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Examining Racial Disparities in Healthcare

As Americans from coast to coast protest the unequal treatment that many people of color experience daily, Cedars-Sinai leaders are developing and directing programs aimed at erasing healthcare disparities.

Since 2013, Cedars-Sinai has instituted a number of employee training programs to raise staff members' awareness about "implicit bias," the unconscious actions that can result in unfair treatment.

When it comes to healthcare, implicit bias can have serious ramifications. According to the Centers for Disease Control and Prevention:

· African Americans ages 18-49 are two times as likely to die from heart disease as whites.

· African Americans ages 35-64 are 50% more likely to have high blood pressure than whites.

Although many factors – including smoking, poverty, obesity, hypertension and ignoring symptoms – can contribute to anyone's health status, "we realize there are implicit biases in all of us. Cedars-Sinai is committed to being part of the solution," said Nicole M. Mitchell, director of Diversity and Inclusion for Cedars-Sinai.

"I have had a lot of leaders reach out to me these last few days to say, 'I see you. I hear you. How can we fix this and what can I do to help?'" Mitchell said. "I am glad we are talking about it. It gives me hope."

Mitchell joined Cedars-Sinai Senior Rabbi Jason Weiner, PhD, Wednesday to host an online vigil for Cedars-Sinai employees to discuss the ongoing protests in Los Angeles and other cities, and to pray for peace and equality for all.

"We have pivoted so quickly when faced with a pandemic," Mitchell said, noting how staff members united to care for COVID-19 patients. "Now, this is the next time for us to come together and support each other."

Weiner said ensuring health equity for all begins with talking about racism and becoming aware of our own biases.

"We can do it, but it's not easy," Weiner said, adding that the challenge will be talking about the issue when it's not in the news. "We have a responsibility to keep bringing it up, to make a difference, to make a change."

Cedars-Sinai began developing specialized training seven years ago, said Linda Burnes Bolton, DrPH, RN, senior vice president and chief health equity officer.

“We began implicit bias training for nurses and other healthcare workers as part of our commitment to human caring and the understanding that our patients and fellow healthcare workers come from all backgrounds,” Burnes Bolton said.

As part of its efforts, Cedars-Sinai is committed to having diverse perspectives and backgrounds represented in leadership positions. And, working alongside both the California Hospital Foundation and Diversity Science, the medical center is planning to begin an education program about implicit biases in perinatal care.

“We are also discussing how to expand this conversation to other departments throughout the health system, as well as continuing to discuss the impact of gender and race during our Grand Rounds presentations,” said Burnes Bolton.

Additionally, Cedars-Sinai's chief anesthesiology resident has collaborated with medical residents across the country to explore whether caregivers have unconsciously discriminated against African American COVID-19 patients and contributed to more black Americans dying from the novel coronavirus.

Adam Milam, MD, PhD, is first author of the collaborative perspective article, published recently in the journal Health Equity.

“The perspective was written in response to the huge racial disparities in mortality related to COVID-19,” said Milam, who cites Michigan as an example, where African Americans represent 14% of the population but account for more than 30% of COVID-19 cases and more than 40% of deaths.

Many factors – such as severity of illness, socioeconomic status, quality of medical care and underlying serious medical conditions, including obesity and unhealthy lifestyles – can influence the outcome for any COVID-19 patient recovery.

By writing the perspective article in Health Equity, Milam hopes clinicians can close the gap in health disparities.

“We are sounding the alarm that we seize this opportunity to address the health disparities and systemic inequities that continue to result in premature mortality and shortened life expectancy among African Americans and other disadvantaged, disenfranchised and already marginalized populations,” Milam said.