Rainbow lgbtq pride flag and trans pride flag.

Sexual Orientation and Gender Identity in Medical Records Can Reduce Disparities

By Jenna Becker

Sexual orientation and gender identity (SOGI) data is widely considered crucial to providing competent care to LGBTQ+ patients. This data can also be used to reduce health disparities among sexual and gender minority populations.

Most electronic health record (EHR) vendors are able to document SOGI data. Many health care systems across the country have been collecting SOGI information for several years. However, SOGI documentation is not broadly required. It’s time to require SOGI data collection in EHRs nationwide.

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NHS building

Update on Developing a Culture of Patient Safety in the NHS

By John Tingle

There are no quick fixes to developing an ingrained patient safety culture in health systems — change will not happen overnight. Nevertheless, the National Health Service (NHS) and the government in the U.K. are committed to continuing to improve patient safety.

In 2019, NHS England and NHS Improvement laid down an NHS Patient Safety Strategy roadmap, which continues to hold potential one year later.

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an ambulance parked at the entrance of an emergency department

The Double Bind of Medicine for Racial Minorities

By Craig Konnoth

Medicine often falls short of helping black, indigenous, and people of color (BIPOC). While many individuals successfully invoke medical framing to offer some assistance to address the serious burdens they face — as I explain in a recent article — such efforts have fallen short in the context of racial justice. BIPOC are either subject to hypervisibility — where their medical trait is made a defining characteristic of their existence — or medical erasure, where their medical needs are left unaddressed and ignored.

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computer and stethoscope

How Telehealth Could Improve — or Worsen — Racial Disparities

By Craig Konnoth, JD, M.Phil., Wendy Netter Epstein, JD, and Max Helveston, JD

Despite upping the stakes of America’s partisan divide, the pandemic has prompted bipartisan support for at least one cause — the rapid rollout of telehealth, which allows people to see their doctors by videoconference or telephone.

In last week’s executive order, the Trump Administration reaffirmed its commitment to the use of telehealth. While telehealth may be, in many ways, a panacea for access to healthcare, particularly in COVID times, we should be concerned that patients of color may be left behind.

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Medicine doctor and stethoscope in hand touching icon medical network connection with modern virtual screen interface, medical technology network concept

Regulation of Access to Clinical Data in Chile’s New Constitution

By Gabriela Y. Novoa and Alexis M. Kalergis

As Chileans prepare to vote on whether or not to create a new Constitution, an issue worth considering relative to this reform concerns access to clinical data.

The Political Constitution of the Republic of Chile dates back to 1980, and, in the past decades, has undergone several amendments, including key reforms in August 1989, August 2005, and August 2019. As part of this last modification, it was agreed to organize a plebiscite to democratically decide whether or not to elaborate an entirely new constitutional text. If the alternative of generating a new constitution is adopted, it will consist of a constitution written from square one, rather than a modification to the existing text.

As part of the public discussion relative to the potential approval of the need for a new constitution, an open debate has taken place about which issues should or should not be incorporated into this new text.

Among several important themes, the need to regulate the access to clinical data of patients, also called “interoperability,” arises as a major one. Such an issue is linked to the rights to life, to health and privacy protection, individual honor and personal data and property, which are currently established as constitutional guarantees by Article 19 of the current Constitution. Further, the legal framework dealing with this issue is currently mainly found in Law No. 20,584, which regulates the Rights and Duties of individuals in connection with actions associated to their health care, and in Law No. 19,628 (on the protection of the privacy of individuals).

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Busy Nurse's Station In Modern Hospital

Violence Against Health Care Workers: Legislative Responses

By Stephen Wood

COVID-19 and other diseases aren’t the only threat to health care workers. Violence in the workplace is a common occurrence and on the rise.

Despite these troubling trends, the policy response at both federal and state levels has, so far, been lacking.

In a recent survey of nurses, 59% reported that they had been the victims of workplace violence. More than half of those respondents went on to report that they were not satisfied with how the incidents were handled.

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Medicine law concept. Gavel and stethoscope on book close up

Addressing Racism through Medical-Legal Partnerships

By Medha D. Makhlouf

Numerous studies have documented that racism is a social determinant of health (SDoH) that negatively impacts Black, Indigenous, and people of color (BIPOC). As such, racism is one of “the conditions in which people are born, grow, live, work, and age” that are “mostly responsible for unfair and avoidable differences in health statuses.”

The U.S. health care system was not designed to respond to SDoH, much less to address racial health disparities. In fact, U.S. health care institutions have racist legacies that continue to influence the way they operate today. When health care providers fail to confront racism within and outside their walls, they perpetuate the racial health disparities that have plagued our nation since before its founding.

Medical-Legal Partnership (MLP) is a model of collaboration and joint advocacy between lawyers and health care providers who seek to improve social conditions that affect health and well-being. MLPs aim to address SDoH on three levels: direct representation in civil legal matters, institutional change, and systemic advocacy. They typically employ legal interventions to ensure that people’s basic needs are met, such as nutritious food, health care, income, safe and stable housing, and uninterrupted energy and water utilities. Improving access to such resources is an important way of engaging with the work of health equity.

While some MLPs incorporate a racial justice lens in their work, many do not. MLPs are generally more oriented toward addressing the effects of racism as a SDoH, rather than as the cause of poor health. But considering the cross-cutting nature of racism as a SDoH, MLPs can and should address it directly. As Director of the MLP Clinic at Penn State Dickinson Law, whose faculty has resolved to incorporate discussions of racism and inequality in the curriculum, I have begun researching Critical Race Theory (CRT) as a framework to understand how MLPs can build on their core activities to further address racism as a SDoH and make explicit the connections between racism and poor health. This post describes how MLPs can address racism as a SDoH in at least four ways that align with the goals of CRT.

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Man holds up a sign at the Black Lives Matter protest in Washington DC 6/6/2020.

How Social Movements Shape the Law to Address Health Disparities

By Aziza Ahmed

We are facing a health crisis in America. In thinking through the causes of health disparities, a now well-developed body of public health law scholarship focuses in on the central issue of law as a social determinant of health. This scholarship examines the issue of how legal rules can determine health outcomes. Property laws that explicitly or implicitly discriminate against minorities, for example, often result in poor Black communities living in neighborhoods in which they may be more exposed to pollutants, resulting in higher rates of breast cancer or asthma. Or, immigration practices, including ongoing profiling at the border, as well as detention practices, may have mental and physical health impacts.

What is missing from legal scholarship on the social determinants of health is an account of how communities respond to change the legal environments that have the effect of producing poor health outcomes. In other words, how do communities demand a better legal system with regard to health inequality? Here, we must turn to social movements who often drive our national conversation on access to health care by doing the hard work of identifying, naming, and drawing attention to the complexity of issues that people face.

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Civil rights march on Washington, D.C. Film negative by photographer Warren K. Leffler, 1963. From the U.S. News & World Report Collection. Library of Congress Prints & Photographs Division. Photograph shows a procession of African Americans carrying signs for equal rights, integrated schools, decent housing, and an end to bias. https://www.loc.gov/item/2003654393/

Structural Racism: The Root Cause of the Social Determinants of Health

By Ruqaiijah Yearby, J.D., M.P.H.

In 1906, W.E.B. DuBois noted that social conditions, not genetics, impacted the health of Blacks, causing racial disparities in mortality rates. In 2010, the federal government formally recognized that social conditions, specifically the social determinants of health (SDOH), were responsible for racial health disparities.

Racial health disparities, estimated to cost the United States $175 billion in lost life years and $135 billion per year in excess health care costs and untapped productivity, persist because of the failure to address their root cause: structural racism.

Structural racism describes the way our systems are structured to produce racial inequalities between whites and racial and ethnic minorities in the SDOH, leading to racial health disparities.

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Woman holding sign that reads "I can't breathe."

Black Women Can’t Breathe

By Michele Goodwin

Years before George Floyd begged to be released from under the knee of Officer Derek Chauvin, Barbara Dawson, a fifty-seven year old Black woman, died begging a police officer, John Tadlock, not to remove her oxygen mask. Her death occurred right outside the Calhoun Liberty Hospital in Blountstown, Florida, shortly before Christmas in 2015.

Just before Officer Tadlock’s arrival, Ms. Dawson arrived at the hospital seeking oxygen. The hospital’s response to Ms. Dawson’s request was to call law enforcement. Photographs show Ms. Dawson slumped next to the police car. A police recording captures the tragic end of Ms. Dawson’s life. Officer Tadlock reprimands Ms. Dawson: “Falling down like this and laying down, that’s not going to stop you from going to jail.”

Ms. Dawson’s life ended on the pavement, feet away from the entrance of the hospital that phoned the police on their patient — because she refused to leave. She lay there nearly twenty minutes before being pronounced dead. It turns out she had a blood clot in her lungs.

In some sense, there is nothing extraordinary about the image of Ms. Dawson, or the interactions of the hospital and officer, which further complicates the deadly exchange. Indeed, the interaction was far too normal: Black women fear for their health and safety when they do not seek care and, troublingly, even when they do.

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