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Tackling racial health care disparities is both a matter of justice and of Cuyahoga County’s future

Posted November 13, 2019 in Articles

Author: Editorial Board, & The Plain Dealer

There may be no more toxic topic than race. But when it comes to the shockingly disparate health outcomes in Cuyahoga County between black and white babies, having that conversation has become essential.

Discussing racial health disparities is by nature a difficult discussion -- even moreso since evidence is mounting that historically rooted biases and stressors might be at its root. That encompasses ingrained prejudices many white people may be unaware of, and toxic stressors among people of color after generations of discrimination.

The evidence for this equation of deeply rooted bias and stress is not definitive, but it goes beyond anecdotal evidence, like the dismissive treatment tennis star Serena Williams received when complications first surfaced in the delivery of her first child.

Exhibit One in Cuyahoga County is the stubbornly high black infant mortality rate.

In December 2015, the county, the city of Cleveland and major local hospitals launched First Year Cleveland, an all-hands-on-deck effort to reduce infant mortality via unprecedented investments and commitment of staff. It’s succeeded spectacularly in reducing white infant mortality and in cutting overall infant mortality -- down 20 percent in three years.

But black babies continue to die at disproportionate rates -- nearly four times more often than white babies. That racial disparity touches African-American infants from well-off households as well as poor ones.

It goes beyond that, however. Whites live longer than blacks, who suffer disproportionately from chronic conditions and illnesses, including diabetes, obesity, asthma and HIV/AIDS, and who are more likely to be exposed to lead-paint poisoning in substandard housing and to suffer from poorer nutrition.

Housing segregation helps drive some of this, as well as transportation inequities; the metro Cleveland area is one of most segregated metro areas in the country, according to the Center for Community Solutions, which points to patterns of investment -- and disinvestment.

But could racial health care disparities also play a role? First Year Cleveland research along with other recent findings suggest it does.

Questionnaires distributed to Cuyahoga County mothers about their treatment in the health care system uncovered a sharp difference along racial lines in how these mothers perceived they were treated, listened to, and helped to overcome pain and other maternal health issues.

The study didn’t correlate that with birth outcomes, but it’s suggestive, and has prompted participating health care systems to initiate efforts to train both caregivers and administrators in implicit bias.

Bernadette Kerrigan, who heads First Year Cleveland and who is the white mother of adopted children of color, told our editorial board she was shocked to discover through her own anti-bias training that she had her own unrecognized biases.

Patient access is hard for most every demographic, but is especially so for women (and women of color). Even as access improves, patients need to know how to maximize the time they get with their providers.

But beyond that, recent studies point to some of the factors that can contribute to unintentional -- and previously unrecognized -- racial bias in health care.

On Oct. 24, WIRED magazine reported on a study published in Science magazine the next day that found racial bias in a widely used software program that determines who gets into programs to help the highest-risk patients manage their conditions. Black patients were being excluded even when they were at greater risk than admitted white patients. The reason? Algorithms included health care costs as a measure of who was likely to benefit most from the programs -- and those algorithms discriminated against blacks.

“Because of the structural inequalities in our health care system, blacks at a given level of health end up generating lower costs than whites,” said Ziad Obermeyer, acting associate professor of health policy and management at the University of California at Berkeley and lead author of the paper, as quoted in a news release from UC Berkeley. reported this week on a study in the Journal of the American Heart Association in which University of Arizona researchers found that 422 medical decision-makers -- when asked to decide who would get a heart transplant -- were unconsciously biased against black patients in the hypothetical cases presented to them. They “perceived black patients as less healthy than whites, less likely to comply with follow-up care recommendations and less trustworthy,” according to a news release.

This doesn’t mean that medical caregivers are monsters who try to bias the system. Quite the reverse.

In these studies, no one was aware of any bias until the assumptions behind equations in the software or the human decision-making were unpacked.

First Year Cleveland is working on 11 different approaches to help keep more black, white and brown babies alive in this county. All these efforts matter.

But in Cuyahoga County if we want to save lives and create a more just and inclusive future, we also can’t close our eyes to the clear racial disparities in health outcomes -- and do our utmost to correct them.

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