The Challenges of Inequities in Healthcare — in conversation with John Stewart

John Stewart

Today we are in conversation with Dr. John H. Stewart, IV, MD, MBA, an advanced researcher, strategist, and clinician. He is the founding director of the Louisiana State university — Louisiana Children’s Medical Cancer Center. He is a strong advocate of diversity, equity, and inclusion in medicine. He has received various teaching and mentorship awards for his work with underrepresented students in medicine.

John, you have been a great advocate of diversity, inclusion and equity in healthcare. What are some of the challenges of inequities in healthcare today, on a global scale?

“I think that our challenges around equity and health care revolve around many of the social determinants of health. That is, many communities don’t have access to important healthcare, or things that help them maintain health.”

“For instance, it is known that lower income neighborhoods tend to have food deserts — low availability of fresh fruits and vegetables. They also tend to have higher toxin exposures, whether it be from chemical plants, manufacturing plants, the leakage of industrial pollutants into their water, or the presence of lead. Those are also important determinants of health. There are also institutional barriers to care, like access to primary care, physicians, insurance coverages, health literacy. All these issues play into the way that a patient is able to access and leverage the capabilities of the medical system.”

“We are also challenged by provider perceptions, and the literature is replete with studies of implicit bias among providers. That not only limits access to some therapeutic interventions but also limits access to preventative measures. This implicit bias can impact how you manage blood pressure in a population, how you do colorectal cancer screening, breast screening, prostate screening, and cervical cancer screening.”

“We have now begun understanding that the presence of health inequities might actually represent genetic imprinting of structural violence that has occurred over the past 500 years. Recent data shows that one zip code has a high correlation with one’s lifespan. We have begun to look at how those differences and zip codes actually represent the aforementioned social determinants of health and those social determinants of health actually impact methylation status and genomic phenomena that occur at the genetic level.”

“This is much deeper than access, it’s much deeper than exposure — it’s understanding how the patient’s history impacts the outcomes for variety of diseases. The next step of precision medicine will be to understand parental exposure to factors like violence and racism, how those factors are further transmitted to their children, and how we might address a lot of these issues associated with health inequities.”

Thank you for sharing, John.

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