As calls increase to correct longstanding inequities in healthcare, pharmacists are exploring ways to improve training and practice to better serve marginalized groups.
By Joseph A. Cantlupe
While discriminatory practices in healthcare settings have existed for decades, the COVID-19 pandemic further revealed inequities rooted in the longstanding unequal treatment of minorities in this country. Academic pharmacists are committing to racial justice, beginning with changes to improve minority enrollment at colleges and universities and by seeking to boost minority faculty numbers. They also say there should be significant curriculum revisions to address inequities, and new language and cultural opportunities in pharmacy schools to better serve the health of diverse communities. Pharmacy schools can help lay the groundwork for needed changes within the profession to improve outreach and care to patients in minority groups.
These issues were raised in a recent AACP webinar, “Mistrust in the U.S. Healthcare System Among Marginalized Groups,” which included a panel of academic pharmacy leaders representing minority groups who challenged leaders within the profession and elsewhere to overcome discriminatory practices. Pharmacists have been doing more to provide innovative practice models and services that directly engage the patient in ways that will decrease health disparities, said Dr. Hope Campbell, associate professor of pharmacy practice at Belmont University College of Pharmacy, but “you still have individuals experiencing racism that is baked into the system.”
During the pandemic, pharmacists have helped expand access and increase public education about the vaccines, she said. “They became more involved in public health, ran mobile clinics, did contact tracing, collaborated with local authorities and nonprofits.” Over the years, however, decisions, policies and procedures have led to disparate outcomes. “We have this historical reference that has carried over and we do see the fallout of that today,” Campbell said, specifically noting discrimination against Blacks beginning with slavery, Jim Crow laws and racist healthcare policies. "The same things that occurred in the past continue. We now have some rules and laws that protect us, but it has not removed the barriers,” she continued, referring to systemic and structural racism against the Black community and other minority groups, which are reflected inside and outside the classroom.
Lack of Diversity
Campbell coauthored a 2016 study that showed that enrollment within most colleges of pharmacy did not reflect the racial and ethnic diversity of the counties in which they are located. The report found that Asian students were overrepresented in most colleges of pharmacy, while Black and Hispanic students were underrepresented, she said. Since then, the situation hasn’t changed.
“To meet the healthcare needs of an increasingly diverse population, each institution should establish a strategic plan for increasing diversity and evaluating and adopting best practices,” Campbell wrote. Pharmacy schools must encourage students of color to go into the pharmacy and “remove any barriers, policies or procedures that we have in place that might be a huge obstacle to a marginalized community member.”
Dr. Carmen “Skip” Clelland, senior public health advisor to the federal Health Resources & Services Administration (part of the Department of Health and Human Services), said pharmacy schools must address myriad issues, among them “the role of pharmacy and the training of pharmacists, the general impact of drug therapy and the social determinant of health impacts on populations.” Among other things, the country lacks effective data collection systems to measure inequities, he said.
“There are challenges with the health data measurement specifically within the minority community,” noted Clelland, a member of the Cheyenne and Arapaho Tribes. “There are unique differences you might see in the general population as far as race or ethnicity. There is the Black population and that may be mixed with American Indians. And part of an American Indian tribe may not be of a singular race. We have to identify and collect data that is meaningful.” It is important to consider genotypes and phenotypes, for instance, in clinical decision making and possible adverse outcomes of medications.
He noted that American Indians and Alaska Natives have suffered inequities related to discriminatory practices. As those unfolded over the years, many people lost faith in the government and the healthcare system, Clelland said. As a result, minority groups must deal with trust issues that impact their healthcare. “I think a lot of the mistrust, especially among American Indian and Alaska Natives, has to do with prior mistreatment by the federal government. That had a negative impact on the general lifespan of American Indians as well as social status and economic conditions.”