Christina Madison, PharmD, FCCP, AAHIVP, discusses disparities in patient populations directly influencing limited access to appropriate treatment and preventative care.
Ryan Haumschild, PharmD, MS, MBA: When we’re thinking about a lot of communities, sometimes it’s not that they are ignorant or don’t understand. Sometimes we just have to meet them where they’re at. Maybe it’s education. Maybe it’s talking with them about some of the fears or experiences they’ve seen in their community and being open to that. One of the patient populations we need to focus on—Dr Madison, you’ve talked a lot about this—is underrepresented populations. We need to focus on what impact the racial and ethnic disparities have on vaccination rates with pneumococcal vaccines. If you could talk about that in these underserved populations, I’d appreciate it.
Christina Madison, PharmD, FCCP, AAHIVP: I want to start with that health literacy piece because there may be a lack of knowledge that this is something that’s needed without hesitation or fear. I want to start with that because historically marginalized groups were often labeled as vaccine hesitant before they were even asked to be part of the conversation. I always say this: nothing about us without us. If you’re having that conversation without asking an individual of color, it’s not going to land well. We also need to think about discrimination, racial trauma, and the implicit bias in our health care system. That keeps historically marginalized groups from seeking health care because they feel they’re going to be judged. They feel they’re going to be stigmatized. They feel they’re not provided access quality care, which is important to mention. There may be instances where patients may have access to care, but the quality of care is not there. They’re not getting that white-glove VIP service. For whatever reason, they’re not seeing the same level of care as someone who isn’t part of a racial or ethnic group.
We also need to understand that structural racism within our health care system needs to be addressed. The AMA [American Medical Association] talks about this now. They have a fantastic guide that they just published on terminology and language. I don’t know if you’ve noticed, but I’m very deliberate about not calling individuals “at risk” or “high risk” because patients aren’t the risk; what’s been done to them puts them at risk. I say things like “historically marginalized” vs “minoritized” populations. I’m deliberate about how I say things because words matter. If you tell somebody that who they are—their authentic selves—makes them at risk for diseases, that makes them feel as if they have a choice. But that isn’t the case. This is something that has been done to individuals. Racism, inequity, the acute and chronic stress that occurs from being marginalized, and microaggressions cause cellular damage, which leads to a reduction in life expectancy. How do you deal with that? Head on. You need to call individuals out. I’ve been impacted by racism as a woman who recently delivered [a child]. I went to the hospital and was denied care. Even though I can advocate for myself and have a doctorate [degree], I was denied care because of stereotypes and tropes around Black women not being believed, being medication seeking, not experiencing pain the same way that other individuals do. Apparently, our skin is thicker.
All these things are what we need to think about when we’re addressing these populations. We need to understand that. We need to look through that trauma-informed lens. Most of the individuals we deal with have experienced some level of trauma, and they may have some form of PTSD [post-traumatic stress disorder] when dealing with the health care system.
Ryan Haumschild, PharmD, MS, MBA: Those aregreat comments. It’s so important and relevant because we’re not going to create change if we don’t embrace it. [We have to] be intentional about how we move forward. I appreciate you sharing that, and I appreciate your passion by the way. It bleeds into the health care we’re providing as a team.
Transcript edited for clarity.