Monica Webb Hooper, deputy director of the National Institute on Minority Health and Health Disparities (Bethesda, USA) works to help reduce healthcare disparities and improve minority health. Among the subjects of her presentation at the second plenary of the Society of Interventional Radiology (SIR) 2022 Annual Meeting (11—16 June, Boston, USA) was the “relationship between racial discrimination and health,” of which a key takeaway was that there is “well documented evidence [that] racism worsens health,” and that therefore it is incumbent upon healthcare professionals to take steps to redress the imbalance.
Webb Hooper began her talk by clarifying that “characteristic differences between population groups, [such as sickle cell disease and colour blindness]” are not the same as health disparities. In contrast to the former, which are determined by genes or biology, the latter result from “disadvantage at multiple levels”. However, the nature of these “systemic obstacles” that racial minority groups face is such that they are “modifiable, by definition.”
Listing some “considerable” disparities when it comes to racial and ethnic minority health, Webb Hooper included overall shorter life expectancy, infant mortality, cardiovascular disease, lung cancer, sexually transmitted infections, mental health difficulties, dental ill-health and COVID-19. Webb Hooper then delved into the reasons why this is the case, beginning by highlighting how Black or African American, American Indian or Alaska Native, and Hispanic or Latino populations are all less likely to be diagnosed early with lung cancer. Consequently, they receive less treatment. Underpinning these inequities, Webb Hooper posited, it is “the assumption” among physicians and scientists “that genetics are responsible” for health issues among these groups, based on which may be less motivation and perceived necessity to intervene medically.
“Race is a sociocultural construct that has varied over time,” Webb Hooper then relayed, but that what has been constant is the “discrimination and chronic stress” to which racial and ethnic minority groups have been subjected. This is why, she noted, it is important to understand “what happens outside the body and how it affects what is going on inside the body.” A further key message for delegates was that “population differences are not the same as health disparities,” and it is believing that they are that hampers “further investigation” into the causes of these health disparities.
Conveying the degree to which racial and ethnic minority groups receive inferior care as a result of ill-founded beliefs around race and health, Webb Hooper asserts that “irrespective of socioeconomic status, [these groups] are more likely to be denied pain medication and opportunities to take part in clinical trials.”
Webb Hooper then took time to reiterate how we must accept the following commonly held belief as flawed: that health disparities either stem from biology, and therefore are not modifiable, or they have cultural underpinnings, and thus the onus lies with the members of said culture to change. There are “clear indicators” of the effects of personal, institutional and structural racism on health, which cannot be ascribed to biological nor cultural factors.
Webb Hooper then discussed the longstanding need to increase the representation among members of racial and ethnic minority groups in clinical trials. Webb Hooper’s first recommendation for how to achieve this is to “focus on setting standards for inclusion a priori.” This may mean making adjustments to inclusion criteria so as to include a sample of racial and ethnic minority individuals that reflects the wider population—this is 19% Hispanic or Latino in the USA, Webb Hooper offered by way of example.
The second recommendation she gave was to “focus on individuals’ motivations for participating in a clinical trial,” and once identified, turn those motivations into active participation. Thirdly, it is necessary to “address the reasons for low participation” among racial and ethnic minority groups. “Research teams must be willing to change their enrolment process,” she averred, suggesting that to inform this, community groups are consulted to gain on-the-ground insight into current attitudes around clinical trials. It is a case of asking more racial and ethnic minority patients to participate and recognising that they are just as willing to, Webb Hooper underlined.
Labelling these groups as “hard to reach” is an excuse, Webb Hooper concluded.