tion groups. On the other hand, your patients likely will reflect the manifestations of these disparities on a regular basis. Where you practice also has a direct influence on the frequency of population-based disparities that you encounter as you work towards improving the outcome of patients with conditions such as asthma, diabetes, hypertension, and heart failure. Inequalities in health outcomes also will impact your ability to score well on measures that are published through the Minnesota Community Measurement program. To put the question another way: What, if anything, can engaged and motivated physicians do to address these disparities in health outcomes for different population groups? Johnny’s story highlighted many of the disadvantages and challenges to improved health status that many MDH disparity reports reflect. The likelihood of any individual physician having a significant impact is low, but that could change if doctors worked collaboratively to end health disparities. Recommendations for change A survey by the UnitedHealth Foundation found that Minnesota ranks 46th in public health funding. This is a sad commentary that contrasts with an otherwise stellar showing in health status outcomes. Without increased support for public health infrastructure, our national ranking likely will diminish over time. Physicians can and should encourage their legislators and local elected officials to boost this support. A physician can even go so far as to participate in a work group or community advisory group. Working with and supporting community groups that address the root causes of health disparities is another opportunity for physicians to actively bring about change. This involvement should not require a huge commitment of time. It often is surprising how much traction community groups can gain with the sup-
port and input of a physician. To make significant progress reducing health disparities will take a higher level of support and commitment. Physicians can have the biggest impact by working in conjunction with public health officials, hospital systems, the Legislature, and any other relevant groups. Getting to the modifiable root cause or causes of disparities should be a first step despite the lack of data and analysis that might help point to the issues. How does unmarried childbearing impact disparities? Getting back to Johnny’s story, he had many disadvantages that could easily overwhelm and discourage even the most committed champion for change. On the other hand, one of the critical events that shaped his entire life was his premature birth at 29 weeks and the complications that he experienced. One of the bigger modifiable risk factors for preterm births, low birth weight deliveries, and small-forgestational-age infants is being born to an unmarried mother (Maternal and Child Health Journal, 2011). This is a variable that is independent from poverty, but often is compounded by the lower socioeconomic status of unmarried women. Non-marital childbearing has increased from an average of 18 percent in 1980 to 40 percent in 2007. There are significant differences in ethnic groups for non-marital child bearing, with African American families at roughly 70 percent compared with whites at 25 percent. In addition, single-parent families are at increased risk of poverty with its associated health risks. Here, non-Hispanic black children are two and a half times more likely to be raised in a single-parent family than the average for the country (32 percent versus 13.6 percent according to the Family Structure and Children’s Health in the United States, Centers for Disease Control, 2010, Series 10, Number 246). Single mothers living in poverty and being at a higher risk for delivering a preterm baby is an area that
needs more investigation when it comes to health disparities. This risk factor does not seem to be actively discussed or included in many conversations about disparities, but will need to be thoroughly explored if the state wishes to make even more progress in this area. An opportunity for change At the end of the day, what can physicians do to help change the course of disparities in health outcomes? Becoming actively engaged in the conversation is a good first step. En-
couraging elected officials and public agencies to join in creating successful interventions is another option. Finally, ensuring that we are getting to the real root causes of health status disparities will be essential if we are going to make significant progress. That would be a great agenda for the physician community to champion. Peter Dehnel, MD, is a pediatrician and co-chair of the Twin Cities Medical Society’s Legislative and Public Policy Committee.
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Respiratory Therapy | Infusion Nursing & Pharmacy Home Care Nursing | Clinical Support Services January 2015 Minnesota Physician
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