Gathered in the parking lot of my hometown church, family and friends were “catching up” with each other before leaving the annual “Homecoming” service and dinner.
While in the parking lot, I overheard a conversation between two cousins. One was sharing that she had attended two funerals the day before, and her husband had been ill for several months. Caring for her husband, maintaining a full-time job outside the home, and responding to the needs of her adult children and grandchildren had taken their toll on her physically and emotionally.
She also commented that she was experiencing back pain but decided it was only arthritis. In this cultural context, arthritis is a minor, recurring and mostly annoying pain that is associated with aging. She had recently celebrated her 51st birthday. Her cousin asked if she had gone to see the doctor about the pain in her back, and she replied, “No, I just didn’t want to hear any more bad news.”
Back in Atlanta, I attended a high school basketball game and sat beside the uncle of one of the girls on the dance team that would perform at half time. He knew I worked at CDC and was curious about my work at the agency. I described our focus on eliminating health disparities, and this ultimately led to a conversation about a health issue he was having. He told me that for several months, he had been seeing blood in his stools. He was very concerned, and wondered if it might just be hemorrhoids. I asked if he had gone to see a doctor about this, and he said, “No, I just don’t want to hear any bad news.”
While conducting research several years ago with black men with type 2 diabetes, I was referred to a man who was experiencing multiple symptoms of diabetes but declined to be tested.
I asked why he didn’t want to know if he had diabetes, and his response was “it’s not a good time to know.” “Why isn’t it a good time?,” I asked, and he said, “I’m taking care of my elderly parents, the economy isn’t good, and it’s just not a good time to know.” I told him that if he in fact had diabetes, it was better to know and take action to control it. He didn’t say anything, but got into his car and drove off. I don’t know if or when he was ever tested for type 2 diabetes.
As a medical anthropologist, I am always interested in these types of arguably anecdotal statements made in unsuspecting community contexts to help explain why despite the progress our nation has made over the past 50 years, racial and ethnic minorities still lag behind the general population on many health fronts.
We know that communities of color are less likely to get the preventive care they need to stay healthy, are more likely to suffer from serious illnesses, such as diabetes, heart disease and colon cancer, and are less likely to have access to quality health care.
But now, because of the Affordable Care Act, preventive services, consumer protections, and other reforms under the Affordable Care Act are giving millions of Americans of all ages, races and ethnicities more value for their health care dollars and contributing to the slowest growth in health care costs in 50 years.
The Affordable Care Act is already making prevention more affordable and accessible for all Americans by requiring health plans to cover many preventive services for free. For example, new health plans must offer no-cost coverage for services that will prevent and control these diseases, like:
- Screening for obesity, and counseling from your doctor and other health professionals to promote sustained weight loss, including dietary counseling from your doctor.
- Blood pressure screening, and counseling on the use of daily aspirin to reduce the risk of a stroke.
- Tests to screen for high cholesterol and diabetes to reduce the chances of developing heart disease.
So how do we work together to ensure that more people actually use and benefit from these services?
Achieving the goals of the Affordable Care Act is a shared responsibility between health care and public health practitioners, policymakers, employers, and the community. A full discussion of strategies that can bridge the availability of services with persons needing those services is beyond the scope of this blog; however, there are places to begin, such as:
- Mobilizing state and local health departments, community-based organizations, voluntary health organizations, and other community resources to implement what has been learned through research and practice about patient activation and patient and family engagement to increase utilization of health services among people who have not previously had access and must now learn how to navigate the health care system;
- Engaging Community Health Workers and Patient Navigators;
- Ensuring a diverse and culturally competent workforce;
- Creating prevention messages that encourage the use of preventive services in ways that leave people feeling empowered by the decision to take advantage of these services rather than “not wanting to hear any more bad news.”
- Acknowledging and addressing the social determinants of health, and the disruptions that come when there is a diagnosis of a life-threatening disease (e.g., new demands on one’s time, attention, and finances; new uncertainties about the future; yet another thing to manage) among people whose lives are already stressed and vulnerable;
- “Reaching in” to communities of color and collectively working to change the community conversation to one that promotes wellness and believes we can prevent disease.
How will you implement and benefit from provisions in the Affordable Care Act to achieve healthier communities?
- Lasser, K.E.,Murillo, J., Lisboa S., et.al. Colorectal Cancer Screening among Ethnically Diverse, Low-Income Patients. Arch Intern Med. 2011; 171(10):906-912.
- Carman, K.L., Dardess, P., Maurer, M., et.al. Patient and Family Engagement: A framework for understanding the elements and developing interventions and policies. Health Aff February 2013, vol 32(2):223-231.
- Hibbard, J.H., Greene, J., Becker, E.R., et.al. Racial/ethnic disparities and consumer activation in health. Health Aff September 2008, vol 27(5):1442-1453.
- Hibbard, J.H., Greene, J. What the evidence shows about patient activation: Better outcomes and care experiences; Fewer data on costs. Health Aff February 2013, vol 32(2):207-214.
- Cooper, L.A., Powe, N.R. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. The Commonwealth Fund. July 2004.
- Cleland, J.G.F., Ekman, I. Enlisting the help of the largest health care workforce – Patients. JAMA, September 22/29, 2010, vol 304(12):1383-1384.