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
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
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?
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 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
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 information, please contact:
Cheri C. Wilson, MA, MHS, CPHQ Diversity and Inclusion, Cultural and
Linguistic Competency, and Health Equity Subject Matter Expert
[email protected] 443-616-6170
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