WORCESTER MEDICINE
JEDI or Die Limitation of Opportunities for a Black Physician in Massachusetts Continued I finally accepted a hybrid position in a practice on the South Shore in 1992, which allowed me to spend one day a week teaching at Beth Israel Deaconess Medical Center for 15 years. I also spent a few years at Boston University Hospital on a per-diem basis. I switched practices in 1994 and was recruited to join two Irish cardiologists at South Shore Hospital. Brigham sent cardiac fellows to South Shore Hospital for a few years and, during that time, our exposure to the fellows allowed us to recruit a diverse group of highly talented young physicians from Brigham, Beth Israel and Boston Medical Center. We became a diverse practice with eight cardiologists with a racially, ethnically and gender-diverse perspective. During that time, spanning 25 years, I became acquainted with Dr. Alice Coombs who was very involved in health care disparities at the National Medical Association, American Medical Association and the Massachusetts Medical Society. She got me involved in organized medicine with a focus on health care disparities. Ultimately, she became the first Black physician to serve as president of the MMS. She recruited me, and others, from South Shore Hospital to the MMS. Although I had not intended to, I literally followed in her footsteps also serving as MMS president and became involved in the MMS and AMA’s Commission to End Health Care Disparities and other state-based initiatives. In 2013, we collaborated on a statewide study of patient access to physicians for Massachusetts Medicaid patients which showed marked access problems in communities with large Medicaid underserved populations. The Medicaid population size in a given area is driven by the wealth and income gap related to race between white and black individuals in Massachusetts. The MMS gave us a platform to pursue disparities and other issues involved with the role of physicians in governance in medicine. Unfortunately, those disparities have been magnified and increased during the COVID-19 pandemic. + Ronald W. Dunlap, MD, FACC Past President, MMS MA Health Policy Commission Advisory Council Past chair and advisor to MMS Committee on Diversity Board Advisor for DEI at Coverys Companies AMA Minority Affairs Section New England Medical Association, NMA Instructor in Medicine, Harvard Medical School
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Diversity, Equity and Inclusion in Health Care: The Time for Action Has Come Mark D. Johnson, MD, PhD, Marlina Duncan, EdD, Milagros C. Rosal, PhD, MS, Brian Gibbs, PhD shown clockwise
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isparities in disease prevalence, treatment and outcomes in the United States are widespread and disproportionately have adverse effects on certain racial and ethnic groups. Indeed, the Centers for Disease Control has amply documented that Latino, Black and Indigenous populations have been disproportionately affected by COVID-19 in the U.S., bringing the existing health disparities in these groups into the spotlight once again. The places where people live, work, learn and play affect the rates of COVID-19 infection, severe illness and death. The COVID-19 pandemic has clearly demonstrated how social factors such as race, ethnicity, education level, income, neighborhood, access to health care, physical environment, occupation and others shape the landscape of disease risk, health care delivery and patient outcome. Additionally, pre-existing disparities in the prevalence of medical conditions – e.g., obesity, diabetes, cardiopulmonary disease, renal disease and others – which correlated with worse outcomes among patients with Sars-CoV-2 infection, also have contributed to the greater burden of severe COVID-19 illness and death borne by some racial and ethnic communities. The observation that COVID-19 vaccination rates for Hispanic/Latino and Black populations have lagged far behind those for white individuals reinforces the notion that many of the health inequities that we see derive from societal policies, practices and institutions that perpetuate them, and are not solely the result of intrinsic biological differences among these groups. The interplay between all of these factors and the powerful impact that they have on the health of our communities are undeniable . Many health inequities mirror inequities in other areas of our society that are the result of decades of widespread, institutionalized and harmful discriminatory practices. Those of us in the medical profession must embrace the professional and moral imperative to correct the numerous health disparities that we see among different patient populations. The importance of doing so is underscored by the rapidly growing diversity in our society. Indeed, a recent analysis of 2019 U.S. Census Bureau data by William Frey of the Brookings Institution shows that our nation is diversifying faster than predicted. (https://www.brookings.edu/research/new-census-data-shows-the-nation-is-diversifyingeven-faster-than-predicted/). For the first time in history, the white population in the U.S. declined during the 2010-2020 decade, largely because the number of deaths among white individuals exceeded the number of births and because white immigration to the U.S. did not
MAY / JUNE 2021
