Eliminating Disparities in Health Care Begins with Education and Training Across the Spectrum

As a black immigrant man who speaks English with an accent, Von Samedi, MD, PhD, has attracted all kinds of stereotypes throughout his career. He was once accused of being an illegal immigrant undeserving of a spot in medical school and a beneficiary of affirmative action. Despite the challenges due to racial stereotyping, his medical career has remained on track. Occasionally, the “imposter syndrome” creeps in and he feels compelled to over-perform. Today, he is an Associate Professor of Pathology, Director of Head and Neck Pathology, and Director of the Residency Program at the University of Colorado School of Medicine. 

He shares his thoughts with us on how healthcare system needs to evolve in order to provide fair and equitable care to all patients.   

How does race affect health care?
It is well documented that Blacks, Native Americans, and Hispanic immigrants not only have worse health than whites, but their access to equitable healthcare is more restricted. The approaches and guidelines for clinically managing the same disease differ by race.  

As a result of longstanding discrimination and asymmetrical treatment by healthcare workers, people of color have a deep mistrust of the healthcare system. Even when marginalized people stand to benefit from a fair and well-intended healthcare system, mistrust keeps them away. A huge proportion of African Americans and Latinos are reluctant to take the coronavirus vaccine. 

Why do racial disparities in health care matter? In other words, how do the struggles of one marginalized community affect all of us as a society? 

It is appalling that our healthcare system consistently undervalues the life and well-being of so many of our fellow citizens because of the color of their skin. For too many, the goal of fairness and equity may be taken as an attack on their privileges. The pandemic has taught us that we are all in the same boat. An uncontrolled virus is not limited to marginalized people.    

Professional medical societies, like ASCP, need to continue the dialogue [on health disparities] and bring these issues to the forefront. Education and training of healthcare providers is crucial.   
  
What needs to happen in order for medical education or medical laboratory education to actually teach and practice respect and open-mindedness for one another, and for those teachings to follow through across a career?  

If medical education is going to teach and practice respect and open-mindedness, it needs to include cultural competence in its curriculum in a meaningful way. It must be infused throughout the curriculum. Accrediting bodies, professional societies and board certifying bodies need to make cultural competence a requirement for progress in your career. 

What are the challenges for you, as a person of color in the healthcare industry, insofar as working to increase diversity and inclusion? 

If only people of color in the healthcare industry push for diversity, it may be perceived as mutiny. When a diverse group advances the agenda, it becomes a movement. We need to impress on colleagues in leadership the importance of diversity and the critical role they can play in tackling healthcare disparities. 

Diversity and inclusion have long been a topic in healthcare systems, so why has the dial not shifted? What needs to be done to actually move that dial?  

The current system is designed to favor one group. Some organizations hire a few minorities to give the perception that they value diversity. We need to revisit recruitment and retention policies and eliminate exclusionary practices. We need to acknowledge these practices are racist, consciously or not. We need meaningful representation, which can only be achieved through systemic and structural change.