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Researchers at Beth Israel Deaconess Medical Center (BIDMC) have contradicted traditional disparities in the US healthcare system. In January 2023, BIDMC released the findings from a student who sought to better understand the impact of the social determinants of health. This research also aimed to provide a more nuanced understanding of how those factors can be critical to creating more health equity and better healthcare outcomes for underserved populations.
Studies show that effective colorectal cancer screening can reduce the risk of death from the disease by nearly 70 percent. However, social determinants of health play a critical role in understanding just who is getting those screenings and who is not. Race, ethnicity, and gender, along with more subtle cultural factors like distrust of medical care, contribute to whether an individual seeks care.
In contrast to broader studies, BIDMC found Hispanic and Spanish-speaking patients screened at higher rates than their white and English-speaking counterparts. These results that fly in the face of most similar studies aren’t an aberration, they’re the reflection of a healthcare system specifically designed to provide equal access to underserved patients.
“Investment into a multicultural workforce and outreach efforts to underserved patients may counteract some of the implicit or explicit biases seen on health systems that have led to traditional racial/ethnic disparities,” senior author Heidi J. Rayala at BIDMC said in a press release. “Our study showed differences in odds of successful screening based on subsections of traditionally defined ethnicities—such as breaking down ‘Hispanic’ into more specific cultures and backgrounds—and that suggests that future research should focus on better understanding individual cultures and communities, rather than lumping patients into overly large groups.”
The findings, published in Preventive Medicine, are a landmark moment for other organizations seeking ways to better address their underserved communities. In Massachusetts, screening rates reflect more traditional trends, with 76 percent of white individuals receiving screening compared to 68 percent of Black and 56 percent of Hispanic patients.
However, at Cambridge Health Alliance (CHA), a BIDMC affiliation, Hispanics were screened at 78 percent, with Spanish speakers recording the highest screening rate. While other factors, such as obesity and neighborhood income levels, often can play an outsized role in patient access and screening, CHA found no discernible difference in screening rates in those populations.
What accounted for the significantly lower numbers of white patients accessing screening? Those factors continue to get more interesting the closer one looks.
Researchers believe that white patients, who were screening at 69 percent, also had significantly higher rates of serious mental illness and substance use disorder—two factors that generally lower screening rates. Researchers believe there is likely a link in these numbers, and future studies provide the opportunity to “examine the intersectionality of substance use disorder and race and ethnicity in safety-net populations relating to cancer screening.”
The results of the BIDMC show that the healthcare system has the potential to fundamentally change itself for the betterment of its patient populations. When health systems commit to understanding the traditional barriers to healthcare and the social determinants of health that impact their patients, real change can occur.
But it takes resources. CHA is known as a well-resourced, safety-net health system in the greater Boston area, with interpreter and mental health services. Its focus on research is in the service of actively improving health equity. To say that BIDMC and CHA are outliers of their kind is a gross understatement. Instead, their examples should be seen as what is possible when we commit to serving the entirety of our population.
