Addressing health inequities in communities of color

At MultiCare, we are committed to working toward health equity — ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location.

But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, can prevent people from accessing the care they need.

In this series — inspired in part by society’s growing awareness that not everyone has the same chance to be healthy — we take a deeper look at the disparities that impact our patients and how we as health care providers and community members can reduce those disparities and improve the health and well-being of all.

Racism leads to health disparities

Health disparities are widespread among racially and ethnically diverse groups in the U.S. These inequities are rooted in systemic racism and bias in the health care system.

Economic opportunities, affordable and safe housing, and access to healthy food and quality education — known as social determinants of health — also contribute to negative health outcomes in communities of color.

Black, Indigenous and other people of color experience higher rates of illness and death than white people, according to the Centers for Disease Control and Prevention (CDC). These groups are also more likely to distrust the health care system because of mistreatment and lack of racial diversity in medical settings.

MultiCare is dedicated to reducing these health disparities to improve the health and quality of life for all the communities we serve. This article will cover some of the ways MultiCare is addressing health inequities in communities of color.

Reducing barriers for immigrants

Roya Jalili, ARNP, is the daughter of Afghan immigrants. She was drawn to practice at MultiCare Kent Clinic because of the diversity of both patients and providers.

“Kent is a very diverse area in South King County. We see a lot of refugees and immigrants in this clinic,” she explains. “Every provider here is of a minority group and either has their own immigration story or one through their parents.”

Immigrant communities often face barriers to health care, such as lack of transportation or financial burdens. They may struggle to get to appointments or access nutritious foods and medications.

“I work with my patients based on these struggles, taking into account systemic issues and the community where they’re living.”

In addition, immigrant patients may have trauma from past experiences in medical settings, or those passed down through generations. This can lead to misinformation and mistrust of the health care system.

“Each person has their own individual struggles,” says Jalili. “I work with my patients based on these struggles, taking into account systemic issues and the community where they’re living.”

For instance, Jalili says many of her patients don’t live in safe neighborhoods.

“So, when I ask them if they can walk 30 minutes a day, it’s not as easy as stepping outside and going for a walk,” she says. “Some of them can’t walk around their neighborhood because there have been shootings and they don’t feel safe. This compounds mental health issues they may have.”

Kent Clinic offers a mental health program for those who need counseling.

“Some are hesitant, but after their second or third visit, they often become more open,” explains Jalili. “It has been incredible for some of my patients and has saved their lives.”

Outreach to communities of color

Accessing health care isn’t the only barrier for communities of color. There’s also a lack of trust, says Sheri Mitchell, outreach manager with MultiCare’s Center for Health Equity.

“When an individual doesn’t see themselves represented in the health care staff from whom they are seeking treatment, they tend to be guarded,” Mitchell explains. “They might have relatives who have had negative experiences with the health care system, where they didn’t receive a welcoming reception or assurance that their medical concerns would be adequately addressed.”

People of color may also fear their health concerns won’t be taken seriously, Mitchell says.

“They may perceive the health care provider suspects them of drug-seeking behavior or feel that their expressions of pain are being disregarded,” she adds.

To break down these barriers, MultiCare hosts community outreach events in areas where many cultures are represented. Teams take blood pressure, perform diabetes risk assessments, and teach about proper nutrition, exercise and ways to prevent disease.

There’s a noticeable prevalence of high blood pressure among African American, Hispanic and certain Asian communities, Mitchell says.

“If a person’s blood pressure is elevated or they are at risk for diabetes, we provide them with guidance for seeing a primary care provider at MultiCare,” she says.

MultiCare also partners with school districts in communities of color to hold annual events offering sports physicals, vaccines and vision screenings.

Students who lack access to health care providers really value these screenings, says Mitchell.

“For instance, students who have never visited an optometrist for an eye exam might discover they require glasses,” she says. “Similarly, they may become aware of conditions, such as irregular heart rhythm or hypertension, that could prevent them from participating in sports. In such cases, we can assist them in connecting with a health care provider for further evaluation and follow-up.”

Increasing diversity in clinical trials

MultiCare’s Institute for Research & Innovation recently received funding to increase inclusion and diversity in cancer clinical trials.

Historically, cancer disparities in the U.S. have impacted communities of color disproportionately, says Deana Williams, PhD, MPH.

Williams is co-principal investigator on this research project alongside Chaya Pflugeisen, MSc, MEd.

The project has a few goals: to enroll more diverse populations in clinical trials; to ensure communities of color benefit from advancements in cancer research; and to decrease cancer disparities.

People of color don’t participate in clinical trials for a number of reasons, Williams says. They’re less likely to have access to health care and medical insurance. Lack of transportation or access to child care can also make participation difficult.

“There is also a very real and justifiable feeling that health care systems are not safe places for communities of color,” she adds.

Health care providers have historically not offered trials to communities of color at the same rates they do to white people. They may have misconceptions that people of color would not be good candidates.

“As a health care organization, we are thinking about how to bring about racial healing alongside and within communities of color.”

Community engagement and collaboration is a central focus of the project, Williams says.

“We want the voice of our community to be heard,” she says. “Therefore, we are convening an advisory group so our team can partner with cancer survivors of color and professionals serving cancer patients of color to help us gain a deeper understanding of barriers and needs related to clinical trials.”

The research team will also hold focus groups with those who were eligible for cancer clinical trials but did not participate.

Insights from the focus groups and advisory committee will inform the development of an anti-racist, culturally conscious intervention that will be piloted and tested.

The work on these projects is expected to span August 2023 to July 2025.

Inequities in diagnosing and treating kidney disease

Another area in medicine where race comes into play is clinical algorithms and calculations that adjust for race. A specific example of this: diagnosing and treating chronic kidney disease.

The standard screening to determine kidney function looks at a biomarker that estimates how well the kidneys filter waste. If the value is low, it means a person has declining kidney function.

The current calculation to determine kidney function was developed 24 years ago, explains Venita Schandorf, DNP, ARNP. It was influenced by a few small studies that inferred people of Black or African descent have greater muscle mass.

Schandorf, of the MultiCare Covington Family Practice clinic, sits on MultiCare’s diversity, equity and inclusion (DEI) committee.

“The equation accounts for a correction factor for Black Americans, meaning it estimates better kidney function compared to non-Black individuals,” she says.

In fall 2021, the National Kidney Foundation and the American Society of Nephrology Task Force developed a calculation not influenced by race or muscle mass. They also recommend using other biomarkers to test kidney function when available.

Schandorf brought forth this information to the MultiCare DEI committee. Since then, she and her colleagues have been working with several leadership teams to implement it.

MultiCare hopes to eventually use the new calculation to more accurately estimate kidney function for all patients, regardless of race.

“Using the older algorithm can lead to delays in starting treatments, safely dosing medications, initiating referrals to specialists, receiving dialysis or getting a kidney transplant,” says Schandorf. “When we implement the newer calculation, we are addressing the inequities.”

Black people and African Americans are three times more likely than white people to have — or die from — kidney failure.

“The work of our committee is invested in the community and health equity,” adds Schandorf. “Along with working to implement the new calculation to estimate kidney function, the committee hopes to address other inequalities pertaining to race and clinical calculators.”

Committed to improving health and quality of life for all

The journey toward health equity is ongoing, and MultiCare acknowledges the continued work that needs to be done. This includes addressing the disparities and dismantling barriers that hinder access to care for our patients and community.

“As a health care organization, we are thinking about how to bring about racial healing alongside and within communities of color,” says Williams. “That includes building trust and establishing rapport among communities of color and an authentic commitment to confronting racial injustice in health care.”

MultiCare’s commitment to diversity and equity

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