Mass. Secretary of Health JudyAnn Bigby, MD, on the Persistence of Racial and Ethnic Health Disparities

Source:

EthnicNewz.org (formerly go-NEWz.com)

Writer:

M. Thang

[1]

Following is an edited trancript of Dr. Bigby's phone interview with New England Ethnic News, on Nov. 29, 2007.

NEWz: Patients of color don't always receive adequate treatment from medical professionals. One reason involves medical professionals' unfamiliarity with diverse ethnic cultures. Is the state planning to improve training in so-called culture competence of doctors or other medical staff?

Dr. BIGBY: First of all, I would say that it has been well documented that African Americans and Latinos specifically don't necessarily get the same quality of care as Whites.
I don't think there's any evidence that cultural competence training would reverse those differences in quality.

There are lots of initiatives looking at trying to understand why those quality differences exist.
There's probably not a one-size-fits-all approach to fixing that. I want to hold institutions accountable for being able to document that they're delivering the same kind of care to everyone.

My goal is to make sure that we're able to measure the quality of care that is provided by hospitals, health centers and others — and, if there are differences, to go back to those institutions and say: "You need to account for how you're going to improve these."

Whether they choose to do it by cultural competence training or another initiative, I think it's wide open, what types of things would improve the quality of care.

NEWz: Is Massachusetts implementing or will it develop any programs or initiatives to counter racial and ethnic health disparities?

Dr. BIGBY: One of the other announcements we made yesterday is that we did award $1 million in grants to different organizations in communities that are specifically focused on disparities.

We see these grants as providing seed money to these organizations to begin to specifically address the disparities in their communities.

They range from giving support to the Worcester Health Department to establish an office of health disparities, to doing diabetes education among African American elders in the City of Boston, to giving resources to groups on Cape Cod to be able to translate (their) health materials into Spanish and Portuguese.

It's a wide range of interventions that these groups will be doing.

NEWz: Besides the $1 million that was disbursed, what are some of the overall goals of Health and Human Services moving forward, in terms of health disparities?

Dr. BIGBY: We have other resources that obviously could be allocated towards health disparities.

First of all, our goal is to use this first report and to to develop a report card that will allow us to track how we are addressing health disparities, either through state initiatives or through initiatives that other entities take on.

We will be looking at how we can improve the strategies to address health disparities within the programs that we already run, whether they're substance-abuse programs, HIV/AIDS programs, programs to support healthy pregnancy, and that sort of thing.

NEWz: How much does socioeconomic status influence one's health outcomes?

Dr. BIGBY: We know that people who are better off economically are generally healthier than those who are less well off economically.

But we also know from decades of research on racial and ethnic disparities that income levels alone do not explain these disparities.
After you account for health insurance, income, levels of education, and those sorts of things, you still see the disparities by race and ethnicity.

NEWz: These health disparities do not go away even after adjusting for socioeconomic status?

Dr. BIGBY: Correct.

NEWz: What are some of these disparities that stick out even for people of color for whom income is not a problem?

Dr. BIGBY: Infant mortality, death from diabetes, death from heart disease, asthma rates, hospitalizations for asthma.
Just about all of the disparities that we document when you control for socioeconomic factors, they don't go away.

NEWz: For African Americans in particular or different racial groups?

Dr. BIGBY: Most of the work has been on African Americans, comparing them to Whites.

NEWz: What were some of the health disparities for African Americans in the various regions of Massachusetts?

Dr. BIGBY: Unfortunately for African Americans — for most of the indicators that we track — it shows that they have worse health outcomes and health risk factors than any other group in the Commonwealth (of Massachusetts).

I think that what was important about this report is that this is not limited to people in Boston. This is something that we see across the Commonwealth, in all the communities where African Americans live.

Heart disease, infant mortality, diabetes, violence — those issues are more prevalent among African Americans.
If you look at any of the (health) indicators, African Americans do the worst for just about all of them.

NEWz: For Latinos, what were some of the health disparities in the various regions of Massachusetts?

Dr. BIGBY: The disparities are related to problems such as diabetes, teenage pregnancy rates among Latina girls or adolescents, HIV/AIDS infection, and death from HIV/AIDS. Those are some of the issues that really stand out about the Latino community.

NEWz: What about Asians and Native Americans in Massachusetts? Did any health disparities stand out for them?

Dr. BIGBY: Asian Americans had higher rates of gestational diabetes (diabetes that occurs in women who are pregnant) than others. For some (Asian American) populations, smoking is a problem. Also, there are relatively high rates of stroke.

Unfortunately in most of the communities, there are so few American Indians or Native Americans that we weren't really able to develop rates of illness or disease among them, so I can't comment on that population.

NEWz: Diabetes is a major problem for African Americans, Latinos, Asians and Native Americans — and increasingly for children, not just adults. Are there any diabetes initiatives in the works or in effect now?

Dr. BIGBY: We do have programs through the Department of Public Health that are looking at diabetes, but we also plan to be doing a more-integrated approach to diabetes and obesity that we hope we'll be able to announce soon.
The (Department of Public Health) has several programs that are focused on diabetes through their collaboration with community health centers.

NEWz: And do these programs focus on particular ethnic or racial groups?

Dr. BIGBY: Some of them do, yes.
[The Mass. EOHHS will give New England Ethnic News separately the details of these diabetes initiatives that serve racial or ethnic groups.]

NEWz: Some patients — such as those facing linguistic or cultural barriers — don't like to ask their doctors any questions. Do you think patients need to ask more questions from their doctors or medical professionals?

Dr. BIGBY: Again, I don't think that this is an issue that can be addressed with one intervention, especially one that puts the burden on the patient to say: "Well, I demand to get the right care." I think that it's more complicated than that.

There actually are studies that show, however, that patients who ask more questions and ask for more information do tend to get at least the care that they are most satisfied with compared to others, but I don't think that that's the only solution to this.

NEWz: Is there anything else you would like to add?

Dr. BIGBY: I appreciate your questions and your interest in this.