Disparities in health care complex, hard to correct
Seven years after the landmark IOM study which established that racial minorities had worse health and were getting poorer care than the rest of the population even after other factors had been controlled for, disparities still exist (AHCJ resource). Newsweek’s Mary Carmichael seeks to explain exactly why health disparities are so difficult to correct.
She discusses study design, classifications for ethnic groups, whether cultural competency training is useful, the quality of care that ethnic groups receive and much more.
Carmichael reports that the medical profession is working to correct disparities, but complex issues like this take time and resources to resolve. Cultural competency training is more common and health care reform proposals include myriad measures intended to help correct disparities. Even if reform doesn’t pass, Carmichael says, those measures could be used as a model for future legislation.
Speaking of solutions, Chris Metinko, of the Oakland Tribune, writes about one effort to address health disparities in some of that city’s poorest areas. Two nurse practitioners and a school board member are working to start a nonprofit organization that “would be a clinic for studying and confronting root causes of health disparities in Oakland and advocating for health equity.” Nurse practitioner Mahedere Solomon “said it would be a place where people could receive health care and where research into some of the area’s most pressing issues could be conducted.” Solomon recently received a 2009-10 Pfizer Community Innovations award, given to nurses who design projects to foster innovation at the local community level.
Meanwhile, HealthLeaders Media reports on a recent study that found nearly half of U.S. doctors say their patient care is being adversely affected by language and other cultural barriers. According to the study, HSC Issue Brief–Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities, sponsored by the Robert Wood Johnson Foundation, reveals that 48 percent of doctors “reported difficulties communicating with patients because of language or cultural barriers, and said they considered the situation at least a minor problem affecting their ability to provide high-quality care.”
In their series “Shortened Lives,” Suzanne Bohan and Sandy Kleffman profiled people from different (though nearby) ZIP codes, finiding wide disparities in their expected life spans, based on where they live, their social status and the toll of chronic stress. The series explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed. Bohan and Kleffman wrote about the project in a piece for AHCJ members and we have included additional resources for those interested in exploring disparities in health care in their own communities.
Report measures health factors at county level
Filed under: Health data, Health policy, Public health, Studies, Tools
A county-by-county collection of reports set to be released tomorrow could be a good source for local data on a number of health factors. The County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, is the first of what is expected to be an annual look at health within each state.
The rankings will “show how counties measure up within each state in terms of how healthy people are, how long they live, and how important factors affect their health, such as tobacco use, obesity, access to healthcare, education, community safety, and air quality,” according to a press release.
A Feb. 17 briefing will include experts representing public health, health policy, education, and business who are expected to discuss the rankings and ways that communities can become healthier. The briefing, which starts at 9:30 a.m. EST, will be webcast. You can RSVP for this event online and a link will be sent to those who RSVP as soon as it’s available. For those in Washington, D.C, the briefing will be at the Columbus Club at Union Station, 50 Massachusetts Ave. NE - you also will need to RSVP.
Speakers are expected to include:
- Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO, Robert Wood Johnson Foundation
- David R. Williams, M.P.H., Ph.D., Norman Professor of Public Health, Harvard School of Public Health
- Patrick Remington, M.D, M.P.H., Associate Dean for Public Health, University of Wisconsin School of Medicine and Public Health
- Andrew Webber, President and CEO, National Business Coalition on Health
- Judith A. Monroe, M.D., FAAFP, State Health Commissioner, Indiana State Department of Health
- Donald Shell, M.D., M.A., Health Officer, Prince George’s County Health Department
(Full disclosure: The Robert Wood Johnson Foundation is one of a number of organizations supporting AHCJ’s educational efforts.)
Update
See how many news organizations have covered the rankings.
Med school prof: Dartmouth Atlas is ‘malarkey’
Filed under: Conflicts of interest, Health data, Hot Health Headline
In a story done in collaboration with The Philadelphia Inquirer, Kaiser Health News’ Jordan Rau’s report on a leading physician’s provocative attack on the Dartmouth Atlas gets off to a lively start:
As he raced through the U.S. Capitol this fall, Dr. Richard “Buz” Cooper, a 73-year-old University of Pennsylvania medical school professor, didn’t mince words. He denounced as “malarkey” a reigning premise of the health care debate – that one-third of the nation’s $2.5 trillion in annual health spending is unnecessary – and said that the idea came from “a bunch of clowns.”
Digging beyond these inflammatory comments, Rau finds that Cooper’s argument revolves around one idea: That the research “doesn’t take into account the high cost of helping the impoverished, who often spend more time in hospitals because they don’t have people to care for them at home and often return to the hospital when they can’t afford needed medications.”
Meanwhile, the Atlas folks’ response has been as blunt as Cooper’s attacks. They say the Penn researcher is wrong and doesn’t adequately understand Dartmouth’s statistical controls.
“It’s impossible to carry on a debate with somebody who does not understand statistics, and seems uninterested in learning,” Jonathan Skinner, a senior author of the Atlas, says of Cooper.
Most experts seem to be lining up on the Dartmouth side of the dispute, and Rau digs past the “clowns” and “malarkey” and helps readers understand the validity of Cooper’s criticism and the Atlas.
Related
To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.
- Covering Health: How hysterectomies spurred Dartmouth Atlas’ birth
- Covering Health: Poor, rural hospitals have higher death rates
- Covering Health: Dartmouth Atlas: Powerful when used right
- Covering Health: Why health costs in McAllen, Texas, resonate
How hysterectomies spurred Dartmouth Atlas’ birth
Filed under: Conflicts of interest, Government, Health care reform, Health data, Hospitals, Hot Health Headline
In the first of a three-part series on health care costs in America, NPR’s Alix Spiegel tells the story of the birth of the Dartmouth Atlas, how some of its founder’s earliest research changed the health care delivery system in Maine and what it tells us about health and money. Spiegel unspools the story as a series of questions, the answer to each of which pushed researchers and physicians closer to an understanding of what drives health care costs in America.
The story kicks off in the mid ’60s when John Wennberg, now famous (among health reporters, at least) as the father of the Dartmouth Atlas, got a grant to study the best way to expand health technology to rural Vermont. To answer that question, Wennberg asked what health care was actually delivered in the state. From there, he discovers massive geographical differences in the frequency of procedures such as hysterectomies, and the questions and answers tumble neatly into line like so many dominoes.
Part two of the series, focusing on how active patient participation drives up costs, will air next week on NPR’s Morning Edition. In the third installment, Spiegel will examine the cost impact of direct-to-consumer advertising of prescription drugs.
Bloomberg explains all five House, Senate plans
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Bloomberg’s Kristin Jensen and Nicole Gaouette have perused all five proposed health care reform plans, each originating from a different committee in either the U.S. Senate or House of Representatives, and were kind enough to explain exactly what they have in common and what they don’t.
In case you’re wondering, they all come with an individual mandate, expanded coverage, comparative effectiveness, increased regulation of insurers and cost-cutting measures. They differ in terms of budget, funding, a public option and an employer mandate.
Profile: Gawande’s self doubt gives writing nuance
Filed under: Health care reform, Health journalism
Harvard Magazine’s Elizabeth Gudrais looks at Dr. Atul Gawande’s Obama-approved work at the New Yorker and explores how and why a Massachusetts endocrine surgeon has become one of the most influential writers in today’s health care reform debate. Gudrais follows his writing career from his start at Slate.com to The New Yorker and the now-infamous town of McAllen, Texas, and examines how Gawande’s own “neurotic self-doubt” has helped his work hit the all the right chords in a nation going through its own period of health care soul-searching.
AIDS advocates: Obama needs to use leverage
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Pharmaceuticals, Public health
The Chicago Tribune’s Tom Hamburger reports that several global health advocacy organizations, including Doctors without Borders and OxFam International, have criticized the Obama administration for not helping to remove Bush-era impediments (primarily regarding pharmaceutical patent enforcement) to cheaper drugs overseas. Advocates claim officials are unwilling to confront major pharmaceutical companies at a time when their cooperation is needed in negotiations surrounding health care reform. For their part, administration officials point out that language in their reports has softened somewhat from that of the previous administration.
Pesticide clouds a risk for children in farming areas
The Los Angeles Times‘ Amy Littlefield reports on children, in this case in California’s San Joaquin Valley, who are sprayed with pesticide while waiting for school buses or on the buses.
There are laws and regulations in place to keep such incidents from happening but Littlefield’s opening anecdote is the third reported case in seven months. The three children were sprayed with a blend of liquid sulfur, gibberellic acid, insecticide and fertilizer.
“Children are almost like a different species in terms of how they metabolize,” said Nina Holland, the lead researcher of a UC Berkeley study that found children are more susceptible than adults to organophosphate pesticides. “We are talking about a very significant difference. We really need to look at protecting children.”
Two of the children in the latest incident say the tractor driver who was spraying the chemicals saw them but didn’t stop, a mental blow that one expert said is “as bad as the effects of the chemical or even worse.”
Two counties illustrate health care disparities
Anna Tong and Phillip Reese of The Sacramento Bee write about health care disparities. They use two local counties to explain many of the issues that are central to the debate over changing the nation’s health care system.
In Yolo County, where many people are uninsured, the residents are diverse in occupation and age. Placer County’s “demographics makes it one of the best for insurance coverage: wealthier, older residents employed by large companies.”
Tong and Reese explain the ties between being uninsured and health outcomes, as well as the cost to society. They also look at the types of businesses that dominate the two counties and point out that employers in Yolo County, where many people are work in agriculture, service and food industries, are less likely to offer insurance than in Placer County, where many people work in the financial industry, professional and business services and high tech.
Other factors they look at include the links between income, ethnicity, age and insurance coverage.
The package includes an interactive graphic that shows California’s counties and how many people in each are uninsured and a series of graphics that breaks down the number of uninsured based on race, income, age, education, employment status and place of birth.
Organ network looks to address regional disparities
Filed under: Conflicts of interest, Health care reform, Hot Health Headline
American Medical News‘ Kevin O’Reilly writes that, spurred on by attention paid to Apple boss Steve Jobs’ trip to Tennessee to take advantage of shorter liver transplant waiting lists, the United Network for Organ Sharing (which has a government contract to run the country’s Organ Procurement and Transplantation Network) will meet in the spring of 2010 to address socioeconomic and regional variations in access to donated organs (see a graph of regional waiting list sizes here).
Jobs did not break any rules, experts say, but he did use his resources to take advantage of an imperfect system. One of the biggest problems? Multiple listings, in which one wealthy patient hops on waiting lists across the country and plays the odds to get the fastest-possible transplant. In what may be an obstacle to reform, some argue that multiple listing is a reasonable practice used by rich and poor alike. Additionally, others say that regional differences in transplant wait times reflect more than just differences in access to health care; they also reflect the high cost of transporting live organs and differing regional success rates in encouraging new donors and standards for harvesting organs.
Related
- In a package for the Los Angeles Times, Charles Ornstein and Tracy Weber looked at UNOS oversight failures and what distinguished the best organ transplant centers from their less-successful peers. Here, the duo tell AHCJ members how they put the project together (includes tips on accessing and using UNOS and other transplant data).
- GAO report on correcting deficiencies at transplant oversight agencies
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
