In medicine, racial and economic differences determine both the quality and the type of health care an individual receives, and this is unacceptable. The disparities in health outcomes between whites and people of color are exceedingly stark. This is true across the field—from conventional medicine to Functional Medicine and beyond. At The Institute for Functional Medicine (IFM), we believe that this must change, and that change must begin now.

Closing this health care gap begins by examining our core values and mission to ensure the widespread adoption of Functional Medicine. This mission, perhaps once loosely defined, has become clear. It does not mean to ensure the adoption of Functional Medicine for those who can afford it; it does not mean Functional Medicine for the elite or those who have been born with a certain skin color. It is all encompassing. Our mission is to ensure the widespread adoption of Functional Medicine for all.

Why now? One might attribute this clarity to COVID-19 or to the recent unacceptable deaths of George Floyd, George Floyd, Breonna Taylor, Ahmaud Arbery, and others, and certainly, these cataclysmic events have propelled our thinking forward. In health care, the flaws that have been apparent for decades are amplified in this environment, particularly inequities in access to care. The system is irrevocably broken, and in today’s environment, the cracks and the fissures are bigger than ever. Inadequacies are laid bare, and they are undeniable in their form.

And, yet, again we ask truly, why now? The answer: Simply put, because it is long overdue. It is time to be bold and take decisive action to ensure that a zip code, net worth, or skin color is not a determinant of one’s health.

“For certain, those who need Functional Medicine the most are not receiving this care. Many of those who are the most susceptible to COVID-19 are also facing chronic disease; these qualities encapsulate the essential worker—those at the front-line who cannot work from home. Statistics show that minority populations in the US disproportionally make up essential workers.”

COVID-19 has turned the spotlight on public health issues, and in particular, the public health crisis of racism. It did so by highlighting the root causes—the social determinants of health. We know that the disparities seen in health and health care are not the result of personal health and lifestyle choices alone. Much of this stems from implicit biases and unconscious stereotypes that can negatively influence patient-provider communication and result in worse healthcare outcomes for the most vulnerable populations.¹

Social determinants of health often start before birth, in the prenatal period of previous generations through epigenetics, and are complicated by a lack of availability of healthy food, a lack of access to equitable health care and a lack of trust in the healthcare system. The medical literature shows that people of color are less likely to receive preventive health services, and that they experience poorer quality medical care than whites.²

Middle-aged Black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their white counterparts.³ Despite the fact that minority groups will become the majority nationwide within 30 years,⁴ 13.8% of Blacks report having fair or poor health compared with 8.3% of non-Hispanic whites.⁵

This issue may be compounded by the fact that the makeup of physicians in the U.S. does not mirror the population. Just over 6 percent of recently graduating physicians are black, perhaps due in no small part to the lack of diversity among academic medical faculty: just 3.6% of faculty at U.S. medical schools are black, while nearly two-thirds are white.^6,7

“It is time to be bold and take decisive action to ensure that a zip code, net worth, or skin color is not a determinant of one’s health.”

For certain, those who need Functional Medicine the most are not receiving this care. Many of those who are the most susceptible to COVID-19 are also facing chronic disease; these qualities encapsulate the essential worker—those at the front-line who cannot work from home. Statistics show that minority populations in the US disproportionally make up essential workers.⁸

According to Sharrelle Barber of Drexel University Dornsife School of Public Health, as reported in an April 2020 edition of the Lancet, the pre-existing racial and health inequalities already present in the US are being exacerbated by the COVID-19 pandemic. These front-line workers typically don’t have the privilege of staying at home.⁸ Grocery store and restaurant staff, front-line healthcare practitioners, delivery drivers, factory and farm workers, and others are putting themselves and their families at great risk to themselves and their families to protect and bring comfort to others.

In order for this to change, there must be a renewed focus on improving access to quality care across all sectors of the health care system. In the Functional Medicine community, we must agree that in order to truly meet our mission of the widespread adoption of Functional Medicine for all, our evolved primary focus must be on access to care.

To improve access, we need to ask the right questions. We need to learn why many in the population who could benefit the most from a Functional Medicine approach, including essential workers and their families, aren’t aware of or able to access this kind of care.  And we need to identify and act on what we can do to build trust between the Black community and clinicians. We look forward to locking arms with all branches of healthcare in this effort.

To do this critically important work, we will find partnership in clinicians and others from across the field to help inform and implement our decisions and our direction. Driving systems change requires a village of diverse thinkers, innovative disruptors, and risk takers. IFM is fortunate to have many of these types of leaders among us already, but we need so many more, especially leaders of color.

References

1. Gray DM 2nd, Anyane-Yeboa A, Balzora S, Issaka RB, May FP. COVID-19 and the other pandemic: populations made vulnerable by systemic inequity. Nat Rev Gastroenterol Hepatol. Published online June 15, 2020. doi:10.1038/s41575-020-0330-8
2. Hostetter M, Klein S. In Focus: Reducing racial disparities in health care by confronting racism. The Commonwealth Fund. Published September 27, 2018. Accessed June 29, 2020. https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confronting
3. Quiñones AR, Botoseneanu A, Markwardt S, et al. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One. 2019;14(6):e0218462. doi:10.1371/journal.pone.0218462
4. National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. National Academies Press; 2017. doi:10.17226/24624
5. Berchick ER, Hood E, Barnett JC. Health insurance coverage in the United States: 2017. US Census Bureau. Published September 12, 2018. Accessed June 26, 2020. https://www.census.gov/library/publications/2018/demo/p60-264.html
6. Noe Ansell DA and McDonald EK. Bias, Black Lives, and Academic Medicine. N Engl J Med 2015; 372:1087-1089 DOI: 10.1056/NEJMp1500832
7. Castillo-Page L. Diversity in medical education: facts and figures 2019. Washington, DC: American Association of Medical Colleges, 2019. (https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019 )
8. Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-1244. doi:10.1016/S0140-6736(20)30893-X