Our Unmanaged Health Crisis: Healthcare Inequity
The history of healthcare inequity and public health crisis is not a new experience, and Monkeypox is shining light on the unfortunate cycle of “othering”. We are outlining evidence-based person-centered approaches to care that will help break this cycle.
With over 60,000 confirmed cases globally, close to 23,000 of which are in the United States alone, Monkeypox is growing amid a struggle for limited resources and inequitable care. Even though we have known of this disease for nearly 50 years and vaccines and treatments are available, monkeypox is more prevalent than ever. The why behind this shines light on decades of healthcare inequity, and decades of “othering,” defined as treatment of a person or group of people as intrinsically different from, or alien to, oneself.
If we apply a Planetree person-centered care approach to social determinants of health, the public health and provider response to Monkeypox must consider how our biases and language impacts a patient’s willingness to seek preventative care and direct treatment, and the impact that our communication has on the individuals most directly affected by the care that we are trying to administer.
The Importance of Language
The impact of caring language, especially while aspiring to deliver authentic person-centered care, becomes incredibly important when communicating risk, treatments, and potential outcomes with individuals. Throughout the health crises that are part of this discussion, one can find words such as, precludes, non-compliant, and promiscuous; along with statements that call out specific groups as high risk and discount personal experiences. This language, and these statements, cause marginalized groups to feel outcasted, and tell the general population that they are not at risk. Both outcomes create risks to public health and safety, and both of these outcomes increase inequities in care.
If instead we deliver language with a person-centered approach, the language is gender neutral and factual without assumptions or bias and should be delivered with context and empathy to make the receiver feel understood and accepted. Language used in communications, public health messages, and during care encounters can either build a person up or tear them down, and when labels are used in staff communications, assumptions and bias are also delivered with the message.
Moving from Bias to Individualized Care
Adding to the experience of historically marginalized groups are the assumptions that are made about individuals. These assumptions are influenced by both language and the implicit biases that impacts the care experience. When care is not individualized or delivered through assumption and bias, it is those thoughts and actions that lead the interaction. Additionally, when care is not individualized the life experience of the individual is not included in the treatment.
A person’s experience with healthcare, along with their experience of living as an individual that has experienced marginalization, impacts the way in which they interact with other people, access healthcare, and receive care. Providing authentic person-centered care requires that our care is centered around who the person is, not what the person has. For clarification, this does not mean we approach people with color or cultural blindness, but instead approach the person while embracing their race, ethnicity, and the experiences that they have had.
Reducing the Implicit Bias
Throughout this discussion implicit bias has been mentioned numerous times. It is the unconscious bias that influences all of us and how we interact with others. The challenge with unconscious bias is just that, the person that holds the bias is unaware that they hold it, however that individual experiencing the bias may know that something in an encounter was not as expected. These Implicit biases have been shown to impact individuals as well as historically marginalized groups. For example, throughout the AIDS crisis individuals were demonized and disregarded by many state and federal public health agencies due to the language they used, and the way treatment was delivered. Gay men were seen as the problem, not the disease. This bias continues with the Monkeypox outbreak, where vaccine rollout has been predominantly centered around the white community, and the language used to describe the risks have been focused on the LGBTQ+ community.
To reduce implicit bias, we must look inward, and acknowledge our own experiences, while remaining open to listening to, and accepting, the experience of our patients. This allows us to deliver care in a person-centered way, placing the person, and their unique background and perspective, at the center of the care experience.
