All posts in Equity

“Since February, like ethicists around the world, I have spent most of my time thinking about the tip of the health care rationing iceberg. As Covid-19 cases exploded across epidemiologic maps, I scrambled to write new guidelines for my health network for the ethical allocation of mechanical ventilators, just in case we ran out. [..] Despite that heady challenge and the urgency of the Covid-19 pandemic, I couldn’t shake the feeling that this effort was all a distraction. Here I was, trying to do a perfect job allocating a handful of mechanical ventilators for an unprecedented viral pandemic, while every … Read More

“In this issue of JAMA Network Open, Hsia et al sought to determine whether efforts to improve access, treatment, and outcomes for patients with ST-elevation myocardial infarction (STEMI) by means of cardiac care regionalization were associated with widened or narrowed disparities between minority and nonminority communities at the zip code level across the state of California. Access was defined as admission to a hospital with percutaneous coronary intervention (PCI) capability; treatment was defined as receiving coronary angiography or PCI (as clinically indicated) the day of admission or at any time during hospitalization; and outcomes were defined as all-cause mortality at … Read More

“SCD [sickle cell disease] is a life-threatening, inherited blood disorder, affecting more than 100,000 Americans. Painful vaso-occlusive crises, the hallmark of SCD, result in substantial suffering and lead to associated stigma. Without adequate treatment, SCD affects all organs and is associated with decreased quality of life and a shortened life span. Among the dozens of conditions that are screened for in state newborn-screening programs, SCD is the most commonly detected condition, regardless of ethnicity. It is thus important to recognize SCD as a common and important medical condition among Americans, and not “just Black Americans.” [..] Although SCD is a … Read More

“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More

“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol. Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional … Read More

“There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people.[..] Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control … Read More

“because a vast majority of programs that tie payment to cost and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups. For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of … Read More

“Just as the Black Lives Matter movement has highlighted racial inequities in law enforcement, so the lopsided toll of Black victims in the pandemic has revealed them in health care. Hospital policing is where these two disparities collide. Cleveland’s prestigious hospitals, which mainly employ and treat whites, are surrounded by low-income Black neighborhoods with some of the worst health outcomes in Ohio, including lower life expectancy and high rates of asthma, diabetes and infant mortality. Hospitals have replaced the factories and plants of a faded industrial era as the most important economic engine in northeast Ohio. The clinic [Cleveland Clinic] … Read More