Four leaders in the field discussed the importance of addressing and eliminating inequities in health care during the Saturday, June 26, symposium Diabetes Through a Health Equity Lens.
The session can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.
Tiffany L. Gary-Webb, PhD, MHS, Associate Dean for Diversity and Inclusion and Associate Professor of Epidemiology, University of Pittsburgh Graduate School of Public Health, provided an overview of the definitions, constructs, and models required for understanding the structural and social determinants of health. The process of defining these social determinants started with a focus on the socioeconomic status of individual home units and has expanded to identify scarcity of nearby healthy food, difficulties in accessing education and health care, and toxic environmental exposures at the neighborhood level, Dr. Gary-Webb said.
She noted the role of policy statements, including the ADA’s “Social Determinants of Health and Diabetes: A Scientific Review,” which was published in 2020 in Diabetes Care.
“Equity is our goal. That’s where we want to be. That’s where we aim to be,” Dr. Gary-Webb said. “But the reality is right now we’re not anywhere near that. The reality is that some people have much more than they need and there are other people who are digging themselves out of a hole.”
Sherita Golden, MD, MHS, the Hugh P. McCormick Family Professor of Endocrinology, Vice President, and Chief Diversity and Health Equity Officer, Johns Hopkins University School of Medicine, discussed the historical social factors that have led to race and ethnic disparities in both diabetes and COVID-19. Those factors reach back into the era of slavery and helped create the implicit bias that continues to impact care today, she said.
Dr. Golden said people can overcome their individual biases and become allies to minority populations in health care through Bias Reductions in Internal Medicine intervention strategies, which include recognizing, labeling, and challenging stereotypes; identifying counter-stereotypical exemplars; practicing common identity formation; and practicing perspective-taking.
Clinical workflows must include equity principles, and a key step is implementation of the National Culturally and Linguistically Appropriate standards, Dr. Golden continued. There are 15 standards, but the principal standard is to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other patient communication needs.
More workforce diversity is also needed, said Dr. Golden, noting that 5.8% of U.S. physicians are Hispanic, 5% are African American or Black, less than 1% are American Indian or Alaskan Native, and less than 1% percent are Native Hawaiian or Pacific Islander.
“If you think about it, those are the populations that are the most impacted by diabetes, yet the workforce to take care of them does not reflect those populations,” Dr. Golden said.
The symposium also included presentations about two programs designed to create health equity in specific patient populations.
Spero M. Manson, PhD, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, discussed the Special Diabetes Program for Indians, a diabetes prevention and treatment program that infuses local cultural activities, beliefs, and practices.
Deborah Parra-Medina, MPH, PhD, FAAHB, Professor of Mexican-American and Latino/Latina Studies, University of Texas, reviewed ongoing efforts in South Texas to prevent obesity in Latino/Latina families. The Y Living Healthy Lifestyle Program, created in conjunction with the YMCA, uses a culturally tailored, family-focused approach that engages local volunteers and is based on YMCA values and priorities. The program has been expanded to rural areas and is ongoing, with data coming later.
Also during the symposium, David G. Marrero, PhD, delivered the Richard R. Rubin Award Lecture, “Diabetes Prevention and Treatment in the American Southwest.”