It was a simple example that triggered this article. One provided by a contributing author to our platform. She is an Asian-American, of Korean origin, to be more specific and she is a healthcare provider. Her article was about her struggle to find a therapist for herself and her family. Like so many other healthcare workers, she is feeling the mental strain of a life lived in close quarters, under a restrictive pandemic.
It is increasingly difficult, if not bordering on impossible, in today’s America to find decent mental health care. Therapists are in short supply and spoilt for choice. They can cherry-pick patients from the long waiting lists of people requiring their help and insurers are reticent to pay for care.
In my colleague’s case, she had the added burden of wanting to find a Korean-speaking therapist who would not only be able to speak her native tongue but more importantly, would understand the dynamic of an Asian family.
She turned to the Employee Assistance Program (EAP) offered by her employer to try and secure the services of a therapist. Although she has now established contact with one, the process was onerous, time-consuming and a far cry from ideal.
The therapist she found isn’t Asian and doesnt speak Korean — according to the American Psychology Association, only 5% of psychologists in America are Asian. He also isn’t covered by her insurer but she is left with no other choice and has decided to commit.
Not everyone does. Providing family therapy is a complex process and it requires a clear understanding of the interpersonal dynamics at play. Asian families differ from Mexican families in the same way that White American families differ from African-American families or European families. It’s a cultural thing.
To provide effective treatment the therapist has to be intimately versed in the family’s culture and traditions. Jewish people look for Jewish therapists, Irish Americans look for therapists with Irish backgrounds, and so on. This raises the question, what happens when you are presented with a system like her EAP that doesn’t have the flexibility to address these elements? The answer is simple.
You are provided sub-standard levels of care or at worst, no care at all as the recommendations are not suited to the patient. This is a system that works partially, but that is built to enforce racial and cultural biases, not intentionally, but consequentially. Before you go off on the racial bandwagon, it is very doubtful that the creators of this system purposely designed it this way.
It merely suffers from a poor or inadequate design that is further restricted by an inability to evolve or adapt to the fluid landscape it inhabits.
The issue here, in terms of the systems we deploy in healthcare, is primarily a discriminatory one, based on cultural ignorance or a conscious decision to focus on the predominantly white American patient model for developing solutions.
This raises another question. Which other systems do we currently use that have been developed using white middle-class American patients as a baseline? Which products are currently being developed that will further enforce this systemic bias? New technology-based solutions that promote cultural disparities in healthcare and reduce access to care?
I can assure you these are in development as we speak, with most developers blithely unaware of the consequences of their chosen data set or model.
The Rainbow Society of Modern Day America
America is a melting pot of cultures, colors, and religions. A human stew, each ingredient having contributed to the growth of the country and each one as deserving of proper medical care as the other. To ignore this is to ignore the very fabric of what once made America great. Diversity is a strength, shared under one flag. That’s the theory.
In practice, things look bleak. Racism and cultural discrimination permeate American healthcare, in much the same way they permeate American society. Healthcare is, arguably, simply an extension of the society it serves, so this shouldn’t come as a surprise to anyone.
Don’t take my word for it, speak to someone of color if you’re white, or read one of the many excellent articles on the topic from people that experience health disparities first hand. This week, Asian-Americans experienced the brunt of this evil, next week the Hispanic community may be up.
This ugly undercurrent flows continuously through modern-day America, thinly disguised beneath an increasingly tenuous veneer of civility. I dislike the term “racism”, but for the purposes of this article, it will suffice and I raise this point for one simple reason.
If we have inherent racism and bias being exhibited by providers, unintentional or otherwise,, and we then add the burden of racially or culturally biased systems to the equation, what chance do these groups stand of accessing fair and equitable care?
Systems and people are not the same things. Systems are easily fixed if the desire and motivation exist. We can easily begin assessing software and digital health solutions for inbuilt biases that may inadvertently discriminate against certain communities. We can examine entrenched systems and develop guidelines for new systems.
Well-built, robust systems are designed to evolve and expand beyond their original parameters. Staid, old, and inflexible solutions will simply fall by the wayside. For instance, simply broadening the societal scope under which products are developed to account for cultural differences would directly and immediately benefit patient outcomes.
It’s a complicated world, where solutions cannot be everything to everyone. Issues around race and culture have to be considered alongside age, sex, and other complex criteria that affect our ability to deliver care. Where patient-facing technology is deployed, inclusivity must be maximized and where certain demographics are left incapable of accessing these solutions, alternatives must be provided.
We no longer have the excuse of ignorance on our side. Healthcare is aware of its failings and it is aware of the steps needed to address these issues. The problem, as I see it, is that this is not the only ill that hangs over American Healthcare. Other issues, equally pressing and equally as important to the delivery of effective care, also need to be addressed.
It is a question of priorities, of repairing other systems that are not fit for purpose. Where the issues of addressing cultural and racial disparities fit into the jigsaw puzzle of an industry barely holding together under the stresses of a pandemic and logistical demands, remains to be seen.
But address them we must. The mechanisms I refer to can and do result in death. Take the simple, but terrible example of mortality rates among black American women in childbirth. Racism and discrimination have no place in our house, and it’s time to draw a line and rid the industry of biases.
Perhaps the most important thing we can do for future generations of patients is to screen healthcare students for racial bias. A purge, forced on us by our current inability to respond to the underrepresented voices clamoring for care and basic dignity.