HSS Case Study: 54-year-old Woman with Chest Pain

00:01 We've talked about a few concepts related to health equity.

00:04 And I want to go through a brief case for us to think about these broad concepts.

00:10 Anita is a 54 year old woman with a history of hypertension who presents to the urgent care clinic with chest pain.

00:17 She shares that she has been working long hours in a stressful job and has not been prioritizing visiting her PCP.

00:25 She's sent home with antacids, breathing exercises, and instructions to follow up with her primary care physician.

00:33 Yet she returns to the ER three days later with chest pain, accompanied by nausea and vomiting.

00:40 And at that time, she's diagnosed with a heart attack.

00:44 This is an unfortunate delay of diagnosis and care for Anita.

00:49 Can you think of systemic factors that may have contributed to the delayed diagnosis of Anita's heart attack? I'll pause for a moment while you write down some ideas.

01:05 What systemic factors may have contributed to the delayed diagnosis of Anita's heart attack? Here are just a few examples.

01:14 Recognizing that we don't know the whole story for Anita, there could be gender bias in healthcare impacting her delayed diagnosis.

01:23 Women, particularly those with cardiovascular symptoms, often face misdiagnosis or delays in appropriate treatment due to the under-recognition of heart disease in women.

01:35 Healthcare providers may dismiss symptoms such as they may.

01:38 They may think chest pain is related to stress or anxiety, and these things could lead to delayed diagnosis.

01:45 What about Anita's health literacy and health behaviors? She may have limited health literacy or insufficient knowledge about managing chronic conditions like hypertension, and this could hinder her ability to adhere to recommended treatment or make informed decisions about her health.

02:02 Anita's socioeconomic status could also contribute to this health outcome if she faces financial hardship.

02:09 This could limit her ability to afford medications, attend regular checkups, or leave her job to seek health care.

02:19 This would then exacerbate her cardiovascular conditions and and risk and potentially delay proper treatment. How can we work toward health equity? What can I do as an individual to contribute to achieving our goal of health equity? I like this framework offered by Anderson and colleagues.

02:43 First, we can identify and prioritize reducing health disparities.

02:48 So let's understand the prevalence, the size of the disparities, the strength of evidence for reduction strategies, and the feasibility of improvement.

02:56 For example, Half of the cardiovascular mortality disparity between African Americans and white people is directly attributable to the prevalence and control of hypertension.

03:08 Number two, we can implement evidence-based interventions to reduce disparities.

03:15 They should be multilevel.

03:17 And this brings us back to the the social ecological model introduced in a previous discussion. And it can be at the patient level, the organization the community or policy levels.

03:28 Number three invest in the development and use of health equity performance measures.

03:33 These are things like dashboards community partnerships provider trainings.

03:38 And finally, we can incentivize the reduction of health disparities and achievement of health equity. This means things like social risk adjustments for provider payment models, payment based on outcomes across patient groups, or specifically for addressing underlying social determinants of health.

03:57 I want to leave us with some final thoughts.

04:01 We've talked about equality versus equity, giving people the resources that they need to achieve the outcome that we want, and also removing the systemic barriers so that we can achieve health equity.

04:16 This picture helps us understand the idea of justice.

04:22 We may not all be starting on equal footing, and we should recognize that we might be putting people in metaphorical ditches or elevating their status in society to begin with, so that these are differences created by us.

04:38 These historical differences that we must think about rectifying.

04:42 And so we must also think about health justice.

04:46 When we think about health equity and health justice is fixing the system to offer equal access for both tools and opportunity to all.

04:56 Thank you.