Racial disparity in access to health care has long been a concern of medical professionals.
Now, with the election of the first Hispanic female president of the Philadelphia County Medical Society, it may get increased attention.
Natalia Ortiz-Torrent, an associate professor of clinical psychiatry and behavioral science in Temple University’s Lewis Katz School of Medicine and medical director of the psychosomatic medicine clinic and chief of consultation and liaison psychiatry at Temple University Hospital, has identified racial disparity as a public health issue she wants to focus on through the society.
Especially now. “Never has there been such a time that the differences in health-care outcomes between ethnic groups have been so noticeable than during this era of COVID-19,” she said. “Because of COVID, we are seeing an increase in suicide rates; unsafe work conditions; psychological effects of physical isolation; economic troubles; civil unrest; and so many deaths.”
We spoke with her recently about issues she wants to address.
Let’s talk about disparities in health care. How have they become more obvious, or more worrisome, during the pandemic?
COVID-19 was very interesting in multiple ways. When we were starting to have the surge, we started noticing disproportionate rates of African Americans and Latin Americans being admitted to the hospital with COVID-19. Other hospitals saw similar things. This was a big concern. We had several meetings with community leaders to determine what the factors were and provide some interventions.
One of the many things we learned was that there was not enough information in Spanish. Now many agencies have integrated the documents and other information into different languages. I am the president of the Society of Ibero Latin American Medical Professionals, and an ad hoc committee on public health COVID-19 care recorded videos explaining about the appropriate use of facial masks, social distancing, and how to wash our hands. It worked well. But we realized we needed a larger collaboration with groups that had a larger range so the information could be broadcast at a larger scale.
You’ve mentioned that social determinants are important when it comes to health care.
I work in Northeast Philadelphia, including Kensington. Through the years, I have noticed differences in social determinants and how they relate to health.
Many patients struggle with access to good education so they can have access to jobs that pay well. There are issues with being able to afford housing, despite working. This is a public health issue because if someone is ill, they might have to make a decision on whether to pay the rent, buy food, or pay for their medications.
If you have a certain income, you can apply to get Medicaid. Or if you have a disability or are elderly, you can get Medicare. That helps you get access to a lot of resources. But what about a single woman who works part time in a store because she has to take care of the kids? She cannot afford child care. She doesn’t have benefits and can’t afford the insurance, or the copays.
Transportation is also an issue. Many patients cannot afford a car, so they have to use public transportation. Some hospitals provide SEPTA tokens. Some insurances will pay for paratransit. The problem here is that many patients are not aware of the resources.
This is why physicians have to get familiar with the community resources. They have to know about all their patients’ challenges. If a patient is not showing up at the clinic or taking their medications, the physician needs to know why. Having access to social workers’ services would be great but is not always available.
Are there more?
Many face the problem of not having access to health-care education in a language that they understand, and that conforms to their culture. We have a large population of Latin Americans in Philadelphia, and some are not fluent in English. Many hospitals have access to interpreters, which is great, but in some places that is not the case. If the patient has Medicaid, they have the right to request an interpreter. But, again, many people don’t know this. It’s up to us as health-care practitioners to notice this barrier and offer help.
When we talk to patients, we have to be careful to be sensitive to the language and understand the culture of the patient. We have to stay away from medical jargon. And make sure we ask, without rushing them, “Do you have any questions?” Sometimes that can be a challenge when we have a full schedule of patients.
Food insecurity and access to healthy food are other issues. I know the government is doing more to address that. But we still have a high rate of obesity, hypertension, diabetes. We know that many fast foods are not very healthy, but the prices are affordable. Some patients have access to food stamps and can go to farmers markets for healthy food. But when I talk to my patients, many of them don’t know about the option.
I know from speaking with colleagues that there are ways physicians can provide a prescription to a program through which the patient can get good, farm-raised food. Other programs offer cooking classes to community groups in partnership with community leaders or congregations. But now, things will have to be online because we have to social distance.
Are these online programs also more difficult for minorities to access?
Yes. One of the challenges we are facing now with COVID-19 is access to technology. Not everyone in the community has access to a computer. Social organizations are donating some, but then not everyone has access to a Wi-Fi signal. We need to work on partnership to help the community get access to technology.
Philadelphia has a great program that brings together 6,000 block captains to teach them about CPR, diet, exercise, diabetes, COPD, heart disease, asthma, depression in the elderly, violence, health literacy issues. You have to engage the community leaders. By educating them, we can reach a larger group.
Now, we need to find ways in which we can communicate with them virtually. We need to make sure they have access to technology — to computers, the internet, and good WiFi.
What else can physicians do to address disparities in medical care?
We have to be realistic when we provide medications and treatments. We have to know if you have challenges with access and transportation and co-pays.
With medications, sometimes there might be a less expensive alternative. Have a conversation when providing the medication. I know, it is more work for the physician. But if we don’t have that conversation, then the next thing we find out is that the patient is coming to the hospital with problems because they are not taking their medication.
Another important part is educating the health-care professionals — physicians — about all these social determinants of health and the racial disparities we are facing. We need to educate our frontline workers. We don’t want to place more burdens on them, but if they have access to people they can collaborate with, we can create tool kits or questionnaires that will make it easier or faster to have conversations with their patients.
We need to share any information we have — for example, where to get farm-raised food. And we need to listen to the physicians. They may have more ideas and have information about what works.