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Social Determinants

SPONSORED | How CEOs of hospitals, medical schools can help correct health disparities through diversity

Hal Paz, MD | February 10, 2020

Health care CEOs know that Americans are paying more and more for health care, yet many continue to get sicker and die younger despite healthcare advances. These facts may come as a shock, depending on your socioeconomic circumstances; the health crisis is particularly pronounced in minority populations and economically disadvantaged groups.

Research shows that these health disparities for certain groups are significant. For example, the Centers for Disease Control and Prevention’s most recent Health Disparities & Inequalities Report showed much higher rates of stroke, coronary heart disease, infant mortality, preventable hospitalization and still other health conditions among racial minorities compared with non-Hispanic whites.

We also know that there are disparities in the health care given to women and minorities. Cardiac care is a prime example: Numerous studies from the past five years show that, when discharged from the hospital after a heart attack, women are much less likely than men to be prescribed medications proven to prevent repeat heart attacks. Compared with white women, postmenopausal black women are half as likely and Hispanic women are 16 percent less likely to receive treatment for their heart attack or coronary artery disease symptoms when they arrive at a hospital, the American Heart Association revealed last year.

Leaders simply can’t allow these disparities to continue—not only is it antithetical to American values of equality, but as our country grows increasingly diverse, top executives have to fix these issues to sustain and improve our healthcare system.

Closing the gaps with representation

If the U.S. is to achieve health equity, it’s imperative that CEOs ensure healthcare providers not only receive proper training to avoid racial and gender bias, but also that they come from all possible backgrounds, more closely reflecting the diverse populations they serve.

A top priority should be to ensure that all patients receive the same level of respect and understanding.

Developing that understanding, especially, can be difficult when the provider and patient are from vastly different backgrounds. Culture can inform lifestyle choices, medication compliance, diet, the level of comfort in medical settings, and perception of pain and even overall health.

A provider’s “implicit bias,” or subconscious perception of a culture, gender or race, can inform how they interpret symptoms or how they share important health information with a patient or patient’s family.

With more backgrounds represented in the health care executive ranks and the broader workforce, patients have access to providers who understand them better. Workplaces can become environments that promote learning culturally from one another.

CEOs of medical schools and health systems must take a critical role in making this happen.

How we can increase diversity and reduce disparities

Increasing diversity in the healthcare workforce isn’t about simply instituting and meeting hiring quotas without regard to workers’ merit. The CEO’s goal is to correct a current lack of workforce diversity by making the hiring and admissions processes more objective.

The Ohio State University Wexner Medical Center, which was just ranked #4 on Forbes’ 2020 list of most diverse U.S. workplaces, prioritizes cultural competency training, employee resource groups and implicit bias training to reinforce that emphasis on cultural understanding.

Let’s take a look at our approach.

Staff interpreters at the medical center are able to help communicate crucial health information between providers and patients in 130 languages, removing a common healthcare barrier for ethnic minorities.

The medical center and the Ohio State College of Medicine, where many of the medical center’s providers serve as faculty, emphasize inclusivity in both hiring and admissions. For example, women make up more than half of the search committee now responsible for finding a new College of Medicine dean, and underrepresented minorities represent at least a third of the committee members.

The college designed its own implicit bias training program, used in both student admissions and hiring at the university and medical center, that uses the latest research in unconscious bias. Now used in colleges across the U.S., the training asks its participants to face their own individual, unintentional biases and to learn how to overcome those biases.

The program has been successful at Ohio State in diversifying incoming classes—not because admissions committees have accepted more women and minority students, but because more women and minorities decided to study there after receiving a letter of acceptance. Minority students reported feeling more welcome during the admissions process.

U.S. News & World Report has since ranked the Ohio State College of Medicine #2 of 152 medical schools in the U.S. for its number of African American medical students. For the past six years, female medical students outnumbered males in incoming classes of medical students, more closely matching the gender split in the wider U.S. population.

The school hasn’t sacrificed excellence for diversity, either: Its most diverse classes had the school’s highest average Medical College Admissions Test (MCAT) scores.

Addressing the social determinants of health

For CEOs and the organizations they lead, increasing diversity is an important pillar in addressing the social determinants of health—those non-medical factors, such as income, housing, transportation and education, that predict health risks and outcomes.

Health care leaders can’t ignore any of these factors. But sometimes addressing one element can help solve another. For example, when health sciences students volunteer in free clinics to increase access to health care in vulnerable populations, they’re learning from those patients and becoming more understanding providers.

Ohio State’s experts in the health sciences regularly reach into vulnerable area schools to expose students to healthcare careers as early as first grade. The faculty and staff who help create these STEM programs have built a pipeline of students into health science careers, with many of the participating students choosing to become nurses, physicians and veterinarians, building a more culturally and socioeconomically diverse workforce.

America is comprised of a melting pot of races, ethnicities and cultures. As our population becomes more diverse, CEOs can’t afford to overlook the cultural barriers to good health—for the sake of America’s future, health care providers need to be a melting pot, too.

About the Author

Hal Paz, MD, Author

Dr. Harold L. Paz is executive vice president and chancellor for health affairs at The Ohio State University and chief executive officer of the OSU Wexner Medical Center. At Ohio State, Dr. Paz leads all seven health science colleges and serves as CEO of the $4-billion Wexner Medical Center enterprise, which includes seven hospitals, a nationally ranked college of medicine, over 20 research institutes, multiple ambulatory sites, an accountable care organization, and a health plan. Before joining OSU in June 2019, Dr. Paz was executive vice president and chief medical officer at Aetna where he led clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses. He reported to Aetna’s chairman and CEO and was a member of its executive committee. Prior to joining Aetna in 2014, Dr. Paz served as president and CEO of the Penn State Hershey Health System, senior vice president for health affairs at the Pennsylvania State University, and dean of its College of Medicine for eight years. Before his appointment at Penn State, he spent eleven years as dean of the Robert Wood Johnson Medical School and CEO of the Robert Wood Johnson University Medical Group. Dr. Paz received his bachelor's degree from the University of Rochester, a master of science in life science engineering from Tufts University, and his medical degree from the University of Rochester School of Medicine and Dentistry. He completed his residency at Northwestern University, where he served as chief medical resident. Dr. Paz was a Eudowood Fellow in pulmonary and critical care medicine at Johns Hopkins Medical School. In addition, he was a post-doctoral fellow in environmental health science at Johns Hopkins School of Hygiene and Public Health.