Closing the Gaps in Healthcare Disparities to Achieve Equity

Racial/ethnic minority groups, rural residents, and adults with low incomes continue to experience suboptimal access to and quality of healthcare in the United States. These disparities are especially strong with respect to cardiovascular disease and cancer, the leading cause of death nationally.

Despite the introduction of interventions to address disparities in healthcare access and quality, there have been only modest improvements in reducing persistent disparities in cardiovascular disease and cancer care nationally, according to an article published in Health Affairs. Tanjala Purnell, PhD, MPH, assistant professor in the Department of Surgery and training director of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, and colleagues offer examples of interventions that can address the missing components of current programs and continuing healthcare disparities.

They provide key lessons drawn from the literature and highlight 15 critical knowledge and translation gaps that many healthcare disparities interventions do not address. These are organized by their target intervention levels. The paper sets out 4 critical gaps that exist across all 4 levels of the model presented and enumerates how interventions are needed that incorporate the engagement of patients and stakeholders in developing, testing, and disseminating interventions.

The paper stresses the need to compare the effectiveness of universal approaches that target all patients versus approaches that address specific barriers or target underserved populations. Recommendations include the following:

• Interventions should do more to enhance linkages between healthcare systems and communities they serve.
• For particular conditions, interventions and research must address the entire spectrum of health care, from prevention and primary care to specialty care, hospitalization and post-discharge treatment.
• Efforts are needed to better address cultural differences in family decision-making and make use of social network dynamics in intervention approaches.
• Patients and their families prefer a healthcare delivery approach that takes into account the whole person and not just a disease-specific approach. Patients want to be connected to community resources and have existing community strengths leveraged to build partnerships between health systems and community organizations.

Complex factors influence disparities in access to and quality of services, including individual patient factors; family, friends, and social supports factors; provider and organizational factors; and policy and community factors. Interventions must address factors at multiple levels rather than just one level in order to be effective, Purnell and coauthors state.

“For example, an intervention to reduce coronary heart disease disparities could include self-management training for patients, a decision support tool for clinicians, and a partnership between a healthcare system and a community-based organization to train community health workers to help address complex psychosocial and financial barriers,” the authors wrote.

Universal policies such as the Affordable Care Act, and health insurance reform in Massachusetts are important but alone are not enough to eliminate disparities. However, when universal policies such as Delaware’s Cancer Treatment Program are combined with approaches that target at-risk populations, results can be dramatic in terms of reduced disparities, the authors show.

“There is still a great deal of work to be done to improve access to and quality of care to achieve health equity,” the authors concluded, but recent interventions show promise in addressing fundamental knowledge and translation gaps. “Practical and scalable multilevel interventions, guided by transdisciplinary research collaborations and broad stakeholder engagement, may be the most effective approach and lead to more sustainable community- and system-level changes.”