The issue of health inequity is very real.
Health equity is considered to be achieved only when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.1
In my capacity as a radiologist, I’ve had the opportunity to evaluate and consult in other countries where access to medical imaging healthcare is dramatically less than what we would consider to be standard for the U.S. The contrasts are glaring.
Within the U.S., disparities between groups can be just as glaring. Especially as radiologists who view our exams in shades of gray, we often don’t appreciate, from the perspectives of our patients, the differences in care depending on demographics. Yet the data is not only compelling but overwhelming. For example, in 2011–2014, the prevalence of diabetes was 18% in non-Latinx/Hispanic Black adults, 16.8% in Latinx/Hispanic adults, and 9.6% in non-Latinx/Hispanic white adults. In 2015–2016, Latinx/Hispanic (47%) and non-Latinx/Hispanic Black (46.8%) adults had a higher prevalence of obesity than non-Latinx/Hispanic white adults (37.9%). Research shows that where one lives is a greater predictor of one’s health than individual characteristics or behaviors. Life expectancy in the U.S. also varies dramatically — by roughly 15 years for men and 10 years for women — depending on income level, education, and where a person lives.2
Radiology is part of the problem as well. Safdar and Betancourt et al. have written excellent articles in the JACR® recently highlighting the health inequities related to medical imaging and interventional care and services.3,4
The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine published a report in 2017, Communities in Action: Pathways to Health Equity.5 The report describes nine determinants of health that are drivers of health inequities: income and wealth, housing, health systems and services, employment, education, transportation, social environment, public safety, and physical environment. This report is the first in a series of activities undertaken by the
National Academy of Medicine’s Culture of Health program, a multiyear collaborative effort funded by the Robert Wood Johnson Foundation.
Health inequity is costly for the U.S. with respect to healthcare expenditures, national security, business viability, and economic productivity, according to the report. For example, a 2009 analysis found that eliminating health disparities for minorities from 2003–2006 would have reduced direct medical care expenditures by $229.4 billion.6
Especially as radiologists who view our exams in shades of gray, we often don’t appreciate, from the perspectives of our patients, the differences in care depending on demographics.
It will take local, state, and national leadership in the public and private sectors to improve the underlying conditions of health inequity. Advancements in the use of large disparate, population-based data with sophisticated analytic tools may allow us to be more focused on possible solutions. Most promising are numerous examples of community- and local-based programs that are taking action against health inequities across the U.S.
As good citizens, we strive to ensure equal opportunity for everyone. Especially as physicians, we dedicate ourselves to optimizing medical care for all our patients. Health equity is an important component of those moral and ethical ideals. Information in this special edition of the Bulletin can help us and our practices take an active role and help contribute to achieving health equity for our patients and our communities.