Resolution: F-20-15: UPHOLDING H409-A/16 AND QUARTERLY REPORTING ON H433-A/15

[Valerie Lile]

1  WHEREAS, medical racism is defined as prejudice and discrimination in the healthcare system
2  due to race¹ resulting in pervasive racial health disparities that harm Black, Indigenous, and
3  People of Color (BIPOC) in medical practices;² for instance presently receive lower quality of
4  healthcare even when controlling for income and insurance status, patient preferences/needs,
5  clinical appropriateness, and treatment options^1,3,4; and
6  WHEREAS, implicit bias refers to the attitudes or stereotypes that affect our understanding,
7  actions, and decisions in an unconscious manner; has been shown to contribute to BIPOC-
8  related health disparities; and can be improved with specific anti-racism training⁵; and
9  WHEREAS, anti-racism educational interventions are effective in changing attitudes about
10  racism and health inequities among health clinicians^6,7,8,8. Institutions recognize the need for
11  increased diversity, implementation of anti-racist medical curricula, and the allocation of faculty
12  training resources for effective curriculum delivery^10,11,12; and
13  WHEREAS, Black patients were less likely to trust their physicians ¹³ and to receive lipid-
14  lowering medication (9% less), the recommended intensity of statin therapy (10.6% less)8,
15  antiplatelet therapy other than aspirin (24% less), angiogram (29% less), and bypass surgery or
16  angioplasty (45% less)¹⁴ as compared to white patients; and
17  WHEREAS, Black patients are disproportionately transferred to lower‐quality hospitals [when
18  suffering from acute myocardial infarction], are more likely to be served by facilities with less
19  capacity to perform needed interventions (even when in closer proximity to high-quality
20  hospitals), and have a 1.52x greater odds (P = 0.01) of mortality as compared to White patients
21  even when considered low surgical risk. These physician decisions are a manifestation of their
22  implicit bias, which research has shown can be mitigated through anti-racism training^6,7,8,9,15; and
23  WHEREAS, physicians of all ethnic groups showed an implicit preference for white people
24  (even when explicit bias was denied) except for Black physicians who did not show any racial
25  preference and have better outcomes when treating black patients. Physicians with higher pro-
26  white bias have worse perceptions of their Black patients, deliver lower quality care, and make
27  medical decisions that adversely affect Black patients^17,16,17,18; and
28  WHEREAS, Black men have been shown to have better health outcomes when treated by a
29  physician of their own race, thereby underscoring the importance of educating a diverse cohort
30  of future physicians to serve marginalized and underrepresented communities;¹⁴ and
31  WHEREAS, the AOA policy H406-A/19 states a zero-tolerance policy on discrimination in
32  healthcare¹⁹; now, therefore be it
33  RESOLVED, that the American Osteopathic Association upholds policies H406-A/19
34  DISCRIMINATION IN HEALTHCARE, H409-A/16 MINORITY HEALTH AND
35  OSTEOPATHIC MEDICAL EDUCATION, and the position statement in H433-A/15
1  MINORITY HEALTH DISPARITIES through quarterly reported updates to SOMA on specific
2  actionable items the AOA has completed.

Explanatory Statement:

These are the nine actionable items that are listed at the end of policy H433-A/15 Minority Health Disparities that we are requesting to have the quarterly reports between the CEO of AOA and SOMA which can then be distributed to the osteopathic student body.

The American Osteopathic Association calls for the following actions to be taken to address minority health disparities and to improve cultural competency of its physician members:

1. The creation of a forum to increase physician knowledge on racial and ethnic healthcare needs, including disparities in the areas listed above;
2. The elimination of provider stereotypical beliefs that may play a role in clinical decision- making;
3. The evaluation and analysis of medical information which would permit the targeting of populations who are at greatest risk;
4. The identification of new methods to involve physician members in the communities in which they serve;
5. The identification and integration of available resources to better serve minority communities, including houses of worship, schools and local government;
6. The inclusion of cultural competency training throughout the continuum of osteopathic education;
7. The development of strategies to actively recruit underrepresented minority physicians into the profession in both primary care and subspecialties;
8. The development of approaches to encourage all physicians to provide care to underserved minority populations;
9. The adoption of strategies to assist physicians to effectively communicate with their patients, addressing translation and other barriers to patient understanding

Relevant Existing Policies:

AOA policy: H406-A/19, H409-A/16, H433-A/15

References

1. Encyclopedia of Race and Racism. Encyclopedia.com. 11 Aug. 2020 . Encyclopedia.com. https://encyclopedia.com/social-sciences/encyclopedias-almanacs-transcripts-and-maps/medical-racism. Published September 12, 2020. Accessed September 12, 2020.
2. Samantha Artiga Follow @SArtiga2 on Twitter KOF@_KOon T. Disparities in Health and Health Care: Five Key Questions and Answers. KFF. https://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/. Published April 1, 2020. Accessed September 12, 2020.
3. Bach PB. Book Review Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Edited by Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson. 764 pp. Washington, D.C., National Academies Press, 2003. $79.95. 0-309-08532-2. New England Journal of Medicine. 2003;349(13):1296-1297. doi:10.1056/nejm200309253491321

4. Hobbs J. White Privilege in Health Care: Following Recognition With Action. Annals of Family Medicine. https://annfammed.org/content/16/3/197. Published May 1, 2018. Accessed September 12, 2020.
5. Devine, P. G., et al. (2012). “Long-term reduction in implicit race bias: A prejudice habit- breaking intervention.” J Exp Soc Psychol 48(6): 1267-1278.
6. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Introduction and Literature Review. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. https://www.ncbi.nlm.nih.gov/books/NBK220344/. Published January 1, 1970. Accessed September 13,
7. Geiger HJ, Others MEGand. Race and Health Care – An American Dilemma?: NEJM. New England Journal of Medicine. https://www.nejm.org/doi/pdf/10.1056/NEJM199609123351110. Published September 12, 1996. Accessed September 13,
8. Black patients less likely to receive statins. Healio. https://www.heacom/news/cardiology/20180613/black-patients-less-likely-to-receive-statins. Accessed September 13, 2020.
9. White-Davis T;Edgoose J;Brown Speights JS;Fraser K;Ring JM;Guh J;Saba GW; Addressing Racism in Medical Education An Interactive Training Module. Family medicine. https://pubmed.ncbi.nlm.nih.gov/29762795/?from_term=educational interventions that reduce racism among health providers&from_pos=1. Accessed September 13,
10. JohnsonMD A, Johnson A, Amber Johnson University of Pittsburgh School of Medicine, Johnson Cto: A, Popescu I. Understanding Why Black Patients Have Worse Coronary Heart Disease Outcomes: Does the Answer Lie in Knowing Where Patients Seek Care? Journal of the American Heart Association. https://www.ahajournals.org/doi/full/10.1161/JAHA.119.014706. Published November 30, 2019. Accessed September 13,
11. Acosta is associate vice chancellor. Breaking the Silence: Time to Talk About Race and Racism : Academic Medicine. LWW. https://journals.lww.com/academicmedicine/Fulltext/2017/03000/Breaking_the_Silence__Time_to_Talk_About_Race_and.15.aspx. Accessed September 13, 2020.

12. Smith WR, University FVC, Betancourt JR, et al. Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care. Annals of Internal Medicine. https://www.acorg/doi/10.7326/0003-4819-147-9-200711060-00010. Accessed September 13, 2020.
13. Armstrong, K., et al. (2007). “Racial/ethnic differences in physician distrust in the United States.” Am J Public Health 97(7): 1283-1289.
14. Differences remain in heart attack treatments for black patients. heart.org. https://www.heart.org/en/news/2018/09/20/differences-remain-in-heart-attack-treatments-for-black-patients. Accessed September 13, 2020.
15. Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial Disparities in Outcomes After Cardiac Surgery: the Role of Hospital Quality. Current Cardiology Reports. 2015;17(5). doi:10.1007/s11886-015-0587-7
16. Chapman EN, Kaatz A, Carnes M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. Journal of General Internal 2013;28(11):1504-1510. doi:10.1007/s11606-013-2441-1
17. Understanding and Addressing Racial Disparities in Health Care. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/00summerpg75.pdf. Accessed September 13, 2020.
18. Torres N. Research: Having a Black Doctor Led Black Men to Receive More-Effective Care. Harvard Business Review. https://hbr.org/2018/08/research-having-a-black-doctor-led-black-men-to-receive-more-effective-care. Published August 10, 2018. Accessed September 13, 2020
19. American Osteopathic Association. (2019). AOA Policy Compendium [PDF file]. Retrieved from https://osteopathic.org/wp-content/uploads/2019-Policy-Compendium.pdf

Submitted by:

Azaria Lewis, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Toni Davis, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Mary Unanyan, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Chardonnay Ward, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Christelle Salomon, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Suria Markus, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Emerald Chiang, OMSII, WesternU College of Osteopathic Medicine of the Pacific
Edie Waskel, OMSIV, WesternU College of Osteopathic Medicine of the Pacific
Gilbert Hernandez, OMSIII, WesternU College of Osteopathic Medicine of the Pacific
Brian Diep, OMSIII, WesternU College of Osteopathic Medicine of the Pacific

 Action Taken:
Date:
Effective Time Period: Ongoing

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