To heal patients, doctors must address inequity first

The recent vote to repeal Obamacare and the attempts to replace it have caused many of us in the medical community a great deal of concern.

Dramatically reducing access to care for millions of Americans, and putting a cap on Medicaid for the first time in history, these attempts may be a little bit better from previous proposals at reform, but it is still a step backwards from the existing situation. If you want to understand why, all you have to do is look at a single map.

It’s a map of life expectancy in Chicago, published in a study sponsored by the Robert Wood Johnson Foundation. And it’s startling. In Washington Park, on Chicago’s South Side, for example, people can expect to live to 69 years old.

A bit to the north, just a couple of quick stops on the L’s Green Line, the number is 81 years. I look at the map often, and I’m baffled and enraged by one simple question: Why would babies born a few miles apart in the same major American city have such radically different health trajectories?

That’s the question that ought to be foremost on our lawmakers’ minds when they debate a new health bill. Tragically, Chicago is hardly an anomaly — the same story occurs in communities all across the country.

And yet, even though we doctors are committed to caring for our patients and their well-being, when presented with such clear evidence of health care inequity most of us shrug our shoulders and say that there’s little we can do. The most underprivileged Americans, we argue, live shorter and less healthy lives because of a host of social factors, like poverty, that we simply can’t control.

But we can and we must. When it comes to health care, we must adhere to the following principle, thankfully gaining momentum with more and more physicians these days: there’s no quality without equity.

To begin to meet these momentous challenges, we should first of all recognize the significant role hospitals play in many communities across the nation. Often, the local hospital is not only an esteemed service provider, but also one of the largest local employers. As such, health systems have a significant amount of social and cultural capital they must learn to invest wisely.

A good first step would be to invest in cultural diversity. This may sound like a mere nicety, but a person’s culture is one of the most profoundly important factors driving his or her decisions when it comes to health care.

Hispanic women from some cultures, for example, are less likely to seek out early prenatal care in certain instances that can have a considerable impact on their health and the health of their babies; this is largely because they often come from cultures that consider it unwise to publicly disclose the pregnancy until the fetus is sufficiently grown and is more likely to survive. The best way to meet and overcome such cultural challenges is by making sure we hire a truly diverse array of doctors, nurses and administrators who can then educate their own communities and effect positive change.

Addressing a culture, however, is one thing; meeting the needs of individuals is another. Earlier in my career, I had the privilege of caring for a patient whom I’ll call Jessica. She was a middle-aged, hard-working woman who was diagnosed with breast cancer, and I was happy to tell her that the chemotherapy my colleagues and I had in mind would very likely help her beat the terrible disease.

Jessica was delighted with the news, but, oddly, soon failed to show up for her treatment. When we tracked her down, we learned that she was living in a run-down apartment, and that her landlord had threatened to evict her.

Terrified, she resolved never to leave her home, even if that meant missing out on a life-saving treatment. The solution was simple enough: we engaged a pro bono lawyer who helped Jessica negotiate her case, and before too long she was back in the hospital, getting the care she needed and deserved.

Not all cases of a health system taking a proactive approach are so dramatic. Some are simpler but just as beneficial. In one hospital where I’d worked, for example, I noticed that many were suffering from health conditions caused by poor nutritional habits. At a minimal investment, I arranged with a local farmer's’ market to deliver fresh fruit and vegetables to anyone interested, by distributing food prescriptions to our patients and were thrilled when my patients began reporting feeling better.

Instead of spending a fortune on complicated and unnecessary procedures later on, when a patient is already sick and suffering, we decided it was much wiser to spend a little on some apples, tomatoes and kale and help the patient enjoy a happier, healthier life. This "Food as Medicine" concept was very rewarding for patients and providers.

These examples are just the tip of the iceberg. Hospitals, long accustomed to seeing themselves as dispassionate centers for research and treatment, must get increasingly involved in the lives and the overall well-being of their communities. If that means hiring professionals, like lawyers or farmers, who are not traditionally considered part of the health care ecosystem, so be it.

And if that means using their considerable political clout in their local communities to advocate for policies that relieve stress and other conditions likely to have an adverse effect on health, even better.

As physicians, our mission isn’t just to fix our patients when they’re sick. It’s to enable them to live their healthiest lives. To do that, we must pay attention not only to medical problems but to socioeconomic ones as well, and demand that the people now rewriting our nation’s health care laws realize that health isn’t just about access to the best doctors, but also access to affordable housing and nutritious food and care providers who look like you and speak your language. Any health law must take these realities into consideration or risk doing little for the well-being of millions of Americans.

This opinion piece also appeared in The Hill.

Many factors face community health today.