Health disparities and race: presentation explores case studies and solutions

The presentation began with a famous quote from Martin Luther King, Jr. Speaking to about 25 health professionals at Mission Hospital’s Glenn Theater on Friday, April 27, Sharon West read the quote aloud: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

The presentation was part of the local YWCA of Asheville’s Stand Against Racism events, and focused on the issue of health disparities. Also known as health-care equity, health disparities refer to differences in quality of health and health care across different populations. The presentation focused on these health differences as it related to race.

“When we’re looking at disparities, we’re talking about what’s unjust, what’s unfair,” West explained, citing such barriers as access to health care, culture, financial situations and mental well-being. Currently, West works as the nurse administrator at the Buncombe County Health Center. “There are other things that feed into whether a person can actually be well and whether they can actually flourish in life,” she said.

This is something that Frank Castelblanco sees when he does outreach and prevention programs for Mission Health, where he works as the director of cardiac emergencies. “Heart disease runs rampant here in the South. You may have even heard it called the stroke belt. You also see obesity rates, you see diabetes rates, you see hypertension — all of these are very prevalent in the general population and even more so in minorities,” he said.

Sometimes these differences can be cultural. Castelblanco used food as an example. “Sometimes people come in and say, ‘My grandmother and my mother cooked this way; this is how we eat.’ But a lot of that is habit and a lot of that is not knowing just how bad it is for you,” he said. To educate these populations, Castelblanco goes out into these communities and conducts screenings for conditions like hypertension. “We try do these specific screenings locally and regionally to try and decrease some of those disparities, because heart attack rates are greater, diabetes rates are greater. Everything is greater in minorities — [primarily] African-American and Latinos … in this area,” he explained.

Unfortunately, sometimes the things that are greatest in minorities, West said, are the problems and factors they must deal with compared to their non-minority counterparts. “It would be great if people only had to deal with health challenges, but most times when you see people who are disparate, or who have health disparities, they’re dealing not only with economic challenges, but financial challenges. They’re with mental challenges. They’re dealing with environmental challenges. All of these add up and it becomes a snowball effect.” West, who has lived in Buncombe County since she was 3, noted that there are zero grocery stores within walking distance of public housing in Asheville like Hillcrest, Deaverview Apartments and Pisgah View Apartments. Convience stores are in walking distance, but, West noted, trying to buy fresh produce becomes a difficult task.

Even creating a habit like going to the doctor’s office for a physical becomes a challenge. “The biggest thing is to develop some kind of relationship with any provider, even if they feel healthy just to start getting a baseline of numbers,”  Castelblanco said. This is why he goes into the community for screenings regularly so that the people who receive these screenings have some sort of routine and can begin to trust him. He considers it the first step to showing people that the medical community not only cares about the well-being of its patients, but also remembers their names. Without access and without trust, as West said, health problems can snowball. “Disenfranchised people come to physicians for care. They don’t do the annual physicals. Disenfranchised people try to handle it themselves and then it becomes stressful, it becomes internal, it becomes biology after a while. Of course the health care access diminishes and survival is decreased,” she said.

Looking forward, West emphasized the importance of diversity at every level of decision-making and planning, going beyond the walls of a medical institution and into the community it serves, and not only collecting data, but bringing that data back to the community affected by it and asking, “What can we do to help?”

However, the former Mission Hospital nurse said the most important steps for lowering health disparities in the future will not happen based on decisions made solely by a medical institution. “It’s time that we look and do some introspection not only for the institution, but in ourselves. We have to ask ourselves whether there are some biases that we may have that are preventing us from going where we need to go.” And, just as she began her presentation with a quote from Martin Luther King, Jr., she ended her presentation with his words as well. “Remember, what Dr. King said,” she stated, looking around the room. “The time is always right to do what is right.”