Trust, Education Are Best Medicine for Health Disparities

Millions of people gained healthcare coverage for the first time under the Affordable Care Act. That’s a step forward in efforts to reduce healthcare disparities, but people of color still face other significant barriers that are important for clinicians to recognize.

“We know that there are variables beyond that lack of access,” says Charles Modlin, MD, a urologist who leads the Minority Men’s Health Center at Cleveland Clinic.

These include:

• Lack of health literacy: Many patients need more information about ways to improve and maintain their health, such as preventive screenings for conditions like prostate and colon cancer, Dr. Modlin says.
• Lack of trust in the system: Many minority patients mistrust the healthcare system because of past experiences ranging from unpleasant to horrific, such as the infamous Tuskegee syphilis experiment of the mid-20th century. People of color are often fearful of participating in clinical trials despite their benefits, Dr. Modlin says, and doctors need to do more to encourage them.
• Cultural competency of providers: A breakdown or lack of clear communication between doctors and minority patients can result in patient noncompliance, Dr. Modlin says. However, communication problems go both ways: “Providers may feel that patients are not listening to them,” he says.
• Knowledge about hereditary predispositions: Conditions like hypertension, heart disease, diabetes and some cancers have hereditary components, so sometimes people need more information about their family histories.
• Social determinants: Environmental factors, ranging from dangerous workplaces to limited access to stores that sell a good selection of fresh produce, can play a big part in the health of minority patients.
• Workplace diversity: Only 4 percent of physicians nationally are African Americans, Dr. Modlin says. “Historically, those are the physicians who go back and treat those communities,” he says.

To push back against those historical trends and close the healthcare gap requires a dedicated, multifaceted effort, Dr. Modlin says. He points to the Minority Men’s Health Center, established in 2003 at Cleveland Clinic, as an engine of change. “We try to eliminate the barriers based on all those factors,” he says.

As part of those efforts, the health center conducts research projects. The Prostate Cancer Foundation recently funded a $600,000 Special Challenge Award which allows the investigators at Cleveland Clinic to examine biological differences in how prostate cancer behaves in Caucasian and African-American men.

The center has built a biobank of tumors and benign biopsies and is exploring an “early hypothesis about the differences in how biologic pathways are turned on and off between the two groups,” says Eric Klein, MD, Chairman of the Glickman Urological and Kidney Institute at Cleveland Clinic.

Specifically, the two-year, multidisciplinary and multi-institutional grant will help the researchers explore whether a natural substance called interferon, which helps the body fight off cancerous growths, might function more effectively in Caucasian men, Dr. Klein says. “Ultimately we may come up with some treatment options that will change things” in terms of health disparities in that area, he says.

The health center holds health talks in the community to promote health literacy and provides free health screenings and research trials. A mentoring program helps young people in minority populations and encourages them to enter the health profession. Another program educates other physicians about minority health disparities. The center also holds an annual Minority Men’s Health Fair. “We’re hitting this on all levels,” Dr. Modlin says.

Above all, the center has learned that combating health disparities requires persistence. “It takes time to engage, especially in the African-American and other minority populations,” Dr. Modlin says. “It takes dedicated initiatives … where you can focus a great deal of your resources, your brainpower and knowledge and expertise on the elimination of health disparities. It takes policymakers to get involved and establish policies to facilitate a lot of these objectives.”