Mar 4, 2016

Dr. Jones: Some groups of people in our society do not receive the same standard of health care as others. But why is that? What can we do? I'm Dr. Kyle Bradford Jones, a family physician at the University of Utah School of Medicine and we are talking about this today on The Scope.

Announcer: These are the conversations happening inside health care that are going to transform health care. The Health Care Insider is on The Scope.

Dr. Jones: Today, I'm joined by Dr. Ana Marie Lopez who is an oncologist at the Huntsman Cancer Institute and is the Associate Vice President for Health Equity and Inclusion at the University of Utah Health Sciences. So, Dr. Lopez, there are significant differences in health among certain ethnicities and races and demographics in the United States. What are some of these differences?

Dr. Lopez: You know, there are so many is hard to know were to start. But, for example, African-American women have the poorest outcomes with the diagnosis of breast cancer. So looking at this different inequities, we need to really understand why people, why some groups might do better and why some groups might not do as well.

Dr. Jones: Now, you mentioned with that example, African-American women with breast cancer, is that more a function of the health care that they receive or is it more a function of other factors that influence it?

Dr. Lopez: Yes and yes. So for most of this factors, they may be from multiple aspects. There may be issues that the disease is more aggressive for some reason. There may also be a factor of access of care. And studies has been done, for example, in fully insured populations, where we think there would not be differences of access and those would give inklings that there might be differences related to biology of disease. But both are often important when we think of different health inequities and different outcomes.

Dr. Jokes: So there's a lot of data and has been for years about the significant differences among races, ethnicities and these health disparities. Have we been successful in narrowing that gap at all?

Dr. Lopez: I think it would depend on what we are looking at and I think is really important if we think of providing quality health care. So if we're thinking of providing quality health care, I think that's only really meaningful if that quality is achieved for every single patient who walks in the door. The differences may be related not just to race/ethnicity, but can also be related to gender, it can be related to age, it can be related to socioeconomic status. And really, this is one of the reasons why access to insurance is so critical. Access to insurance is how most people access health care so a lot of the literature would say that fixing that would at least give people entry into the door.

Dr. Jones: Now, in addition to kind of providing that health care access, what are some other things we can do to help narrow this gap?

Dr. Lopez: Probably one really important step is patient education. For some diseases, we know . . . it's so incredible if you think about it. Sixty-six percent of cancers are probably life-style related. Lifestyle impacts heart disease, which is still in many, many . . . in some populations, cancer has become the number one cause of dead, but really, heart disease has been the number one cause of dead. And that's so impacted by lifestyle. And lifestyle is something we all have control over.

Now, if there were a pill that was even 50% able to give us change an outcome so profound we'd all be on it. It'd be in the water. But lifestyle is more difficult to control and it's behavior and maybe is influenced by education but is also influenced by other factors: culture, habits, the media. If there are commercials out there targeting children for sugary cereals, for sugary drinks we become habituated. So breaking habits is much more difficult than creating habits.

I remember, I mean it's different now, I think young women now are much more into physical activity, physical activity across the lifespan is critical. One of the major reasons for morbidity in elders in falls. Maintaining muscle mass is critical and yet is young women, I mean, our biggest thing was, "How can I get out of PE?" So really instilling those good, healthy habits at the start

Dr. Jones: So instilling those habits, what is the best way to go about that? Is this more of a broader policy issue, more community engagement or community-related activities?

Dr. Lopez: I think it's all of those. So for our schools to really engage in physical activity, in nutrition and the other part of wellness that we may not think a lot about is stress reduction. And in many ways, many psychologists would say, "The work of childhood is play." Children need to play and even as adults, we need to have that space where our minds are floating and that really allows our minds to be creative. Workplace, school place that would encourage those areas would really be positive for overall wellness.

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