Overcoming Systemic Health Inequalities May Start With Acknowledging They Exist


Healthcare practitioner finds that institutions need to acknowledge advantaged and disadvantaged groups of patients as motivation to overcome systemic barriers.

Orville Newton Ray Bignall,MD, FASN, pediatric nephrologist, Nationwide Children's Hospital, Columbus, Ohio, discusses social determinates of health with Pharmacy Times. As a first-generation American, he is empathetic with all types of families who come to receive treatment. Bignall highlights groups of patients that may be considered disadvantaged in the healthcare system, and why awareness is so important, at ASN Kidney Week in Orlando, Florida.

Q: What are some ways that social determinants of health and social misconceptions impact patient and physician care and patient outcomes?

Orville Newton Ray Bignall,MD, FASN: I think they really significant way that social determinants of health impact patient’s kidney outcomes is through health inequities. I think that examples of health care systems that we operate within as health care providers differentially advantage or disadvantage groups of patients, I think based sometimes on demographic characteristics like what someone looks like, where they’re from, the language they might speak in their home. Sometimes those characteristics on which we differentially manage our patients might also include their location, ease, or ability for them to access those certain kinds of care.

You know, I take care of children in Central Ohio, largely, at Nationwide Children’s in Columbus, but I see families who will drive 3, 4, 5 hours away, and even from neighboring states to receive care at our hospital. And I am amazed that families will do this in. I often will try to work with the family to arrange for care closer to home, but many of these families would rather come to significant distance than receive care local to them. They perceive that the care they will be receiving at Nationwide Children’s will provide care with dignity and give them the best opportunities they need for success. I take that as a huge credit to our institution and to the work that we’re trying to do. It’s just really really important to me that all patients are treated with dignity and respect, and we can’t do that if we are not aware of the ways in which we treat patients differently.

In our country today, I think we become a little bit more willing to acknowledge those differences we’ve become in many cases more aware of those differences. We, like I said, we talk a lot in the context of race and ethnicity, but you know, I’m a first-generation American myself. My parents are immigrants, and I think a lot about that immigrant experience when I’m interacting with patients of mine, who themselves or their parents have immigrated from another country. I think a lot about the experience that they are having. I mention rural families that I take care of in Ohio and some of the incredible lengths they go to ensure their children can get high-quality care.

I think about children living with disabilities- the forgotten area of inequality in our society. I have a very good family friend who is a physician and researcher at the University of Michigan. He is an individual that uses a wheelchair for mobility. He has help to open my eyes to the ways our society is so inaccessible to people who use wheelchairs to get around. And that’s just one aspect of an accessibility for individuals living with disability. Once we become more aware of these differences and ways these differences negatively impact the patients we are caring for, we should then feel activated and motivated to make some positive changes on their behalf. 

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