It has been over 50 years since Dr. Martin Luther King Junior’s famous “I Have a Dream” speech; however, he should also be known for his support of health equality. Three years following the historic speech, Dr. King spoke at the second convention of the Medical Committee for Human Rights, during which he said: “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”1 Almost 60 years later, minority groups and people living in poverty continue to experience poor health outcomes compared to the general population. Although the primary reasons seem to be associated with access to quality health care, race and social conditions are also underlying causal factors.
For African Americans, 58 percent of individuals have a basic or below basic health literacy proficiency, compared to 28 percent of white counterparts.2 Low health literacy has severe consequences, including health costs that are four times higher, hospital stays that are two days longer, and six percent more hospital visits.3 Additionally, low health literacy results in medication adherence rates that are 7.5 percent lower than non-minority groups for chronic conditions,4 also impacting long-term health outcomes.
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These persistent disparities require action focused on the variables that are likely to have the greatest impact allowing people from all walks of life to experience health equality. In the memory of Dr. King and in support of Black History Month and beyond community stakeholders such as physicians, politicians, community leaders and of course public hospitals, should work together to address the obstacles and gaps in education. Such action would positively impact equal access to quality health that is customized to the needs of the individual and promote better health outcomes and lower costs.
Empowerment through health literacy
Without sufficient health literacy, patients cannot appropriately advocate for their own health. For example, a major consideration is preventative health, which can easily be illustrated with vaccination rates. As of January 31, 2022, out of the 74 percent of Americans who received at least one dose of the COVID-19 vaccine, only 10 percent were African Americans and 20 percent Hispanic5. These statistics translate into a significant toll: African Americans and Hispanic Americans are nearly 2.5 times more likely to be hospitalized from the virus and twice as likely to die.
Maternal mortality and other issues
Another concerning impact of health literacy is the effect of racial disparity on maternal morbidity, mortality, and infant health. It is a startling statistic that the United States reports the most childbirth-related deaths out of any developed country, with African American women three times more likely to die in childbirth than white women.6
Interestingly, the issue affects even women with advanced education, indicative that the issue is rooted in systemic and structural unconscious biases perpetuated by the American health care system.7 To curb this troubling trend, patients need access to resources that will help them better understand the need for pre-natal care and to understand their specific risk profile. In addition, social determinants play a role including mental health, housing, domestic violence, economic equality, food insecurity, and transportation access.8
Taking a holistic approach
Improving health outcomes in minority populations is more than just having resources available. The issue is complex, with factors like a patient’s location, distrust of health professionals, job conditions, and income, all of which influences the ability of minority groups to address health concerns. These are issues that cannot be eliminated or addressed alone; instead, they require a concerted effort between policymakers, community leaders, medical professionals, and other stakeholders.
At Nashville General Hospital (NGH), we focus on being the hub of a model for community care delivery, with health care at the center and the ability to address social determinants of health (SDOH) such as employment, food insecurity, transportation, and housing which helps minorities overcome obstacles to health equity attainment.
Improving healthcare with community engagement
As a public safety-net hospital, NGH has seen great promise in community-based programs to improve health literacy. A unique component of our care delivery model is the Congregational Health and Education Network (CHEN), which as one of its four key pillars, aims to enhance Health Literacy, by leveraging relationships with the faith community. CHEN engages with churches to address health literacy issues and provide essential resources that make a difference to congregation members. Historically, African American churches are a place where individuals have deep relationships and trust, a place where they are comfortable turning for help. CHEN offers peer support for clergy leaders of diverse faiths, social services, program resources, and direct access to health education from NGH.
Preparing health practices for the future and increased equity
In 2022 there is mounting support for actionable solutions offering a proactive approach to health care equality.9 Addressing social determinants of health through health literacy training in safe spaces, reducing fear and concerns about treatment protocols, identifying and offering solutions for food insecurity, transportation and behavioral health concerns are all critical to leveling the playing field for all Americans regarding health.
It’s the least we can do to honor Dr. King’s legacy and Black History Month.
1. PNHP, Getting Martin Luther King’s words right
2. NCBI, Health literacy in African-American communities: barriers and strategies
3. Center for Healthcare Strategies, What is health literacy?
4. NCBI, Racial and ethnic disparities in medication adherence among privately insured patients in the United States
5. Kaiser Family Foundation, Latest data on COVID-19 vaccinations by race/ethnicity
6. AJMC, Racial disparities persist in maternal morbidity, mortality and infant health
7. American Medical Association, Examining the Black U.S. maternal mortality rate and how to cut it
8. U.S. Centers for Disease Control and Prevention, Working together to reduce Black maternal mortality
9. Healthcare IT Today, 2022 predictions for health equity