Disparities in Healthcare Why Do Inequities Persist?

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When receiving care from your provider, how important is informed consent? What if you learned that, statistically, people in your group, be it race, ethnicity, gender, gender identity or religion were not being offered informed consent? How would you feel? Most importantly, what would you do?

As a member of the case management department on the inpatient medical unit, my colleague worked diligently on a safe discharge plan for a World War II veteran. She was white, the patient was African American. Try as she might, the patient was resistant to every proposal, including the possibility of residing with family members. Days turned into weeks, which turned into a month with no resolution in sight. One day another colleague, a psychiatrist, posited I work with the veteran.

After introducing myself and explaining my purpose, I asked if there was anything I could do. Motioning me to lean in and gesturing toward his white roommate, he whispered, “where are my flags?”, referring to two small American flags attached to the headboard, likely provided by a visiting family member or friend. Within the hour I returned with four flags. One week later, arrangements were made for his daughter to fly in from Atlanta to take him home. What was it that made this veteran believe he was being denied the dignity he rightfully deserved, or that my colleague would have acted differently?

Perhaps at the age of 10 he overheard his elders discussing the 1932 Tuskegee Syphilis Study where the United States Public Health Service began a study on the effects of untreated syphilis on 600 Black men in Macon County, Alabama. In exchange for treatment of “bad blood,” the men received free medical exams, meals and burial insurance. Informed consent was not offered. Through investigative journalism exactly 40 years later, the study was abruptly halted. It was deemed ethically unjustified.

Perhaps six years after the war, this same veteran learned about Henrietta Lacks. Tissues taken from a tumor of this 31-year-old African American woman and mother of five became the first human cells to be successfully cloned as she succumbed to cervical cancer. HeLa cells, as they are known today, were instrumental in testing the polio vaccine and developing drugs to fight cancer. Henrietta never granted John Hopkins Hospital permission to use her cells, and her family was never made aware. Informed consent was absent.

Today in the United States, informed consent is both an ethical and legal obligation of medical practitioners. Unfortunately, the same cannot be said about access and personal biases.

Access to healthcare begins with financial stability. According to a 2019 Kaiser Family Foundation study, the median net worth for white families was $189,100 versus $36,050 for Hispanic families and $24,000 for African American families. From 2013 to 2019, the Survey of Consumer Finances discovered the median wealth for female same-sex couples to be $82,000, representing less than half the median wealth of heterosexual couples. In 2021 KFF found 52% of white adults received mental health services versus their African American (39%), Hispanic (36%) and Asian (25%) counterparts.

As we learned previously, Henrietta Lacks’ cells enabled countless scientific and medical innovations, including in vitro fertilization (IVF). Today the Veteran Heath Administration’s (VHA) guidelines regarding IVF care are clear. A woman must be legally married to a man. Donor eggs, sperm, embryos, and surrogacy are not VHA covered services. Arizona, Arkansas, Georgia, Idaho, Mississippi and South Dakota are six states allowing pharmacists to deny prescriptions like birth control or Plan B if they have a moral or religious objection.

According to David Williams, PhD, MPH, chair of Harvard T.H. Chan School of Public Health and professor of African and African American studies, racism is a significant contributor to inequities in healthcare. Research using the implicit association test found over 70% of all Americans, including physicians who are committed to egalitarian principles, have an anti-black bias. “Without our conscious awareness we will treat others differently and will be unaware because there was no intent,” says Williams. These biases stretch well beyond race. When asked about the harms of not addressing bias in healthcare, Anurag Gupta, founder and CEO of Be More America stated, “I feel bias is one of those things that is preventing human beings from living to their true potential.”

One in eight Americans work in the healthcare sector. As case managers we must be acutely aware of unconscious biases. We must become allies for the underserved and advocates for healthcare equality.

michael norde

Michael Nordé, LICSW, is an activist on matters of race, diversity and gender equality. While earning his graduate degree from Rhode Island College (RIC), he interned on the Providence VA Medical Center’s inpatient psychiatric unit. Upon graduation he accepted the position as case manager on their inpatient medical unit. During that time, he participated in two research studies which focused on suicidal ideation resulting from combat trauma. In 2017, Michael was bestowed the Alumni of The Year Award from the School of Social Work (SSW). That same year he joined their Diversity Task Force. Their mission is to change the “face” of social work in Rhode Island by diversifying RICs student body, providing support for students of color, advocating for systemic changes within the School of Social Work and creating a perpetual scholarship.


At a young age Michael became acutely aware of social inequities when his family stood as the first of color in a town whose population exceeded 10,000. Today he facilitates Diversity Trainings as part of personal development seminars
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In 2020, the PVAMC recognized Michael for his contribution to the African American Special Emphasis Program in promoting diversity and cultural awareness during the Dr. Martin Luther King Jr. holiday observance.

In 2021, Michael was promoted to the position of Patient Advocate Coordinator and named Social Worker of the Year.

Image credit: ISTOCK.COM/ARINA KUMYSHEVA

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