According to the World Health Organization, “the social determinants of health are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.” Access to health systems also influence individuals and population.
Health care disparities are seen in chronic medical conditions like heart disease, diabetes, and arthritis in lower socioeconomic populations.
Rectifying health care disparities is championed by physicians, especially primary care doctors, nurses, social service providers, and other medical professionals through individual and community education and community outreach.
In fact, you do not need to have a medical education to provide outreach – it just requires that you care. There are two primary goals of health equity endorsement: social obligation and benefit to the U.S. economy. As President Franklin Delano Roosevelt said, “The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little.”
Addressing the social determinants of health requires thinking in a novel way, as well as a concerted effort of diverse people and stakeholders who have collectively different life experiences.
Some of you are probably wondering how a radiologist like me can play a role in furthering health equity. Information technology is at the heart of radiology’s daily practice, and employing technology through clinical-decision support tools like the Radiology Support, Communication, and Alignment Network (R-SCAN) is where radiology can play a significant role on the health care team.
In radiology, addressing health care disparities means putting special emphasis on reducing unnecessary tests, while generating financial savings. This aligns with one of the aims of the Transforming Clinical Practice Initiative, a Centers for Medicare & Medicaid Services (CMS)-funded program designed to empower clinicians to expand their quality improvement capacity.
R-SCAN is a free, online, informational instrument that cultivates increased communication between radiologists and referring health care providers in advanced imaging appropriateness of patients in both the outpatient and emergency settings.
This online software has an ever-expanding list of Choosing Wisely topics, with the goal of increasing quality of care by removing inappropriate imaging and by decreasing costs to health care systems.
At Baylor College of Medicine’s affiliate institution, Harris Health System, I along with several trainees collaborated with primary care physicians at a few Harris Health outpatient clinics on a low back pain and MRI lumbar spine project. We successfully reduced inappropriate MRI lumbar spine imaging in our patient population. Harris Health is a public health system that serves a population comprised of 59.4% Hispanics and 25.1% African Americans, and in which 60.1% are uninsured and 20.6% are covered by Medicaid.
The family medicine physicians at Harris Health-Baylor College of Medicine were receptive to our overture for constructive collaboration, and thus translated the project into a successful, collaborative, health equity venture. As I think back to my years of radiology training, I recall my mentor, Jacqueline A. Bello, MD, always stating that collaboration with our clinical colleagues is the key to the best outcomes for our patients, and that stays in my heart as I practice radiology today.
Christie M. Malayil Lincoln, MD, is a board certified radiologist with a certificate of added qualification in neuroradiology at the Baylor College of Medicine in Houston. She will graduate from the TMA Leadership College in May 2019.