Occupational Therapy’s Role in Addressing Health Disparities

Lindsay Cowen OTD-S Resident Intern, Mallory Rapalyea OTD-S Resident Intern, and Barbara Kornblau JD, OTR/L, FAOTAAdditional contributions from Shade Ojo MPH, OTD-S and Jessica Henry OTD-S

Serena Williams and Beyoncé are known around the world for their incredible talents, but did you know they both suffered complications during and after their pregnancies? Williams survived a birth complication that involving a pulmonary embolism. Beyoncé and her twins experienced preeclampsia. You probably have not heard of Dr. Shalon Irving, an African American epidemiologist for The Centers for Disease Control (CDC), who died three weeks after giving birth due to postpartum complications.

Black mothers die from pregnancy-related complications at three to four times the rate of white mothers (Tucker, Berg, Callaghan & Hsia, 2007). While maternal mortality has been dropping in Sub-Saharan Africa, rates of maternal mortality for African Americans have increased in the United States from 2000 to 2014 (MacDorman, Declercq, Cabral & Morton, 2016). Even after taking into account income, neighborhood, comorbid illnesses, and health insurance type (factors typically invoked to explain racial disparities), research shows health outcomes among blacks, in particular, were still worse than whites (Hostetter & Klein, 2018). Neel Shah, M.D. an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School stated “studies suggest...we believe black women less when they express symptoms, and we tend to undervalue their pain.” The experience of being a black woman in America is, itself, a risk factor (Hostetter & Klein, 2018).

As occupational therapy practitioners, we have a common goal of helping our clients and communities achieve optimum health and well-being. The CDC defines health disparities as preventable differences in the burden of disease and opportunities to achieve optimal health, experienced by groups that have experienced greater social or economic obstacles (CDC, 2018). The key word in this definition is “preventable.” The World Health Organization and Healthy People 2020, among others, acknowledge racial or ethnic minority population experience direct and negative health outcomes due to widespread past and current discrimination (CDC, 2014). This is where occupational therapy and preventing health disparities meet. Williams, Beyoncé, and Dr. Irving were not believed when they expressed symptoms, and their pain was undervalued. These women and their families suffered and Dr. Irving died, leaving her newborn baby without a mother.

Implicit bias and structural racism have, and still do, play a large role in creating and perpetuating racial health disparities in our healthcare system. Implicit bias refers to learned stereotypes and prejudices that operate unconsciously. Structural racismtakes into account the many ways our society fosters racial discrimination through systems such as healthcare. It is important to focus on implicit bias and structural racism as more than mere negative feelings or prejudices, because while interpersonal racism is important, implicit bias and structural racism are more likely to remain undetected and unacknowledged (Hostetter & Klein, 2018). When occupational therapy practitioners understand and acknowledge implicit bias and structural racism, we can begin to prevent differences in how we treat, view, and educate our clients, communities, and health care systems.

There has been a new term floating around the disability community bringing new meaning to the populations we serve. The term “intersectionality” refers to the interconnected nature of social categorizations including but not limited to race, sex, LGBTQ status, ethnicity, religion, and disability. These social categorizations create overlapping and interdependent systems of discrimination or disadvantage. Serena Williams, Beyoncé, and Shalon Irving faced intersectionality due to their race and sex. As occupational therapy practitioners, our clients more often than not, are dealing with biopsychosocial concerns that are exacerbated by the intersection of their race, ethnicity, and sex.

“Health disparities” is a large and multifaceted problem that questions the core of our character, identity, and spirit. Occupational therapists acknowledging this preventable, global problem is only the first step. It is easier for us not to face this challenge internally or externally, which is why it still influences individuals and greater systems to this day. It might be tempting to say “this doesn’t pertain to me”, “this problem isn’t up to me to solve,” or maybe “I’m so small, what can I do about this?” That’s a great question and a positive step in the right direction. There are multiple concrete steps occupational therapy practitioners can and should take to decrease the health disparities our clients face.

1. Take some time to reflect

To combat these disparities, health care professionals must explicitly acknowledge that race, ethnicity, disability[BLK2] [MOU3] , LGBTQ, and religion impacts health care. We, as occupational therapists, have to make efforts to identify implicit bias and structural racism in our organizations, and develop customized approaches to engage and support clients to overcome health disparities.

2. Register for trainings

Occupational Therapists can encourage managers and coworkers to register for trainings from the Racial Equity Institute. These trainings include sessions on racial disparities and the roles of racial bias and gatekeeping in health care.

3. Obtain education and resources

The Institute for Healthcare Improvement has put out a guide for health care organizations. Achieving Health Equity: A Guide for Healthcare Organizations, offers a framework for how health systems can advance health equity in five key areas; 1.Making health equity a strategic priority, 2. developing structures and processes to support equity work, 3. deploying specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact, 4. decrease institutional racism within the organization, and 5. develop partnerships with community organizations.

4. Have conversations that matter.

As occupational therapists, we spend invaluable time with our clients and within our communities. This includes the school system, where we have an opportunity to discuss these topics with young minds. There are countless opportunities to have conversations that matter with students, clients, friends, family, and leaders. Conversations must include active listening; believing our clients when they express symptoms, valuing the subjective measure of their pain. This step can immediately increase our clients functional abilities in everyday life.

As occupational therapy practitioners, we spend more time with our clients than many other health care professionals. It is our responsibility to advocate for our clients and communities. Being aware and acknowledging the impact of health disparities in our country is just the first step. When in clinical practice, try to recognize your patterns and the patterns of others. Pay attention to how you identify an individual. Remember not one of us is exactly the same. We are our intentions, our values, our beliefs, and so much more than just a skin color, religion, LGBTQ status, or disability status. Holistic and client centered care has been a core belief of occupational therapy since the inception in 1917. Occupational therapists have the power to change lives in ways no other field can. It is important to remember this and implement this practice everyday with every client.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2018, August 17). Disparities: Adolescent and school health. Centers for Disease Control. Retrieved from https://www.cdc.gov/healthyyouth/disparities/index.htm
Fingar, K.R., Mabry-Hernandez, I., Ngo-Metzger, Q., Wolff, T., Steiner, C.A. Elixhauser, A. (2017, April). Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005–2014. Health Care Costs and Utilization Project, Statistical Brief #222. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from www.hcup- us.ahrq.gov/reports/statbriefs/sb222-Preeclampsia-Eclampsia-Delivery-Trends.pdf
Hostetter, M., & Klein, S. (2018, September 27). In focus: Reducing racial disparities in health care by confronting racism. Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confronting MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent increases in the U.S. maternal mortality rate: Disentangling trends from measurement issues. Obstetrics and Gynecology, 128(3), 447–455. doi:10.1097/AOG.0000000000001556 One Mother's Death: Shalon's Story. (2018, June 29). Health Resources & Services Administration. Retrieved from https://www.hrsa.gov/enews/past-issues/2018/july-5/shalons-story.html Tucker, M. J., Berg, C. J., Callaghan, W. M., & Hsia, J. (2007). The black-white disparity in pregnancy-related mortality from 5 conditions: Differences in prevalence and case-fatality rates. American Journal of Public Health, 97(2), 247–251. doi:10.2105/AJPH.2005.072975

Links to additional resources

The National Black Occupational Therapy Caucus

Office of Minority Health

In Focus: Reducing Racial Disparities in Health Care by Confronting Racism

CDC Vital Signs: African American Health

To cite this page in APA format, please use the following citation:
Cowen, L., Rapalyea, M., & Kornblau, B. (2019, September 13). Health disparity. Retrieved from https://www.otonthehill.com/current-issues

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