Transcription:

Roxanna Gapstur PhD, RN (Host):  On this episode of Inspiring Health, we're putting a spotlight on health disparities. We know health disparities negatively affect groups of people based on a variety of factors, including gender, race, socioeconomic status, age, gender identity. Today, we'll talk about health disparities disproportionately impacting women, and what disparity looks like for our friends and neighbors in South Central, Pennsylvania. And finally, the steps that we're taking to eliminate the barriers women face in accessing and receiving health care. Joining me is Dr. Angelique Ridore. Dr. Ridore is an OB-GYN Physician at WellSpan serving patients in Franklin and Cumberland counties in the West. Dr. Ridore, welcome. Thanks for being here in here.

Angelique Ridore, MD, FACOG (Guest): Roxanna, thanks for inviting me. It's a real pleasure to be speaking with you today about such an important topic.

Host: Dr. Ridore, I know we feel a shared sense of urgency and wanting to tackle and eliminate health disparities. I think it's so important that we establish a common understanding about what we mean when we use this term. Very simply, it's the acknowledgement that illness, disease, disability, and premature death affects specific groups of people disproportionately. Would you agree?

Dr. Ridore: Absolutely. And let's take it one step further. We know from well-studied research that certain factors experienced by groups contribute to health disparities. Social determinants of health, like education, employment, and income are key factors, healthcare coverage, co-morbidities and behavioral risk factors also lead to health disparities. In some instances, we're talking about disparities in health conditions and outcomes. For others, we're defining disparity in health care services, and we can't overlook the impact of implicit and explicit bias within the healthcare system.

Host: That is a great call-out Dr. Ridore because the solutions look different depending on the cause of the health disparity. Can you walk us through the health disparities impacting women?

Dr. Ridore: Sure. And I think it's important to acknowledge the two lenses through which I see disparity, Roxanna. The first one is the disparity experienced in obstetrics and gynecology, and higher rates of maternal morbidity and mortality occurring in the US compared to other developed countries. Removing the barriers women face to receiving high quality care has both been a personal and professional mission of mine since med school.

Additionally, we see inequitable health outcomes, disproportionately affecting Black, Latino, and Native American women. These women and birthing people of color are faced with disparities in health outcomes like infertility, unintended pregnancies, preterm birth, fetal deaths, maternal death, breast cancer death, and diabetes related death. And on the health access side, we know that Black and Brown women lack equitable access to prenatal care, infertility treatment and birth control. Unfortunately, the COVID-19 pandemic has only exacerbated these challenges.

Host: Yeah, absolutely. The disparities in equities we see in this country are significant. Can you get us a little closer to what you've seen locally in your own patient population?

Dr. Ridore: Women in our region, exhibit higher rates of obesity and mental health illnesses, such as anxiety and depression. Additionally, poverty rates among Black and Latinos is more than double that of Caucasian people in our region. This actually reminds me of one of my patients in particular. She had all of the above Roxanna. She was a working mom, living below the poverty line, severe anxiety, and obesity. On top of that, she had poorly controlled hypertension and the demands of caring for a special needs child who was suffering the lifelong effects of being born extremely premature. Her first pregnancy was complicated by severe preeclampsia and HELLP syndrome resulting in an early delivery.

When she presented for prenatal care, her blood pressure was off the charts. She wasn't even taking her medication. In lieu of labeling her as non-compliant, we really were able to dig into her barriers. She had a deep distrust for the healthcare system as a whole, as she felt that it had failed her in the past. She also didn't understand how to manage her hypertension. We identified key social determinants of health that were challenges for her and connected her with community resources, such as the Gleaning Project. This initiative helped to provide her and her family with fresh produce. More importantly, she felt that her providers were listening. They were culturally competent and able to educate her about her health conditions. So, she could take better care of herself. Through the partnership with her healthcare team, she went on to have a full term uncomplicated delivery.

Host: Wow. Well, thank you for sharing the detail of your patient's lived experience. Dr. Ridore. You know, sometimes when we look at data on health equity, it can often feel faceless and mechanical, but when you pair a name and a patient story with the data, it becomes real and a connection forms to the patients that we serve. And this woman, as well as others are deserving of high quality care, dignity, and respect. You know over the last two years, we've invested significant amounts of time and resources to collaborate with community partners who can identify and eliminate inequities in community members facing housing and food insecurity. But we also know that even after we remove these barriers, some disparity remains because of factors at the patient, provider and healthcare system level.

Dr. Ridore: You're right, Roxanna. At the patient level, there are preferences, attitudes, and differences and value placed on healthcare. We also know one's cultural identity affects their dietary practices and physical activity. Beyond that our healthcare system is largely built for those who have access to health insurance. And we know there are large groups of people who lack coverage. Some communities lack access simply because of their geography. And lastly, we know that the implicit and explicit bias of providers is also a root cause of health disparity among women and particularly women of color.

For example, social and demographic biases have been shown to affect a provider's recommendation for long acting reversible contraception for women at risk of unintended pregnancy. And there are legacies of coercive sterilization among poor women of color that have led to great mistrust. Even the very roots of the field of gynecology started from experimentation on enslaved women.

Host: Yeah, it's really amazing when we look back at the history, and you covered a lot of ground there, Dr. Ridore. So thank you for helping us explore the healthcare access and services aspect of disparity. It's a really important topic for our health system. Dr. Carlos Roberts joined us on a previous episode to explore the topic of maternal health equity.

And he shared that our black female patients were experiencing preeclampsia and eclampsia at higher rates than white patients. And it was a leading cause of severe maternal morbidity for patients delivering at WellSpan. The good news is that a multidisciplinary team analyzed the disparity and established a plan to eliminate that disparity through a combination of low dose aspirin therapy, standardized care, and the use of safety bundles. I know that this work continues today in the maternal health equity space.

Dr. Ridore: Roxanna, that's a really great example of intentionally and skillfully analyzing the data to identify a problem and use a multidisciplinary approach to solve it. I think another way we can eliminate barriers for women is by eliminating bias, providing cultural competency training, and showing our providers how to identify their own biases and the way they affect the care they give. I appreciate that we've been intentional about teaching people about diversity of lived experiences, being curious and not making judgements. So many separate yet unrelated things drive healthcare disparities. So, our solutions must be intersectional and attack the problem from a variety of angles.

Host: I couldn't agree more, Dr. Ridore. It will take all of us working in the same direction to eliminate health disparity within our communities. Thank you for being with me today. I appreciate your dedication to improving access and delivering high quality care to the women in our community.

Dr. Ridore: Thanks so much for having me on, Roxanna.

Host: That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.