Dr. Miguel Ruiz

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84 appearances 1 recordings 1 series first heard Jul 2024 last heard Jul 2024

Dr. Miguel Ruiz’s voice in public audio — every appearance, attributed to the second.

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Health Chatter · Health Disparities · 5 Jul 2024 podcast

All right, good, great question. Thank you very much for having me here with you. And I'm glad this is going to be a conversation because as you know, some of these deep questions don't have a clear cut answer or a simple answer.

These are very complex topics. And, you know, I'm not sure what has brought this to the forefront now in the last few years. You're right. Disparities have always existed. From the very beginnings of medicine and history, there's been discrimination, disparities, and the forces behind them that have existed. And that is actually...

And in the case, even in the beginnings of medicine, we have an increased awareness of how our early fathers in the medical science really, unfortunately, use very racist approaches to care. from the mistreatment of enslaved individuals to the use of these for experimentation to really misconceptions, even in our most prestigious journals.

For example, the New England Journal of Medicine earlier this year and in the last couple of years have had some series of articles on racism in medicine and healthcare disparities in medicine. And they go to a historical review of such. So this is not a new topic. Healthcare disparities and health disparities have existed from the beginning. I think many factors go into why now, to your question.

I think one of the factors is that we have had a greater capacity to measure. We have been much more focused on outcomes and because of the technological progress and development, we are able to extract data much more easily than we used to in the older days when a lot of the research was much more manual.

And now with powerful computing systems, we're able to extract data from electronic health records, which we didn't have before. in a much easier way. Therefore, having access to these metrics very quickly and in a very efficient way. Thus, in terms of the technological, then there is obviously the whole social moment that we are living.

And as you can see, obviously the history of our country and the history of humanity has had highs and lows and peaks of awareness of the disparities, racial and otherwise. And as you know, the last four or five years have been very active years for unfortunate reasons on those issues of the injustices.

of our society, and obviously with healthcare injustices are at the very core of injustice in general because of the consequences of such. So I think those are two things that come to mind. I know there are probably many others, but there have been scientists and researchers that have been looking into this topic for many years, not just the last few years.

Great, great question as well. I think one of the contributors to a greater gap for Minnesota is that the outcomes for some individuals are very excellent. So when you have a gap, the gap is differential in between a health status or health outcome in between two different or three or four different groups. So when one group has excellent outcomes,

that makes the gap bigger, even when the outcome for that more disadvantaged group are not worse than the outcome for that such a group in other parts of the country. So I think that's one of the contributors.

And of course, when we are going to talk about closing the gap and about eliminating or decreasing disparities, what we want to do is to bring the lower group up to the standards and the outcomes of the upper group. or the more advantage group, not lowering that higher group into the lower.

And just a fact that I think hopefully will lead us to also talking into what we call social determinants of health is the fact that, for example, Latino high schoolers have the lowest graduation rate in the country. That is Latino... students in Minnesota have the lowest graduating rate from high school in the US.

So we have these pockets of inequity, to call it somehow, in certain groups for reasons that are I don't think completely understood, but are a painful reality. How can we have such a good performance in so many metrics and indexes as you refer to, Clarence? And yet we have this very painful realities of specific groups being really very behind compared with even the rest of the country.

Yeah, no, that's great. I think the question is no longer, do we have healthcare disparities?

The answer is very clear. And, you know, it's very clear to most people, to most stakeholders. There was a time not that distant in the past where some people were very skeptical about, yeah, about the disparities because hospitals and medical groups were providing good care to everybody who comes through our doors. And there was that perception of we are doing the best we can with everybody.

We don't... quote C color and so forth. And really showing this data has been very important to leaders in healthcare to say, actually, yes, you are doing your best, you think, but you do have healthcare disparities in your system. And these are the numbers. So now the question is what are we going to do about it? Because we do have those disparities.

And perhaps we do make a parenthesis because I think the answer to that question really requires that we have clear concepts about some of the terms that we use here interchangeably. One of them is what is health disparity? And basically health disparity is a difference in health, in health status, in outcomes.

that is in between groups, that is closely linked to social, economic, environmental, and so forth disadvantage, okay? So it's about health outcomes are different in between two groups. Then we have healthcare disparities, which are basically the difference in accessing care, in the quality of the care, in the use of the care, in having insurance or no insurance.

So because I think when we talk about what can we do about the disparities, we need to know what the problem is. There are health disparities. There are now also health care disparities. That is, the way we provide medical care for patients has some inbuilt disparities. And then what is my area of impact? I think each one of us has to ask the question, what can I do?

Because what is clear is that some of these social, economical, environmental disadvantages, these are huge policy, political, and societal issues that one can feel very important to do anything about. And then you can say, well, there's nothing I can do to change this huge monster of injustice. And basically you give up and just do nothing.

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