HJNO Nov/Dec 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2020 11 what we did. Not everyone has a medi- cal school that can do their own testing in house, and most universities our size don’t have the resources we have. Editor I understand part of your inter- est is health disparities/outcomes among races. ProPublica reported recently that in Mississippi, African-Americans had a dis- proportionally high occurrence of ampu- tations than Caucasians with the same dis- ease. Are we seeing those same outcomes in Louisiana? LaVeist I don’t know the data for Louisiana, so I can’t speak to that. But I can say, that is not a new finding. It is something that’s been noted for years, nationally. I would suspect that Louisiana does have similar statistics as Mississippi, but I just don’t know. Editor In a television interview last year with the Healthcare Journal of Baton Rouge, then Secretary of Health, Re- bekah Gee, an OBGYN, said that racism was causing unnecessary post-partum deaths in African-American mothers at hospitals. Do you agree? LaVeist Well, I hesitate to disagree with Rebekah Gee. But again, I’m going to have to punt on this one, because I just don’t have the Louisiana data on that specific question. I would say that my instinct, given what I do know from a national standpoint, is that is probably an accurate statement. I think rac- ism plays a huge role in health outcomes in general. I don’t know why Louisiana would be any different from other parts of the country. Editor What practical advice can you give practitioners in dealing with racial health inequities? LaVeist I think one practical thing I would say is that it’s important to check your assumptions. Everyone has biases. It is sim- ply the way the human brain is wired. We are designed to take a tremendous amount of information and try to distill it into some- thing that we can digest. We do that by cre- ating heuristics. Another word for heuristics in this context is stereotypes. You see a pat- tern, and you say, “Well that pattern happens here,”and you see something else going on, “Well it’s probably the same pattern again.” Many times, that is the case, so we create stereotypes. It helps us to process a lot of information. But, when you’re dealing in the clinical setting, you can’t. You have to take that part of our natural inclination and set it aside and deal with the specific individual that’s in front of you. While it is the case that people in certain ethnic groups or people in certain cultural groups may have certain patterns and there may even be certain culturally related beliefs and values of that group, it doesn’t mean that every single member of that group prescribes to that belief or that value, even though it’s part of their culture. You can’t just assume this person is a member of that group and people in that group do this. You can’t just operate that way when you’re dealing one-on-one with an individual person. You have to say people in that group tend to have this proclivity, but I need to make sure that this specific indi- vidual fits into that pattern as well before I make decisions. The perfect example is the story my sister told me when she went in and had a preg- nancy test. Immediately, the physician starts counseling her about abortion. Her response was, “Well, maybe before we consider an abortion, I should have a conversation with my husband about whether or not he thinks I should abort the child that we’ve been deliberately trying to have.” The ste- reotype was “young black woman pregnant,” must be a single mother. Let’s see if we can talk about abortion. When in reality, this was a married woman who was trying to get pregnant; this was what she was trying to accomplish. This was operating on ste- reotypes rather than operating on the basis of this specific individual, making decisions and making assumptions rather than deal- ing with the person. You need to deal with the individual per- son in front of you and not deal with the fact that they’re a part of a certain group. Whatever understanding you have about that group, even if it is accurate, it may not be accurate for that particular person. Editor You said that the reason you went into public health was because you wanted to understand why racial disparities exist. Do you know now? LaVeist I understand a lot more now than I did then. That was 30-plus years ago in the 1980s. At that time, we knew a lot less about racial disparities than we do now. Some things, [I’ve learned] through my work and other people’s work as well. The trick is, what do you do about it?The explanation of why the disparities exist, we understand a lot better. I still don’t think we have all the solutions. Most of what affects health disparities is not a health care issue. Most of what affects the health of the “It’s all of these factors—the environment, the social interactions between people—that affect the health disparities issue, and some of those are not things that healthcare systems have resources to affect.”