The need for equity-oriented health care to save the health of Americans, especially in chiropractic

• Updated on: 2024-08-09
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Research has found that when patients have a health care provider of the same race or ethnicity, they are more likely to visit that provider for preventative care, new health issues, and ongoing medical problems. This research affirms that providing more equity-oriented health care is the key to serving larger populations, especially those who avoid health care due to comfort or confidence issues in providers.

A recent survey conducted by the Urban Institute and supported by the Robert Wood Johnson Foundation indicates that people of color have less access to a same race/ethnicity provider, potentially harming their access to equitable care.

According to the survey released in March 2022, 73.8% of White adults have a usual health care provider of the same race while only 22.2% of Black adults could say the same. Additionally, 29.2% of Hispanic or Latinx patients reported that their provider had the same ethnicity and 23.7% said that their provider had the same race and ethnicity.

The Urban Institute adds that almost one in three survey respondents did not have a usual health care provider at all, suggesting that this number is a result of lower access to affordable health care coverage through the patient’s employer, insurance eligibility restrictions, immigration concerns, and a lack of access to a provider who speaks the patient’s primary language.

A paper published in The Milbank Journal, a multidisciplinary journal of population health and health policy, titled “How Equity‐Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy,” summarized in its policy points, “This study empirically demonstrates that providing more equity‐oriented health care (EOHC) in primary health care … predicts improved health outcomes across time for people living in marginalizing conditions. This is achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems.”

The 2022 survey also found that only 23.1% of Hispanic or Latinx patients had the same race and ethnicity as their provider and that the provider spoke to them in their preferred language. Previous studies have noted that language differences can create several barriers in health care.

For example, a 2021 study published in Academic Pediatrics indicates that for Spanish-speaking patients specifically, a lack of bilingual health care personnel and heavy reliance on interpreters are among the barriers this demographic faces, along with long wait times and challenges when communicating via phone. In the study, Spanish-speaking caregivers noted that access to interpreters, bilingual health care staff, and Spanish health care materials all helped facilitate care.

Chiropractic Economics’ 2021 survey reveals that the lack of diversity in the health care workforce extends into the chiropractic profession. When DCs were asked whether they owned or worked for a minority-owned practice, only a little more than 15% said yes. While this may have been representative of the population long ago, it’s not conducive to where we are headed as a nation.

A 2012 study in The Journal of Chiropractic Education shared that while the 2010 census found that the 72.4% of the U.S. population was White and the remaining 27.6% of the population was Black, Hispanic, Asian, and Native American, by 2050, these percentages were going to “change drastically” and minorities would be the majority within the United States.

The question these researchers posed was whether chiropractic was ready for this change, to which they answered no. They further noted that awareness of the lack of diversity was the first step to moving forward and creating “a more diverse and culturally competent chiropractic workforce.”

A 2021 survey conducted by the Institute for Healthcare Improvement shares that 58% of health care professionals have made equity-oriented health care one of their top three priorities. Some of the ways they are striving to improve this equity are through incorporating efforts into their strategic plan, developing community partnerships, and creating a more equitable hiring and promotion process.

Fifty-five percent of the survey respondents added that they are actively taking action to advance health equity, such as by capturing patient data related to equitable health care. This includes asking patients about their race, ethnicity, ancestry, language, sexual orientation, and gender identity.

Thirty-seven percent of the respondents felt that their efforts were either effective, very effective, or extremely effective at eliminating the inequities that exist.

In a March 2021 article published in JAMA Network Open, authors state that, while the health care workforce does appear to be becoming more diverse, “additional policies are needed to further strengthen and support a workforce that is more representative of the population.”

Data transparency is critical, say the authors, as is addressing barriers to workforce diversity, such as those related to financial support, access to mentors and role models, and educational environments that are unreceptive to this change.

Designing programs that support diversity at the university level and in the workplace is a critically-recommended step toward equity-oriented health care, making it easier for people of all races and ethnicities to enter the health care workforce.