By Edwin Aroke, PhD, CRNA Assistant Professor, University of Alabama at Birmingham; Terrica Durbin, DNP, PhD, CRNA Program Chair, University of Tennessee Knoxville
Reprinted courtesy of AANA NewsBulletin: May 2020
Countless studies have shown that despite significant improvements in the overall health of the U.S. population, racial, ethnic, and socioeconomic status disparities in health persist.1 For instance, racial and ethnic minority parturients are more likely to have general anesthesia for cesarean delivery than non-minority women.
After controlling for demographic and body mass index, black patients undergoing orthopedic surgery have more prolonged induction to recovery times than whites. Following tonsillectomies, black children reported more postoperative pain than whites. After controlling for patient and procedure risk factors of postoperative nausea and vomiting and provider influence, patients of lower socioeconomic status were administered less antiemetic medications than those of higher socioeconomic status.
Thus, many healthcare professionals, policymakers, public health administrators, and researchers have made reducing or eliminating health disparities a priority. So, what causes health disparities, and what can CRNAs do to reduce or eliminate disparities in anesthesia care? To address these questions, we clarify the definition of health disparities, then summarize current ideas of the causes of health disparities and suggest recommendations for CRNAs.
Defining Health Disparities
While the term health disparities is often used interchangeably with health differences, there are subtle differences. Health differences primarily refer to variations in health that result from divergence in underlying biology such as genetic makeup.
For instance, there are racial differences in sickle cell anemia because the genetic variant that causes sickling of red blood cells is more common in Africans and African Americans.
Health disparities, though, refer to “a particular type of health difference that is closely linked with economic, social, or environmental disadvantage.”1 Hebert and colleagues7 describe the relationship between health differences and disparities as a continuum from health differences that are mainly biologic with a little connotation of unfair treatment, to disparities that reflect the influence of bias and discrimination.
When a group of people experience systematically greater social or economic impediments “to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location or other characteristics historically linked to discrimination or exclusion” health disparities emerge.1 Thus, the mistreatment of a group of people appears to be the line between health differences and health disparities.
Origins of Health Disparities
Unequal treatment of a group of people because of historical exclusion or discrimination significantly contributes to health disparities. This unequal treatment may divide into patient, cultural, and provider factors.
When patients lack access to care or when they mistrust the healthcare system, they are less likely to seek timely care. Unfortunately, such mistrust is often attributed to historical mistreatment, microaggression, and other forms of oppression experienced both within and outside of the healthcare system. As a result, individuals from disadvantaged backgrounds may mistrust healthcare providers despite the provider’s ability to provide quality care.
This combination of historical facts, mistreatment, mistrust, and discrimination feed into the cultural beliefs of patients and providers alike. Providers’ view certain groups of people may be rooted in flawed historical and sociocultural stereotypes and biases such as the perception that African Americans are “insensible to pain… or could tolerate surgical operations with little, if any, pain at all.”8 Left unchecked, such misconceptions could result in undertreatment and pain disparities.