Health care officials wrestle with  ongoing racial health disparities in nation’s capital 

By Helen Bezuneh
Special to the AFRO

As the U.S. confronts a fresh surge of COVID-19 infections this winter, the ongoing issue of racial health disparities in D.C. continues to show nagging gaps.

While D.C. is home for some of the nation’s highest ranked medical centers, data from the District’s eight wards show uneven health outcomes. Residents in predominantly White Ward 3 have a life expectancy averaging 87.6 years, yet life expectancy is 74.7 years for residents in Ward 7 and 72 years in Ward 8, according to Conduent Healthy Communities’ 2023 Health Equity Index.

“Those living in Ward 8 are 2.5 times more likely to die from cancer, four times more likely to die from heart disease, six times more likely to die from diabetes and, for Black mothers in D.C., the maternal mortality rate is 10 times the national average,” Mara Vandlik, spokesperson for Unity Health Care, largest health care system east of the Anacostia River, said.

Those numbers echo troubling conclusions reached in a 2021 study conducted by AARP District of Columbia and Georgetown University’s Department of Health Administration. The study found that rates for heart failure, diabetes, stroke, chronic obstructive pulmonary disease and asthma in D.C. were two to three times higher in Black older adults than their white counterparts.

“At Unity, 90 percent of our patients are people of color and approximately 70 percent live below the federal poverty line,” Vandlik said.  “We know that the life expectancy difference between Ward three residents and Ward eight residents, where we have a strong footprint, is 16 years.”

D.C. is home for seven general acute care hospitals, two long-term acute care hospitals, two psychiatric hospitals, one pediatric acute hospital, one rehabilitation hospital, two community hospitals and four level-one trauma centers. 

But when D.C. health analyzed health care disparities In a 2018 health equity report, it found that clinical care accounts for only 20 percent  of what influences health outcomes. It found that the critical social determinants of health are income, education, transportation, housing and employment. 

A shortage of medical professionals may also contribute to the racial health disparities observed in D.C. The District has nine Health Professional Shortage Areas (HPSAs) and eight Medically Underserved Areas (MUA), areas that are experiencing a shortage of primary health care services, according to D.C. health. 

Although social determinants significantly impact the health outcomes of D.C. residents, hospitals have developed specific plans to address and mitigate racial health disparities in the area. 

Children’s National Hospital has 10 target areas to measure equity in care, some of which include sickle cell anemia, telemedicine access and pain management in the emergency department for long bone fractures, according to their 2023 diversity report. In July 2020, the hospital established a bias review committee to pinpoint and report bias. 

The District of Columbia Hospital Association’s  (DCHA) Diversity, Equity and Inclusion Committee have developed strategies to broaden access to care and enhance health outcomes among those disproportionately facing poor outcomes.

Such efforts are aimed at “ensuring accountability, mitigating bias, diversifying leadership, developing workforce pipelines, purchasing and investing locally and addressing the social needs of the community as well as hospital operations and staff,” DCHA president and CEO Jacqueline D. Bowens told the AFRO. “Hospitals report progress through key metrics and shared expertise to facilitate collective learning and improvement.”

MedStar Washington Hospital Center and MedStar Georgetown University Hospital recently developed the D.C. Safe Babies Safe Moms (SBSM) initiative, which aims to improve maternal and infant health outcomes –– especially for Black birthing people, who face a higher risk of poor maternal health outcomes compared to their white counterparts. In 2023, the Lown Institute recognized MedStar Washington as the most socially and racially responsible hospital in D.C.

“It is well-documented that health is impacted by racial inequities, economic factors and other

structural challenges that disproportionately impact communities of color,” Brendan McNamara, MedStar Health’s director of public relations for the D.C. region, told the AFRO in a written statement. “MedStar Health is taking action through clinical practice, research and community programs to evolve our organization to deliver equitable care and improve the health of the communities we serve so that all our patients can achieve the best outcomes, regardless of neighborhood, race or creed.”

MedStar Health has also conducted research to examine how and why racial disparities emerge within the varying sectors of their hospital system. In particular, they have analyzed the prevalence of bias in the process of selecting patients for enlistment in clinical trials. 

“Earlier this year, in a first-of-its-kind study, MedStar researchers found that biases in screening

potential participants for cardiology clinical trials may account for disparities in clinical trial enrollment,” McNamara added. “Their results illustrate opportunities to make clinical trials more equitable across the MedStar Health system and other healthcare settings nationwide, including the need for study design to consider diversity with less restrictive criteria, to allow more patients to participate and thus offer findings that are more representative and inclusive to our country’s demographics.”

A recent study conducted by MedStar researchers explored how systemic racism contributes to patient safety events, exploring how bias and other factors can disproportionately harm patients of color.

“Based on our findings,” McNamara wrote, “MedStar Health is enacting changes to how we approach patient safety and achieve our goal of zero harm: One, we now incorporate patient race and ethnicity data in our voluntary safety reporting to promote transparency; and two, associates responsible for reviewing serious safety events receive training regarding how discriminatory bias can influence patient outcomes and safety. The MedStar Health process for reviewing serious safety events includes an assessment of the role that implicit bias may have played in the event.”

As documented racial health disparities in the region persist, D.C.’s hospitals will continue to design new ways to target racial health disparities, all aimed at hopefully equalizing health care outcomes in  the District’s eight wards.

“I want to increase the average life expectancy in the District,” United Health Care’s Dr. Jessica Henderson Boyd says. “When I think of what success looks like, I’m focused on health equity and improving the outcomes of our patients.”