with those currently in power, but by educating and engaging the next generations of faculty, trainees and students who will become our future health care providers, teachers, policymakers and leaders.”
Efforts to eliminate racism also require financial investments. The researchers noted the potential economic gain of eliminating health disparities could be $135 billion per year in untapped productivity and excess health care cost savings. These financial investments could include payer incentives to improve care for minority groups, resources to resolve inequities in compensation for minority endocrinologists, investments in educational reform and more.
Dhaliwal said the Endocrine Society has incorporated diversity, equity and inclusion into all of its policies and initiatives, with programs such as Excellence in Clinical Endocrinology Leadership (ExCEL), which offers training mentorship to early career physicians of underrepresented communities, and the Future Leaders Advancing Research in Endocrinology (FLARE) program, which helps create a more diverse research workforce through training and mentorship.
Dhaliwal said health care professionals must take a deliberate and proactive approach to address health care inequities and steps can be taken in one’s own workplace.
“We can start by identifying and examining how racism is operating in these places,” Dhaliwal said. “Efforts range from examining patient experiences and the use of race in clinical documentations and diagnoses to changing hiring, promotion and recruitment policies and allocating resources.”
For more information:
Ruban Dhaliwal, MD, MPH, can be reached at [email protected]