ACR Bulletin

Covering topics relevant to the practice of radiology

Diving Into Racial Disparities in Healthcare

ACR 2021 highlighted the College’s commitment to equity within radiology and the entire house of medicine.
Jump to Article

“We need to become the community we serve.”

—Raymond K. Tu, MD, MS, FACR
June 29, 2021

With the same discretion of the College’s decision last year to put the health and safety of ACR members, the patients they serve, and ACR employees and local hospitality staff first, this year’s Annual Meeting was once again completely virtual.

The flagship announcement of the Annual Meeting was the launch of the Radiology Health Equity Coalition.

To complement the weight of the Coalition, there was a two-part presentation on health equity, featuring a host of expert panelists speaking on the ACR’s commitment to health equity within the specialty and beyond to the entire house of medicine. First-day health equity panelists were Johnson B. Lightfoote, MD, MBA, FACR, chair of the ACR Commission for Women and Diversity; Efrén J. Flores, MD; Lucy B. Spalluto, MD, MPH; Zahra Kahn, CPA, CGMA, MPA; and Iris C. Gibbs, MD, FACR.

Flores opened by noting that the COVID-19 pandemic did not affect all populations equally. It has disproportionately impacted people of color, even though the pandemic has highlighted how interconnected we all are, he told attendees. “Where you live matters, we have learned, but it should not,” he said.

Flores went on to say that racism in America is a real threat to the public health of the country and a driver of social injustice and health inequity. “It is important that we have a commitment at all levels to change this and advance social justice,” he said. “As a specialty, we have to be committed. Advancing health equity is the responsibility of every specialist, and radiology must play a central role.”

Kahn, a health and financial policy expert, spoke on racial equity in breast cancer screening. She pointed out that when women skip screening in their 40s based on U.S. Preventive Services Task Force guidelines, it leads to even more injustice and worse health outcomes for Blacks, Latinx/ Hispanics, and Asian Americans.

Gibbs explored the role of racism in health equity — including life expectancy among minorities. More importantly, she spoke to the deeply-rooted racial ideologies and institutional policies in the U.S. that make it challenging for health equity initiatives and perceptual changes in healthcare and radiological practice to advance. “The first step to health equity is awareness,” she said. Gibbs delved into a longstanding history of scientific racism, particularly directed at Black Americans — and how this has fueled implicit bias in modern medicine.

“As a specialty, we have to be committed. Advancing health equity is the responsibility of every specialist, and radiology must play a central role.”

—Efrén J. Flores, MD

Spalluto presented on radiology’s specific role in diversity, equity, and inclusion efforts, the impact of these efforts on more favorable patient outcomes, and leading the charge for health equity. Disparities in health outcomes, Spalluto said, including infant mortality, cancer outcomes, obesity, malnutrition, and cardiovascular disease are the result of existing systemic inequities. “Quality of food, schools, and insurance status all drive healthcare disparities,” she said.

The second day of the program was introduced by outgoing ACR President Geraldine B. McGinty, MD, MBA, FACR, and included health equity presentations by Jacqueline A. Bello, MD, FACR, vice chair of the ACR BOC; Frank J. Lexa, MD, MBA, FACR, chief medical officer of the Radiology Leadership Institute® and chair of the ACR Commission on Leadership and Practice Development; Karthik Sivashanker, MD, MPH, CPPS; Raymond K. Tu, MD, MS, FACR; and Rajan T. Gupta, MD, as the moderator. Sivashanker called equity an “accelerator of all we do.”

“It has to be a core mission of what we’re doing,” Sivashanker said. “There is no such thing as high-quality inequitable care. The approach of hiring one person of color, charging them with driving change, and then being surprised that it doesn’t work is not the right approach.”

Tu talked about his work in Washington, D.C. — one of the most diverse cities in the nation. During the pandemic’s peak, his hospital worked closely with local businesses to get the word out about safety procedures and testing. Tu continues to encourage local partnerships with academic and community physicians to enhance what he calls “the joy of good medicine.” Working with medical students, too, is critical to fostering diversity, he said — and noted that America will be a majority minority country by 2050, with Whites making up only 46% of the population. “We need to become the community we serve,” he said.

“When approaching the challenges of healthcare inequity, good intentions are just not enough,” Lexa told attendees. “Figure out how you’re going to quantify your results. A demonstration project might be the answer.” He suggested trying out ideas first before putting together your final plan.

Breast imaging in certain populations might be a good place to start, he said. “But don’t get obsessed about one idea,” he said. “It is ok to start small and it is important to build alliances with groups who can advance your cause — not just those you like.”

Bello emphasized that radiology touches every part of patient care, and that radiologists are uniquely positioned to spearhead efforts to address health disparities and accommodate the needs of diverse patient populations. “I encourage all to pledge their commitment and action to advance health equity,” she said.

Every presentation affirmed the importance of advancing health equity. Speakers discussed how radiologists can serve as leaders of the charge, stressing the importance of building alliances and recognizing the problem is deeply rooted and no small challenge. Significant strides have been made as a result of this year’s meeting — but no doubt, health equity will remain a focus of ACR 2022 and onward.