Today, college campuses are more diverse than two decades ago, with 45 percent of undergraduate students identifying as people of color. However, healthcare disparities for students on and off campus continue to exist.1
Healthcare disparities
Healthcare disparities are the differences in clinical outcomes that occur due to a population’s racial or ethnic affiliation, as well, such as age, gender, socioeconomic status, religion, sexual orientation, or disability.
Research shows that college students experience elevated levels of stress related to changes in lifestyle, school workload, responsibilities, and interpersonal relationships.2 Unfortunately, coping strategies and medical attention for these often go ignored, leading to negative consequences.
Additionally, data supports that the stressors experienced by Black, Asian, Latin-x, and Indigenous people of color students often go untreated at a higher rate than their white counterparts.3 This can be attributed to their experience with systemic racism and bias. However, compounding this is that a higher percentage of these students identify as low-income and/or first-generation college students than do their white classmates — helping lead to significant impacts on their overall health and wellbeing.
COVID-19 impacts on student wellbeing
In the last two years, COVID-19 has had a significant impact on college students’ health and wellbeing. However, research from Hope Center for College, Community, and Justice at Temple University highlights the impacts may have been greater to non-white students due to racial and socioeconomic disparities among students who were infected by the virus.4
Part of this is because students of color reported having been sick with COVID-19 at higher rates. Data showed that 14 percent of Indigenous students, 10 percent of Latinx students and seven percent of Black students said they believed they had caught the virus compared to six percent of white students.5
In addition to reporting they had contracted COVID-19, Black, Asian, Latin-x, and Indigenous students reported they were more likely to experience anxiety, depression, and food insecurity. This was attributed to a greater loss in loved ones, financial challenges, and inadequate access to healthcare due to shifts to remote learning.
The role of Social Determinants of Health (SDoH) racial disparities
Some students that we provide coverage for come from countries that have nationalized healthcare and are not aware of the procedures or preferred ways to receive appropriate care in the United States. Further, their healthcare options at home may have been limited, so challenging care options or seeking alternatives may not be an apparent option.
Disparate students from the U.S. might feel that challenging care options in a system with institutionalized biases and racism is useless. Lastly, some students may have an engrained mistrust of the medical system due to racism and unfair treatment from medical providers, both in the U.S. and in their homeland.
Studies show that Social Determinants of Health (SDoH) play a larger role in healthcare outcomes than the quality of care provided by healthcare professionals.6 SDoH include factors such as economic stability, education, access to food, neighborhood/physical environment and community and social context.7 In addition to some of the SDoH themselves being disparate factors in healthcare outcomes, racial and ethnic minorities are more likely to be adversely affected by SDoH, doubling their burden. Healthcare providers need to consider addressing SDoH since simply addressing a diagnosis will, by itself, likely lead to ineffective care in disparate populations.
How we can reduce disparities in the healthcare system
Studies have shown that the disparities are primarily based in issues with the system. Practitioners play a role in healthcare outcomes when students visit them. For some students, there is a mistrust or an apprehension for the care, so it is so important that trust is built from the onset. There needs to be a foundation of trust, built on compassion and empathy for the patients. In other words, they need to look beyond their ailment to identify what is going on with their lives to understand their backgrounds and beliefs, whether they’ve experienced trauma, prejudice, etc. They need to understand if there is something deeper that needs to be uncovered?
The goal of the practitioner should be to understand who the patient is and what external factors may impact their medical care. By taking more into account than acute symptoms, providers can remove any unconscious bias and treat the person on their individual needs.
This starts with listening to the patient and gaining an understanding of who they are to aid in helping them get well. When engagements start by building trust, it is easier to diagnose key issues and provide more appropriate individual treatment options. This helps ensure that treatments are followed. Care providers need to be cognizant that the people they treat are going to live with the consequences of their diagnosis, coverage, treatments, etc. By looking at the ‘whole’ person, it helps promote equity and inclusiveness – leading to better outcomes.
The path forward
In addition to better training and awareness for healthcare professionals, there needs to be better plan communications, a greater emphasis on increasing the proportion of underrepresented racial and ethnic minorities in the healthcare community, and increased government and private sector funding.
In analysis of the 2018 census, it was found that about 13 percent of the U.S. population was Black, but only 5.4 percent of physicians were Black.8 Further, data showed that black doctors earn about $50,000 less than their white counterparts. What makes this even more disparaging is that according to the Association of American Medical Colleges (AAMC) in 2020-2021, less than 12 percent of medical school applicants identified as African American.9
Additionally, there needs to be better funding for ethnic students from low-income households looking to enter the medical field. Further, government subsidies to low-income healthcare systems need to increase, to improve the level of care as well as the salaries of the medical professionals. The improvements in facilities and salaries will help attract and retain ethnic talent in financially depressed areas that have been looked at unfavorably.
Fortunately, better care can start with better training, outreach, and services for student members. Campus health centers can lead the charge by:
- Communicating – Students should be notified of and encouraged to engage with available wellness programs, including general care and wellness, behavioral health services and financial wellness. The communication resources should be available in students’ native languages.
- Collaborating – Through regular engagement with diverse students, including international students, those of color, and those with disabilities, as well as the partners who serve them, plans can be developed to improve their understanding of and utilization of healthcare.
- Advocating – Programs should be put in place for students and other community members to get assistance regarding questions or concerns, including financial assistance for students.
Further, there needs to be more government intervention to improve access to care and reduce financial burdens for racial and ethnic minorities. Evidence shows that expanding coverage is strongly associated with improved mortality outcomes, poverty reductions, and protection from debilitating financial bills. It also moves the system closer to equitable access to healthcare.10
Resources:
[1] Bradley University. (n.d.) Diversity in higher education: Statistics, Gaps and Resources. Retrieved on March 3, 2022, from https://www.ucda.com/journal/diversity-in-higher-education/.
2 NYU. (n.d.). Stress. Retrieved on March 3, 2022, from https://www.nyu.edu/life/safety-health-wellness/live-well-nyu/priority-areas/stress.html.
3 Baciu A, Negussie Y, Geller A, et al. (2017, January 11). The State of Health Disparities in the United States. Retrieved on March 3, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK425844/.
4 Goldrick-rab, Sara., Coca, Vanessa., Gill, Japbir, et al. (2021, August). August 2021 research brief – Self reported COVID-19 infection and implications for mental health and food insecurity among American college students. Retrieved on March 3, 2022, from https://hope4college.com/wp-content/uploads/2021/08/COVID19-Infection-Implications.pdf.
5 Baker-Smith, C., Brescia, S., Coca, V., Conroy, E V., Dahl, S., Gill, J., Goldrick-Rab, S. et al (2021 August) #Realcollege 2021: Basic needs insecurity during the ongoing pandemic. Retrieved on March 3, 2022, from https://hope4college.com/wp-content/uploads/2021/03/RCReport2021.pdf.
6 Schroder, SA (2007). We Can Do Better: Improving the Health of the American People. NEJM, 357:1221-8. Retrieved on March 3, 2022, from https://www.nejm.org/doi/full/10.1056/nejmsa073350.
7 Heiman, H.J., and Artiga, S. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Issue brief. The Henry J. Kaiser Family Foundation. 2015. Retrieved on March 3, 2022, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.
8 Preidt, Robert. (2021, April 21). Little Progress in Boosting Numbers of Black American Doctors. Retrieved on March 3, 2022, from https://www.usnews.com/news/health-news/articles/2021-04-21/little-progress-in-boosting-numbers-of-black-american-doctors.
9 Heiser, Stuart. (2021, December 8). Medical School Enrollment More Diverse in 2021. Retrieved on March 3, 2022, from https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021.
10 Baumgartner, J.C., Zephryn, L. (2022, February 2). How Health Care Coverage Expansions Can Address Racial Equity Retrieved on March 3, 2022, from https://www.commonwealthfund.org/blog/2022/how-health-care-coverage-expansions-can-address-racial-equity.
