Here we chat with Daniel Laroche, MD, a lauded glaucoma specialist in New York City who received his bachelor’s degree from New York University and a medical doctorate with honors in research from Weil Cornell University Medical College. Laroche completed a medical internship at Montefiore Hospital and his ophthalmology residency at Howard University Hospital in Washington, DC, where he was the chief resident in his third year. He later completed his glaucoma fellowship at New York Eye and Ear Infirmary of Mount Sinai.
Besides encouraging his patients to keep their eyes healthy during the coronavirus pandemic—with protective glasses or face shields—Laroche is working on the front lines to spread awareness about the inequalities in health care among people of color.
In general, what key factors contribute to disparities in health and health care?
Key factors include the lack of universal health care coverage, structural poverty caused by inequality in government and corporate policy and spending, and continued racial bias both conscious and unconscious.
How did the current coronavirus pandemic work to crystallize the pervasiveness of disparities in health care in the United States and how this issue primarily impacts African Americans and other people of color?
The coronavirus shined a light on health care disparities that have existed since America was founded. This is due to historical and structural differences in wealth and health, which are largely based on race.
How does race, racism, bias and privilege contribute to institutionalizing disparities in our health care systems?
Government spending has been biased to favor white communities and against Black communities since America was founded. In the past, white peasants from Europe were given land to start an economic base, whereas indigenous Blacks and other peoples had their land taken away from them and were told they could not own land or a business and became lawfully treated as property. This is how it started and lasted for hundreds of years. Despite the progress we have all made in dismantling slavery and Jim Crow segregation, we have not corrected the structural policies, systems and disparities in funding that continue to lead to these disparities.
In your opinion, in what ways did the Affordable Care Act help to address disparities in health care?
The Affordable Care Act helped to insure that more Americans, including Black people, would receive greater access to health care. However, we also need to address policies that contribute to the current plantation capitalism and wealth inequities we are seeing.
How would universal health care help minimize or eliminate health disparities among African Americans and other people of color?
Universal health care would help provide greater access to the health care system. However, it does not address the wealth gap, which is equally important. Despite all of the elderly insured with Medicare insurance, 30% of Black people have less access to cataract surgery, and glaucoma rates of blindness in Blacks are seven to 10 times higher. We also need to address diversity at the highest levels of government and ensure that corporations eliminate bias in how funds are appropriated. This would help to end the disparities that have been created in housing, education, health care, criminal justice and mass incarceration.
How would increasing the number of Black and Afro-Latino physicians worldwide help address and combat health disparities among African Americans and other people of color?
Studies have shown that Black and Afro-Latino physicians are more likely to practice in Black and Afro-Latino communities and that patients can often better relate to them as well due to similar cultures. There is also a huge maldistribution of physicians in America in large part due to the lack of diversity. This unfortunately affects Black communities the hardest.
How does the current system in the United States of tying health care to employment contribute to continued health care inequities among African Americans and other people of color?
Once people lose a job or move to another job, often they can lose their health insurance. If people have a preexisting condition, they may not be able to get insurance again. This causes health care insecurity. Also, the privatization of health care insurance has to end. Health insurance companies do not have the patient’s best interests at heart. Instead, they really focus more on the best interests of their shareholders. This has to end.
How can medical schools help stop health care disparities?
Medical schools have to fund and implement pipeline programs that have been created by the Student National Medical Association to reach Black and Afro-Latino college and high school and college students to expose them to medicine. This would also help to support and guide their aspirations to be excellent future physicians. It is quite ironic because the first physician multi-genius was Imhotep, a gifted and influential African man who helped to lay the foundation of Western medicine. The first medical textbook was an African medical textbook now known as The Edwin Smith Surgical Papyrus, [which is] currently locked in a vault at the New York Academy of Medicine.
What role do implicit bias and structural racism play in creating and perpetuating racial and health disparities in health care systems?
Structural racism in government funding of housing, education and the allocation of health care monies as well as the building and funding of prisons and the financial support for policing have all contributed to wealth inequity and health care disparities. All of the government financials and documents for corporate spending have to be reviewed to ensure that Black people receive their fair share of funding to bridge the wealth gap. These actions require systemic reform.
How do providers, patients and managers in health care systems contribute to disparities and health inequities?
Racism exists in health care as well. We have to better educate everyone to become more culturally competent and hold those who are not accountable. Practicing medicine is a privilege not a right.
In general, how would addressing social determinants of health help address disparities in our health care system?
Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks. Social, economic and physical conditions in various environments and settings, such as schools, churches, workplaces and neighborhoods, have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency and health services and environments free of life-threatening toxins.
Some examples of social determinants include the following factors: availability of resources to meet daily needs, such as safe housing and local food markets; access to educational, economic, and job opportunities; access to health care services and the quality of education and job training.
Other determinants that matter are the availability of community-based resources in support of community living; opportunities for recreational and leisure-time activities; transportation options; public safety; social support; social norms and attitudes, such as discrimination, racism, and distrust of government; exposure to crime, violence and social disorder (for example, the presence of trash in neighborhoods and pickup services provided and the lack of cooperation among local officials who govern communities).
Additional factors that are key include socioeconomic conditions, such as concentrated poverty and the stressful conditions that accompany it; residential segregation; language and literacy; access to mass media and emerging technologies—along with the devices and methods they require such as cell phones, the internet and social media—and culture.
To minimize or eliminate disparities, we have to audit all local, state and federal funding to ensure Black communities receive their fair share of funding because historically they have not.