Racial Health Disparities

Focus on Vulnerable Populations and Address Racial Disparities

Osteopathic family physicians are committed to treating vulnerable populations, such as rural patients, uninsured/underinsured individuals, and racial/ethnic minorities. ACOFP believes there are several ways to improve family physicians’ ability to ensure health and longevity for these populations.

Social determinants of health (SDOH) have been shown to have a major impact on patients’ overall health. Even when a physician provides high-quality care, follows evidence-based guidelines, and provides access to community resources, patients still may not achieve the desired health outcomes because of their SDOH. Making changes to a patient’s social environment is key. This includes utilizing social services to ensure access to adequate housing, good nutrition, language interpreter services, and transportation.

While physicians may direct patients to community resources that can assist them with services to address SDOH, it is beyond the capacity of physicians and the healthcare system alone to completely address these factors. Physicians should not be held accountable for eliminating or mitigating that which is in the social environment, nor should they be penalized for failing to fully ameliorate a patient’s SDOH.

Additionally, ACOFP strongly believes all individuals—regardless of race, color, religion, sex, gender identity, sexual orientation, age, or disability—should have access to high-quality health care. As an organization, we have expressed disapproval of federal efforts to restrict or otherwise limit care based on immutable characteristics of an individual. Congress and the federal government must uphold the rights of all individuals and ensure there are no discriminatory laws or regulations.

The COVID-19 outbreak highlighted systemic inequities in our country’s healthcare system. Studies have found that COVID-19 death rates of Hispanic, Black, and American Indian/Alaska Native (AI/AN) individuals are disproportionately higher than those of white individuals.[i] Specifically, Hispanic, Black, and AI/AN individuals are at least twice as likely to die from COVID-19 than white individuals, and Hispanic and AI/AN individuals are at nearly two times greater risk of contracting COVID-19 than white individuals. In addition, rural and urban healthcare discrepancies have been highlighted throughout the COVID-19 pandemic, including disproportionately high incidence and mortality rates in nonurban areas during some periods of the pandemic.[ii]

Other studies have shown that ethnic minorities are less likely to receive preventative care, and despite improvements in the overall health of the American population, ethnic and racial minorities are not receiving the same quality of care in the U.S.[iii] These same disparities exist in the maternal mortality context with data showing that Black women have higher rates of pregnancy-related deaths than white women.[iv]

As osteopathic family physicians, we have been trained to treat the patient holistically and look beyond the disease. We pride ourselves on understanding the SDOH for our patients, and we embrace diversity and inclusion in our profession. Our foundational principles require us to treat all patients, regardless of their ethnicity or racial background. ACOFP encourages policymakers to create meaningful changes that improve the lives of minority populations in our country and, in turn, all Americans.

Advocacy Positions:

• Ensure recognition and inclusion of SDOH and their overarching impact on health care in policymaking.
• Advocate for federal health program policies that assist and support, rather than financially penalize, physicians for unmet patient needs related to SDOH.
• Expand physician knowledge of population health and how it relates to the understanding of patient outcomes.
• Develop and advocate for policies ensuring access to equitable and high-quality health care.
• Encourage Congress to recognize and act on racial health disparities to improve health outcomes for minority populations.
• Advocate for healthcare workforce and education programs that increase diversity among family physicians, (e.g., programs that recruit students from underserved or diverse communities to practice in their community).
• Preserve and enhance Medicare and Medicaid reimbursement for rural and underserved area physicians, including the facilities where they provide care (e.g., Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Critical Access Hospitals, and Disproportionate Share Hospitals).

[i] Hill L, Artiga S. COVID-19 cases and deaths by race/ethnicity: Current data and changes over time. Kaiser Family Foundation, August 22, 2022. Accessed January 20, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/

[ii] Ullrich F, Mueller K. COVID-19 Cases and Deaths, Metropolitan and Nonmetropolitan Counties Over Time (update). RUPRI Center for Rural Health Policy Analysis Rural Data Brief. January 2023. Accessed January 12, 2023. https://rupri.public-health.uiowa.edu/publications/policybriefs/2020/COVID%20Longitudinal%20Data.pdf

[iii] Hostetter M, Klein S. In focus: reducing racial disparities in health care by confronting racism. The Commonwealth Fund. September 27, 2018. Accessed January 12, 2023. https://www.commonwealthfund.org/publications/2018/sep/focus-reducing-racial-disparities-health-care-confronting-racism

[iv] Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018;61(2):387–399. doi:10.1097/GRF.0000000000000349