Inequitable Health Care Research Articles

Racial underrepresentation in dermatological datasets leads to biased machine learning models and inequitable healthcare

Clinical applications of machine learning are promising as a tool to improve patient outcomes through assisting diagnoses, treatment, and analyzing risk factors for screening. Possible clinical applications are especially prominent in dermatology as many diseases and conditions present visually. This allows a machine learning model to analyze and diagnose conditions using patient images and data from electronic health records (EHRs) after training on clinical datasets but could also introduce bias. Despite promising applications, artificial intelligence has the capacity to exacerbate existing demographic disparities in healthcare if models are trained on biased datasets. Through systematic literature review of available literature, we highlight the extent of bias present in clinical datasets as well as the implications it could have on healthcare if not addressed. We find the implications are worsened in dermatological models. Despite the severity and complexity of melanoma and other dermatological diseases as well as differing disease presentations based on skin-color, many imaging datasets underrepresent certain demographic groups causing machine learning models to train on images of primarily fair-skinned individuals leaving minorities behind. In order to address this disparity, research first needs to be done investigating the extent of the bias present and the implications it may have on equitable healthcare.

Between life & death: Political economy of breast cancer care for refugee populations in Lebanon

Refugees and displaced groups have been shown to face increased risk of developing advanced cancer stages. This has been shown to be evident in Lebanon, whereby refugees are detected at later stages when compared to the Lebanese population. Lebanon is one of the biggest host (per capita) of refugees worldwide, and suffers from difficult political situation, compounded by an economic crisis, the COVID-19 pandemic and a blast which hit the capital Beirut in 2020. The main determinants of poor health outcomes among migrant populations in Lebanon include a fragmented and inequitable healthcare system and legal constraints to healthcare accessibility. The health care system is largely privatised with multiple health systems operating simultaneously for different nationalities. The current multi-crisis situation has exacerbated the fragility of the health system and its ability to cope with increasing needs. On the other hand, legal constraints for refugees to obtain residency in Lebanon has also contributed to insufficient access to health care and poor health outcomes among this population. Health system reforms, improved emergency preparedness and response measures, and an ease on legal and political restrictions for the refugee populations in Lebanon are considered key policy recommendations to ensure refugees right to health in Lebanon.

The gaps unaddressed in competency-based medical education (CBME) curriculum

It is crucial to glare at the lacunae of the current competency-based medical education (CBME) curriculum. Certain areas are inadequately addressed, namely issues about gender health and development with a particular focus on the healthcare needs of the LGBTQ+community. It is needed to insist more on health care of disadvantaged sections of the population like primitive tribal groups, the scope dimensions and utilities of palliative and rehabilitative care in patient care, addressing workplace violence against health care professionals, the role of universal health coverage and health insurance in addressing inequitable health care accessibility, the sensitization and application of digital and machine learning technologies in health care, use of artificial intelligence (AI) and 3D printing to solve complex health issues, the utilities of telemedicine to address inaccessible quality health care and most notably the absence of sensitization and training on Chemical, Biological, Radiological, Nuclear (CBRN) casualty management as a subset of disaster.

Women’s Experiences of Health-Related Communicative Disenfranchisement

ABSTRACT Women’s inequitable healthcare experiences are epistemic injustices by which women are discredited and harmed in their position as knowers of their health and their bodies. Drawing on the theory of communicative disenfranchisement (TCD), we sought to amplify voices of women experiencing communicative disenfranchisement (CD) and to unify their stories according to theoretical premises, namely, attention to power, material conditions, discourse, identities and relationships, and process. We interviewed 36 women living in the United States whose health issues have not been taken seriously by health care providers, friends, and family – pervasive sources of disenfranchising talk surrounding health. Mapping onto the TCD framework, our findings explicate the process of CD, including the material and immaterial consequences of disenfranchising talk and women’s responses to such talk. CD unfolded as a protracted and often circular process of women seeking care but encountering health dismissals and minimalizations, blaming and shaming, normalizing of their pain, and psychologizing. We unpack how disenfranchising talk rendered women crazy and dehumanized them and inflicted shame and loss. Women responded to disenfranchising talk with silence, and they (re)claimed their voice by resisting psychogenic explanations for their problems, critiquing women’s healthcare, asserting their needs, and advocating for others. We discuss the implications of this research for theory and praxis.

When Experiencing Inequitable Health Care Is a Patient's Norm, How Should Iatrogenic Harm Be Considered?

Inequitable care and outcomes experienced by persons with mental illness have long been exacerbated by stigma expressed by clinicians. This commentary discusses a case, considers physical and psychological dimensions of iatrogenic harm to patients for whom inequitable health care is the norm, and suggests how psychological iatrogenic harm can be recognized and addressed by clinicians.

Implications of systemic racism in emergency medical services: On prehospital bias and complicity.

Public health research has increasingly proven racial disparities within emergency medicine, as exemplified by the fallibility of pulse oximeters resulting in unreliable detection of respiratory compromise, to implicitly biased clinical perception of pain in Black and Brown patients.1 There is a lack of literature detailing the complicity of Emergency Medical Services (EMS) clinicians who sit among a nation with an inequitable healthcare system. In this piece, we aim to shed light on how disparities in prehospital emergency medical care harm patients of color.

Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process.

BackgroundExpanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws.MethodsWe conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL.ResultsParticipants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system.ConclusionsExperts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.

Understanding surgical disease and care for Māori in Aotearoa: protocol for a scoping review

IntroductionMāori continue to experience inequitable healthcare and health outcomes compared with other New Zealanders. A narrative review conducted in 2016 described disparities in access to and through the surgical care...

Staphylococcus lugdunensis Endocarditis: Lower Mortality in the Contemporary Era?

BackgroundStaphylococcus lugdunensis is a virulent coagulase-negative Staphylococcus that is a rare cause of infective endocarditis (IE) associated with high mortality. A linear growth of IE has occurred over the past several years in Saskatchewan, with overlapping epidemics of human immunodeficiency virus (HIV)/hepatitis C virus driven by injection drug use (IDU). We hypothesized that given the unique challenges faced by our population with IDU and inequitable healthcare access, our cases of S. lugdunensis IE might differ from those in the published literature. MethodsWe retrospectively reviewed the cases of S. lugdunensis endocarditis admitted at our tertiary care hospitals in Saskatoon over a 6-year period and analyzed their baseline characteristics, antimicrobial susceptibility data, management, and outcome data, where available, for each patient. ResultsOf the 24 blood cultures positive for S. lugdunensis, as identified by our laboratory, we verified 6 cases of definite IE, and 2 cases of probable IE, applying the modified Duke’s criteria. A total of 5 of 8 cases involved native valves, with only 1 infection of the bioprosthetic mitral valve, seen in patient with IDU. A total of 5 of 8 cases involved the left-sided valves, with 1 of 8 involving the tricuspid valve. Only 1 death was recorded. ConclusionsThe male predominance and primarily left-sided valve infection we noted in our review were similar to results in the published literature. We noted a lower rate of surgical intervention and mortality than previously observed, which merits further study. We did not find coinfection with HIV and/or hepatitis C virus as an epidemiologic risk factor, likely owing to the low rate of IDU in our study.

Health Technology Adoption in Liver Disease: Innovative Use of Data Science Solutions for Early Disease Detection.

Chronic liver disease (CLD) is an ignored epidemic. Premature mortality is considerable and in the United Kingdom (UK) liver disease is in the top three for inequitable healthcare alongside heart and respiratory disease. Fifty percentage of patients with CLD are first diagnosed with cirrhosis after an emergency presentation translating to poorer patient outcomes. Traditional models of care have been based in secondary care when the need is at community level. Investigating patients for disease based on their risk factors at a population level in the community will identify its presence early when there is potential reversibility. Innovation is needed in three broad areas to improve clinical care in this area: better access to diagnostics within the community, integrating diagnostics across primary and secondary care and utilizing digital healthcare to enhance patient care. In this article, we describe how the Integrated Diagnostics for Early Detection of Liver Disease (ID-LIVER) project, funded by UK Research and Innovation, is developing solutions in Greater Manchester to approach the issue of diagnosis of liver disease at a population level. The ambition is to build on innovative pathways previously established in Nottingham by bringing together NHS organizations, academic partners and commercial organizations. The motivation is to co-create and implement a commercial solution that integrates multimodal diagnostics via cutting edge data science to drive growth and disrupt the currently inadequate model. The ambitious vision is for this to be widely adopted for early diagnosis and stratification of liver disease at a population level within the NHS.

Language Interpreting in Undergraduate Medical Education: Developing a Framework for Educational Practice

Linguistic differences between patients and clinicians can result in ineffective and inequitable healthcare delivery. Medical students should therefore be facilitated to develop the requisite knowledge and skills to work effectively within language discordant clinical situations. This paper explores language interpreting processes in an undergraduate medical education programme. The study utilizes a constructivist paradigm incorporating an action research approach. Action Research Cycle 1 (ARC1) examines the use of interpreters during clinical examinations while Action Research Cycle 2 (ARC2) focuses on language translation technology. In Action Research Cycle 3 the data that was generated in ARC 1 and ARC 2 is reviewed in association with international literature to develop a framework for practice. This study demonstrates that language interpreting procedures should be based within a collaborative framework with students, interpreters and educators receiving appropriate educational preparation, predicated on a cross cultural approach to care.

COVID-19 Outcomes Among Racial and Ethnic Minority Individuals With Inflammatory Bowel Disease in the United States

The coronavirus disease 2019 (COVID-19) has affected more than 29 million people and led to more than 542,000 deaths in the United States.1 Older age, comorbidities, and racial and ethnic minority status are associated with severe COVID-19.2 Among patients with inflammatory bowel disease (IBD), racial and ethnic minorities have worse outcomes, mediated in part by inequitable health care access.3 Racial and ethnic minority patients with IBD and COVID-19 may be an especially vulnerable population. The purpose of this study was to evaluate racial and ethnic disparities in COVID-19 outcomes among IBD patients and the impact of non-IBD comorbidities on observed disparities.

Historically Black Schools of Medicine Radiology Residency Programs: Contributions and Lessons Learned

Black radiologists remain significantly underrepresented in the radiology workforce, despite a 1973 plea by Black radiologists of the National Medical Association to increase training programs for minority radiologists. The authors provide a qualitative narrative that highlights the radiology residency programs of three historically Black schools of medicine (HBSOM) in the U.S., their contributions, and lessons learned from their closure. Data from public repositories, interviews, and conversations were conflated to chronicle significant events and establish a timeline during these residency programs' existence. Radiology residencies at Howard University School of Medicine (1945), Meharry Medical College (1949), and Charles R. Drew University of Medicine and Science (1972) were established to train Black doctors to treat communities of color. These programs provided care to underserved and under-resourced areas of the country, where inequitable health care fueled a legacy of poor health outcomes. These radiology residency programs collapsed under the weight of suboptimal funding, strapped capital budgets, attrition of faculty, a declining hospital patient census, and failure to maintain other residency specialty programs.` CONCLUSION: Understanding the history and impact of these programs, and of their closure, can be leveraged to develop strategies to increase the representation of racial and ethnic minorities in radiology. Possible reinstatement, with appropriate allocation of resources and creation of intentional policies to ensure sustained success, merits further investigation and may be a pathway to achieve optimal representation.

Denied the right to comfort: Racial inequities in palliative care provision.

People who are racialized often exist in the margins of our health systems. Inequitable health care is experienced from the moment of birth and continues throughout life, extending into end of life and palliative care. This occurs even though the United Nations acknowledges palliative care as a human right [1], and the World Health Organization (WHO) mandates that all states provide it [2]. As we strive for health systems where all people are treated equitably, palliative care must be included. To begin, it is important to collate what is known, and then to chart a way forward.

Structural Racism and Barriers to Breastfeeding on Chicagoland's South Side.

For African American (AA) families on Chicagoland's South Side who choose to breastfeed, finding and receiving services needed to reach their goals are difficult. The disparities in breastfeeding support across Chicagoland are symptomatic of inequitable health care access shaped by persisting structural racism. A number of community hospitals that once served AA families by providing easy access to care no longer exist. Recently, South Side obstetric unit and hospital closures have increased. Simultaneously, funding is increasingly competitive for community health organizations and federally qualified health centers. Institutions and agencies that do receive funding or adequately allocate funding to include lactation services cannot address breastfeeding barriers within socioeconomically marginalized communities. The unmet funding needs not only affect breastfeeding families but also impede the growth of a multilevel lactation care workforce. Finally, inconsistencies persist between breastfeeding information provided by lactation providers and delivery team care received in the hospital. Despite these barriers, we believe pathways exist to improve breastfeeding rates among South Side AA communities, such as perinatal home visiting services. Stakeholders must recognize the longstanding effects of structural racism and address the inequitable distribution of perinatal care across Chicagoland. Stakeholders must also place value in and be supportive of lactation care providers and the families they serve through both funding and policies. These changes, in addition to community-level collaboration, can improve breastfeeding rates for AA families on Chicagoland's South Side.

Economic Motives and Problems of Health Tourism in Asia Pacific

Abstract Nowadays, health tourism has emerged as a multi-billion-dollar industry due to the fact that people have frequently traveled in order to improve their wellbeing. The internationalization of health tourism has also motivated production and consumption of healthcare services as well as increased variety of intermediaries and ancillary goods and services to support this sector. Although the significant benefits of health tourism, its actual contribution to economic growth and related issues have remained ambiguous. Therefore, this paper aims to: (i) Discuss the potential economic aspects of health tourism based on the published figures of major destinations in Asia Pacific with an international focus and (ii) Examine the economic risks related to health tourism that either directly or indirectly harm the process of economic growth. The results indicate that development of health tourism satisfies patients’ demand for high quality healthcare at competitive prices, boosts the value of foreign exchange inflow and expands job opportunities. Health tourism services have become the subject of international earnings which has elevated economic opportunities of potential destinations. Besides that, increasing international health tourist flows with high income could evaluate costs of healthcare services, brain drain of healthcare professionals, inequitable health care access. Additionally, increases in international traveling might produce a new economic burden of communicable diseases, environmental degradation; brokers and organ transplants associated with black-market in some destinations. Hence, sustainability and responsibility have been considered as key criteria in the health tourism industry in order to improve tourists’ health performance and maximize benefits for local communities. Such economic analysis also enables us to evaluate benefits and losses from health tourism development and track the balance of trade around this economic sector.

COVID‐19 and the Marshallese

<scp>COVID</scp>‐19 and the Marshallese

Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting

Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This studysought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.

Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families.

* Abbreviations: CIF — : children in immigrant families COVID-19 — : coronavirus disease DACA — : Deferred Action for Childhood Arrivals ICE — : Immigration and Customs Enforcement LEP — : limited English proficiency SDH — : social determinant of health TPS — : temporary protected status WIC — : Women, Infants, and Children Program Like many health conditions that disproportionately impact vulnerable populations of color, we expect that the coronavirus disease (COVID-19) pandemic will inequitably affect the health and livelihoods of immigrant families. One in 4 children (>18 million) in the United States lives in an immigrant family, in which the child or ≥1 parent was born outside the United States.1 Among children in immigrant families (CIF), >7 million live in “mixed-status” families, meaning ≥1 parent is not a US citizen.2 Before the COVID-19 pandemic, immigrant families faced increasingly restrictive policies and discrimination. Regardless of legal status, CIF experience increased health and social risks compared with peers in nonimmigrant families, including lower rates of health insurance coverage and higher poverty levels.3 The COVID-19 pandemic amplifies existing inequities and introduces new ones as immigrant families navigate school closures, lack of health insurance and paid leave, and decisions to seek medical care or public services amid ongoing immigration enforcement. Additionally, immigrant families are more likely to live in multigenerational households,4 heightening the risk of COVID-19 for multiple family members. Families with limited English proficiency (LEP) must decipher rapidly evolving public health directives, such as “shelter-in-place” orders and recommendations for mask-wearing, without multilingual and culturally relevant messaging. Underlying these challenges is the implicit presumption of a safe place in shelter-in-place and social distancing directives. For immigrant families seeking safe haven in the United States, “place” may include violence and abject poverty, both in home countries and at the US border. For CIF in US communities coping with persistent fears of immigration enforcement and family separation, … Address correspondence to Rushina Cholera, Duke University School of Medicine, 200 Morris St, 3rd Floor, Durham, NC 27701. E-mail: rushina.cholera{at}duke.edu

Tuberculosis among First Nations, Inuit and Métis children and youth in Canada: Beyond medical management.

First Nations, Inuit and Métis people in Canada continue to be disproportionately affected by tuberculosis (TB), a disparity rooted primarily in factors such as poverty, crowded and inadequate housing, food insecurity, and inequitable health care access. Historical TB control practices in Canada have contributed to stigma and discrimination toward those with the disease, as well as fear and mistrust of the health system. These individual and system-level factors result in delays in TB diagnoses, ongoing transmission, poorer outcomes, and lower treatment completion rates. Children are especially vulnerable, as they are more likely to develop disease once infected with TB bacteria and to experience life-threatening conditions such as TB meningitis. Paediatric health professionals can help to increase TB awareness and literacy, reduce stigma and discrimination, and ultimately, improve the quality and uptake of services for treatment and prevention in families and communities at risk. They can also advocate for sustainable, community-driven TB elimination strategies that incorporate First Nations, Inuit and Métis principles of wellness, healing and self-determination.