October 24, 2008

Speaker examines health care’s persistent disparities

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Neil Powe, M.D., at last week’s Discovery Lecture. (photo by Susan Urmy)

Speaker examines health care’s persistent disparities

“To be a poor man is hard, but to be a poor race in a land of dollars is the very bottom of hardships.”

This quote by W. E. B. DuBois presciently highlighted the issue of health disparities — both racial and socioeconomic — long before the study of such disparities became common, noted last week's Discovery Lecture speaker, Neil Powe, M.D., M.P.H., M.B.A.

In his talk, Powe, the University Distinguished Service Professor of Medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins University School of Medicine, detailed some of the recent research on the types and sources of health disparities and suggested strategies to enhance equality in health outcomes across groups.

“Health care disparities are pervasive,” Powe said. Disparities exist across different conditions, across different populations, in different settings (primary care versus hospital care versus specialty care), and across different levels and types of care (preventive, acute care, chronic disease management).

For the past two decades, researchers have been trying to understand the barriers, the mediators and the outcomes of care, he said. “We all seem to try to search for a common mechanism, a common pathway that leads to these disparities.”

Using examples from his own field of kidney disease research, Powe pointed out that biological factors may account for some fraction of health disparities. But “there's a myriad of reasons why health care disparities exist,” he said. Major drivers of these disparities include socioeconomic factors, psychosocial factors (stress), cultural factors, behavioral and lifestyle factors, and access to health care, he explained.

The knowledge gained has led to some improvements and a reduction in some equality gaps, but Powe noted that “progress has been slow in coming because we have not held ourselves, and others, accountable for better results.”

“It is time to get serious about equitable health care for all of us.”

Powe is also the deputy director of the Institute for Clinical and Translational Research at Johns Hopkins School of Medicine and a member of the Institute of Medicine.

For a complete schedule of the Discovery Lecture Series and archived video of previous lectures, go to www.mc.vanderbilt.edu/discoveryseries.