Racial disparities have been a significant barrier in promoting and advancing global health. So how are these disparities being addressed? To answer this question, Elise Wilfinger sits down with board-certified nephrologist Dr. Keith Norris, a Professor of Medicine at the David Geffen School of Medicine in the Division of General Internal Medicine and Health Services Research and the Executive Vice Chair of the Department of Medicine of the Office of Equity, Diversity & Inclusion at UCLA.
Several determinants of health have driven outcomes for patients with chronic kidney disease (CKD), including social, behavioral, and economic disparities. One of the primary determinants, racial disparities, have been a significant barrier in promoting and advancing global health. How are these disparities being addressed?
To answer this question, Elise Wilfinger sits down with board-certified nephrologist Dr. Keith Norris, a Professor of Medicine at the David Geffen School of Medicine in the Division of General Internal Medicine and Health Services Research and the Executive Vice Chair of the Department of Medicine of the Office of Equity, Diversity & Inclusion at UCLA.
Ms. Wilfinger began with some background on CKD, explaining that this disease represents one of the most dramatic examples of racial and ethnic disparities in health the U.S., and that African American patients are 3.5x more likely to develop later-stage kidney disease and 10x more likely to develop hypertension-related kidney failure. She then asked Dr. Norris if any other patient populations experience similar disparities.
Dr. Norris then shared data from the USRDS and explained that “there is an 88%* greater adjusted incidence for ESRD (end-stage renal disease) among Hispanics than for Caucasians. It’s a 31%* greater incidence in the Asian community, and 112%* greater in the American Indian community,” urging clinicians to dedicate more time and financial resources to both education and early intervention to prevent further increases of later stage disease in these patient populations.
Dr. Norris then gave an example of how disparities in access to health-affirming resources have worsened outcomes for minority populations, specifically African American populations:
“Still up to the 1950’s-1960’s, “society” had laws that told African Americans where they could and could not live,” Dr. Norris explained. “And there was a catch: no one (businesses, grocery stores, hospitals, etc.) wanted to invest resources (time nor money) in those neighborhoods, putting the African American community in a big hole.”
Because of this, he explains that racism is a risk factor for poor health, and that being part of a marginalized racial group increases the risk of being exposed to social and psychological factors that increase the risk of kidney disease. But there are three things clinicians can do to help combat these disparities:
Make kidney care a priority within the entire healthcare ecosystem: providers, systems, payers
Engage primary care physicians early in the process as they are at the frontline of chronic disease management, but make sure they have the support needed, such as a multidisciplinary team, to address the social and psychologic issues that increase the risk of CKD progression
Make any new measure easy for the primary care physician to implement. All specialties, including cardiology, gastroenterology, endocrinology, are looking to the primary care physician to help with earlier-stage detection and care
And according to Dr. Norris, rates of kidney disease have declined due to the delivery of kidney disease risk factor education, high quality care, improved access to care, and improved affordability through the Indian Health Services organization, and leaves the readers with one final message:
“At some point, we have to make the ultimate decision: Is it important enough to us, as Americans, to change how we’ve always done things, and embrace a vision for America that’s based on true equity and justice for all?” Dr. Norris asks. “And we must also change those ‘community factors’ – like education – that also correlate with health. If we improve the equity of the educational system, it allows marginalized population groups to get better jobs, better housing, and insurance. All of these factors yield better health and improved ability to manage chronic diseases, like kidney disease.”