There are two major buzz words in health care in 2022. One, which I have discussed several times, is “disruption.” It is going to affect more and more of you over the next few years. But the other one I have not addressed is “disparities,” and it is time.
First, we need to define what true health equality is if we are going to understand when there is disparity. The CDC states that the achievement of health equality is when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
The Kaiser Family Foundation (KFF) states that health disparities are driven by social and economic inequalities with racism and discrimination as underlying themes. These include:
- Economic Stability – employment, expenses, debt, medical bills.
- Neighborhood and Physical Environment – housing, transportation, zip code/geography.
- Education – literacy, language, early childhood education, vocational and higher education.
- Food – food security, access to health options.
- Community, Safety, and Social Context – social integration, support systems, exposure to violence/trauma.
When you look at the list, these are definitely not in the realm of an allergist’s care. Government intervention would be required to help solve these inequities, and there is no short-term solution.
But there is one other social and economic inequity noted by KFF that I did not mention yet, and that is the Health Care System. Under this topic KFF lists: health coverage, provider and pharmacy availability, access to linguistically and culturally appropriate and respectful care, and quality of care. When you look at this list, you find that there are elements where the community allergist can try to make a difference.
Provider availability is a major issue, especially access to specialty care. COVID has led to more physicians leaving the health care arena. With minimal growth in our allergy training programs, there is likely going to be a continued decline in the number of board-certified allergists. I am not sure I have ever seen so many job openings for our specialty. We need to support the allergy training programs in our area and work to increase the number of slots for allergy fellows. Individually, you can look at volunteering at neighborhood clinics in underserved areas and providing allergy care. If you don’t take Medicare or patients without any insurance, you may consider opening a few slots in your schedule for them. This may not cure the problem, but it is something all of us can do to help.
Access to linguistically and culturally appropriate and respectful care is another aspect where we can make a difference. The College has increased the amount of Spanish allergy information on our public website. You can use this resource for your Hispanic population. Any handouts you use in your day-to-day practice need to be easily understood for those with minimal education. It goes without saying that a person’s race or economic status should not matter in delivering care that is respectful. We know that there is a great deal of distrust of the health care system in many minority populations, and we can do our part to help relieve this anxiety by showing the caring nature of the allergist.
Disparity in food allergy is a major issue for many children and adults in affording replacement foods for the ones they are allergic to. Generally, replacing cow’s milk or peanut butter in the diet is going to cost more when switching to a plant-based milk or sunflower seed butter. Especially with the rate of inflation, it is putting even more of a burden on these patients and their families. Of course, we can’t do anything to bring the cost of these foods down. There is an organization in Kansas City called the Food Equality Initiative. This nonprofit has placed more than $100,000 worth of “free-from” food into the hands of food allergic patients. Check out their website at foodequalityinitative.org. You can refer patients that need help in getting safe foods to them. Please consider making a donation. You can also donate “free from” foods to your local food pantry, but inquire whether they have a way to set these foods aside for clients with food allergies.
The College has many ongoing programs addressing disparities in the care of allergy patients. We have an active diversity task force led by Dr. Cherie Zachary. We have produced webinars, podcasts and roundtables addressing this subject. Along with the Allergy and Asthma Network, we developed a program related to atopic dermatitis in skin of color for physicians and patients. Monies have been allocated to encourage students from historically black medical schools to attend our annual meeting in the hope that more will go into our great specialty.
No, we as allergists can’t fix the issue of health care disparities alone, but we can do a small part to help turn it around and achieve health equality.