My Great American Adventure – Inequalities & disparities

I’ve lost count at the number of people that have said to me that I should leave the world of diversity and do something more strategic: “You want to get out now Yvonne or you’ll get stuck” they say. I think it’s interesting that people believe that diversity is something you can dip in and out of, and leave behind when you get fed up of it. For me, inclusion and wanting diversity as standard comes from an inbuilt belief and values system that is an integral part of who I am. It isn’t something that I can opt out of like jumping off a bus. Even if I took on a new role quality-controlling widgets, I would still champion the equalities and health inequalities agenda, which will never change.

Those of you that read my blog regularly will know I am currently in the US – Boston to be exact – Cambridge to be even more precise. I am loving every minute of it and am learning new and interesting things every day. The IHI is an amazing organisation with some of the warmest, most clever and inspiring people I’ve ever met; it is a real privilege to be here.  It is interesting though, that the issues with regards to diversity and inclusion that we are wrestling with in the UK are equally thorny and difficult here.  The issue of health inequalities or disparities as they are known over here are worldwide and therefore everyone’s business, not just the people with diversity or inclusion in their titles. Yesterday, I was fortunate enough to be able to sit in on a lecture given by Thomas Sequist, MD MPH to the Quality Improvement Fellows. He was an excellent speaker and had a lot of evidence to share about the gaps in the quality for services that people receive depending on their ethnic background. Shocking but not surprising.  Ethnic groups receiving a ‘different’ level of service to white people is well documented, take-up and access to services for some groups is poorer and this is not just in the UK; it occurs in Canada and Australia where research has shown the Inuit and Aboriginal people all have poorer health outcomes than their white counterparts.

Services for people from ethnic backgrounds is good here (Medicaid and Medicare), the issue is that they have higher levels of chronic disease, and the health inequalities gap between white and black people here is wide and indeed widening. This is where it gets interesting. His research showed that the majority of primary care physicians believed there to be health inequalities across America, in other states, in hospitals, everywhere but in their own practices. The reality was rather different; the inequalities were everywhere including their practices. The evidence showed it was the attitude of the doctors themselves that didn’t help the situation to improve. Why? Because they prided themselves on treating all patients the same, when in reality, we know that for there to be equality everyone needs to be treated according to their needs, that is treated differently; the Hispanic woman would need different treatment to the Native American man for example.

In order to improve the situation, diversity training was made available to clinicians. The interesting thing about this is that you would think that the training would improve things. Surprisingly it only shifted the outcomes for patients slightly; therefore demonstrating that diversity training alone is not the answer to improving health care for minorities; a multitude of interventions need to be used consistently for a sustained period of time is necessary.

What this says to me is that diversity and inclusion is not a soft option, it is definitely not for the faint hearted, or something to opt out of. In order to make even minor changes in people’s beliefs, attitudes and behaviours there must be demonstrable support from everyone at the top of organisations to the bottom, as well as several strategies that remind people of the fact that groups and indeed individuals need different interventions to support and enable change. This focus needs to be consistent and sustained for long periods of time.