Promoting equity in healthcare is a global priority, yet socially disadvantaged and marginalized groups continue to report inadequate care, often stemming from discrimination and stigma. Research underscores that ‘race’ and ethnicity are central to health inequities, intricately linked to racism and xenophobia. These disparities manifest across different countries, affecting diverse ethnic and racial minority groups.
Studies from North America, Australasia, and Europe reveal that ethnically and racially minoritized patients face adverse health outcomes, such as higher risks of birth complications, increased mortality, and poor treatment. These outcomes persist even when controlling for socio-economic status and education. Conversely, achieving health equity requires eliminating such disadvantages and discrimination.
Understanding Health Inequities
The terms health inequity, inequality, and disparity are often used interchangeably, but they differ significantly. Health inequalities and disparities refer to systematic health differences between groups, while health inequity refers to inequalities based on unjust systemic and structural conditions. Addressing these requires different problematizations and solutions.
Despite extensive research documenting health inequities, less focus has been placed on how these inequities manifest in clinical practice. To reduce disparities, it is crucial to consider structural conditions affecting care and treatment. This perspective implies that patient-staff encounters are shaped by broader systemic structures.
Standardized Treatment: A Double-Edged Sword
Standardized treatment, such as Enhanced Recovery After Surgery (ERAS), aims to ensure optimal patient outcomes through evidence-based, uniform care. This approach is perceived as neutral, based on a ‘one-size-fits-all’ rationale. However, research indicates lower adherence to ERAS protocols among minoritized populations, with the mechanisms largely unexplored.
Orthopedic surgery, often following ERAS protocols, highlights ethnic and racial disparities, including underutilization of surgery and poor postoperative outcomes. Increasing adherence is seen as a solution to mitigate these disparities. Adherence involves actively choosing to follow guidelines, a concept more affirmative than compliance.
“Adherence is proactive behavior, actively choosing to follow predefined guidelines.”
ERAS Pathways and Patient Adherence
ERAS pathways consist of five key elements: preoperative information, surgical stress, pain management, early mobilization, and oral nutrition. Except for surgical stress, these elements require active patient compliance. Healthcare staff face dilemmas in balancing standardized care with individual patient needs to mitigate disparities.
Exploring the connection between adherence and ethnicity is crucial. Ethnically minoritized patients’ health behaviors are often scrutinized under a lens of (non)adherence, affecting their treatment and care.
Ethnographic Insights from Denmark
An ethnographic study conducted in two orthopedic departments in Denmark provides insights into how hospital staff position ethnically minoritized patients during standardized treatment. Denmark’s universal healthcare system aims for equal access, yet disparities persist.
The study involved participant observations and interactions with patients, relatives, and hospital staff. It revealed that staff often attribute nonadherent behavior to essentialized and stereotypical understandings of ethnicity, linked to cultural food habits, collectivist family structures, and perceived un-stoic pain behavior.
“Nonadherent behavior is entangled with essentialized and stereotypical understandings of ethnicity.”
Challenges in Clinical Practice
Preoperative information is crucial for ERAS pathways, yet ethnically minoritized patients often face barriers due to language and cultural differences. Nutritional guidelines also pose challenges, as patients’ food habits may clash with hospital protocols. Early mobilization is hindered by family-oriented structures, while pain management is complicated by stereotypes about ‘ethnic pain.’
These challenges highlight the need for healthcare staff to navigate conflicting demands, providing standardized care while accommodating diverse patient needs.
Implications for Healthcare Equity
Addressing ethnic disparities in healthcare requires a shift from focusing solely on individual patient behavior to examining systemic structures. Equity-oriented healthcare emphasizes transforming systems that produce unmerited advantages and disadvantages.
Standardized treatment, while aiming for equality, risks concealing biases that marginalize certain groups. Incorporating health inequities into research, policy, and clinical practice is essential to improve outcomes for all patients.
“Equity-oriented healthcare shifts focus from individual behavior to systemic transformation.”
As healthcare systems strive for equity, understanding and addressing the structural roots of disparities is crucial. This involves recognizing the complex interplay of ethnicity, culture, and standardized treatment in shaping patient experiences and outcomes.
Ultimately, achieving health equity requires a comprehensive approach that considers both individual and systemic factors, ensuring that all patients receive fair and just care.
