American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Panel: Health care disparities can be eliminated

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday First Edition

“When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”  Herophilus, Ancient Greek physician and anatomist

“Think about when you have the flu and what happens,” said Jonathan Woodson, MD, FACS, Boston University Institute for Health System Innovation and Policy, Boston, MA. “It just sucks your energy, you can’t think, you can’t interact, you can’t work.”

An analogous malaise affects many American minority communities that lag the general population in health status, Dr. Woodson said during a Tuesday panel. He and others showed that even within the VA system and in Medicare, where minorities nominally have equal access, disparities persist. The data show higher mortality rates for African Americans across a broad range of surgical procedures, as well as reduced access to treatment for arthritis, pain management, cardiac and cancer care, and other areas.

“Just having an insurance card does not create access if there are high copays,” Dr. Woodson said. Other barriers also need to be better understood, he said, citing factors such as the patient’s experience with and knowledge of the health care system, trust in providers, ability to participate in dialog and decision-making, adequate housing and transportation, and a host of other “thorny” social determinants associated with race and culture.

Dr. Woodson praised the U.S. military’s performance as evidence that disparities can be eliminated. For example, African American active-duty service members have outcomes equal to or better than civilians in four types of cancer: breast, lung, renal cell, and bladder.

“Why is this?” he asked. “In one equal-access system (the VA), you see disparities. In the other (active-duty service), being ready is a condition of employment,” with required exams, preemptive attention to one’s physical status, and rigorous screening, alleviating some of the social determinants that depress access in civilian life.

David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons, praised the panel’s host, former ACS President L.D. Britt, MD, MPH, FACS, Eastern Virginia Medical School, Norfolk, VA, for leadership in raising the profile of the disparities issue within ACS.

He said Dr. Britt’s Presidential Address theme, “no quality without access,” will be put into action through his work under a grant to ACS from the National Institutes of Health to study ways to address disparities in surgical care.

Dr. Britt expressed his determination to succeed. “At the end of the day, I don’t care what your politics might be, you can’t afford to have 45,000 people die each year because they’re uninsured,” he said.

Four other speakers addressed the panel: Edward E. Cornwell, MD, FACS, FCCM, chairman of surgery, Howard University College of Medicine, Washington, DC; Carlos A. Pellegrini, MD, FACS, chief medical officer, University of Washington, Seattle, WA; Regina James, MD, Director, Clinical & Health Services Research, National Institute on Minority Health & Health Disparities, National Institutes of Health, Bethesda, MD; and Amil Haider, MD, MPH, FACS, Harvard University Medical School, Cambridge, MA.

Additional Information:
The Panel Session, Current State of Health Care Disparities in Surgery and Solutions for the Future, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at

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