Health Equity: Panel Discussion

Cheri C. Wilson, MA, MHS, CPHQ

2017 DC, MD & NJ Healthy Start Regional Meeting

August 3, 2017

Session Objectives

1. Learn about community‐based strategies and actions that were successful in addressing health equity

2. Discuss innovations being implemented to address health equity

3. Relay example and lessons from community‐level efforts to address health equity, especially related to Healthy Start

The Patient The Birth Outcome

32 year old AA woman Attended a preconception

appointment Started taking prenatal

vitamins before pregnancy Sought prenatal care as soon as

discovered pregnant (~6 weeks) – 1st pregnancy

Received care from a CNM Completed prenatal yoga,

childbirth, breastfeeding, and hypnobirthing classes

Unmedicated vaginal birth at a hospital assisted by the CNM, a doula, and the woman’s spouse

Baby girl 37.5 weeks 5 lbs. 11 oz.

Initiated breastfeeding soon after birth

Case Study

Why?

Our Usual Focus

Preterm birth Low birthweight Infant mortality Maternal mortality Breastfeeding Contraception planning

Video Clip:

Unnatural Causes: Episode 2 - When the Bough Breaks

How Racism Impacts Pregnancy Outcomes

https://www.youtube.com/watch?v=xUUJIG0-SlA

A Troubled History with the Medical Profession

Illustration of Dr. J. Marion Sims with Anarcha by Robert Thom. Anarcha was subjected to 30 experimental surgeries.

Pearson Museum, Southern Illinois University School of Medicine http://www.npr.org/2017/02/07/513764158/remembering-anarcha-lucy-and-betsey-the-mothers-

of-modern-gynecology

A Troubled History with the Medical Profession

A Troubled History with the Medical Profession

A Troubled History

What is Implicit Bias?

Why should we care?

What is Implicit Bias?

• In 1995, Anthony Greenwald and M.R. Benaji hypothesized that our social behavior was not entirely under our conscious control.

• According to their study, the concept of unconscious bias (hidden bias or implicit bias) suggests that: “Much of our social behavior is driven by learned stereotypes that operate automatically—and therefore unconsciously—when we interact with other people.”

Implicit Social Cognition: Attitudes, Self-Esteem and Stereotypes (1995)

Kirwan Institute State of the Science: Implicit Bias Review, 2014.

Implicit biases are robust and pervasive.

Implicit and explicit biases are related but distinct mental constructs.

Implicit associations do not necessarily align with our declared beliefs.

We generally hold implicit biases that favor

our own in group.

Implicit biases have real world affects on our behaviors.

Implicit biases are malleable, therefore can be unlearned.

What Is Implicit Bias?

What are Microaggressions?

What are microaggressions?

A question, a comment, even an int ended compliment, sometimes, that nevertheless suggests something demeaning White people often ask Asian

Americans where they are from, conveying the message that they are perpetual foreigners in their own land.

Example – telling a person of color that he/she is “so articulate,” which implies that all other people of color are not.

Example – “You’re not like those other [women, gays/lesbians, Blacks, Latinos], etc. This implies that the person is

an exception.

rt for a Woman,” “Boss Says You’re Smahttp://www.npr.org/2014/04/10/301417507/boss-says-youre-smart-for-a-woman

What are microinvalidations?

Communications that subtly exclude, negate or nullify the thoughts, feelings or experiential reality of a person of a marginalized group. You’re playing the “race” card You’re being too sensitive #Black Lives Matter – what about OTHER lives? All lives

matter What’s the big deal? They’re only words…

Practical Strategies and Tips to Mitigate Implicit Bias

Practical Tips to Combat Implicit Bias in Health Care

1. Have a basic understanding of the cultures your patients come from.

2. Don’t stereotype your patients, Individuate them

3. Understand and respect the tremendous power of implicit bias

4. Recognize situations that magnify stereotyping and bias

Augustus White, MD, Seeing Patients: Unconscious Bias in Health Care, 2011

Practical Tips to Combat Implicit Bias in Health Care

5. Know the CLAS Standards

Augustus White, MD, Seeing Patients: Unconscious Bias in Health Care, 2011

CLAS Standards (2013)

https://www.thinkculturalhealth.hhs.gov/clas

Practical Tips to Combat Implicit Bias in Health Care

6. Do a “Teach Back” or National Patient Safety Foundation

What is my main problem? What do I need to do? Why is it important for me to do this?

7. Assiduously Practice “Evidence-Based Medicine”

Augustus White, MD, Seeing Patients: Unconscious Bias in Health Care, 2011

Video Clip:

Dr. David Williams: How Can Providers Reduce

Unconscious Bias?

https://www.youtube.com/watch?v=3KoTi3LRBXI

What Can Healthy Starts Do?

Serve in the unique role of providing technical assistance to healthcare providers on implicit bias and how it can impact screening, referral patterns, treatment options, etc.

For Further Reading

Take Home Points: Equality ≠ Equity:

Originally created by: Craig Froehle; Adapted by: Many others

For further information, please contact:

Cheri C. Wilson, MA, MHS, CPHQ Diversity and Inclusion, Cultural and

Linguistic Competency, and Health Equity Subject Matter Expert

cwilson366@comcast.net 443-616-6170