CEU 2021 Preview: Mitigating the Real Culprits of Health Disparities: Social Determinants of Health

Health disparities remain one of the most daunting obstacles to delivering care to a variety of patient populations. We talk to Rocio I. Pereira, MD, about her CEU 2021 session, “Health Disparities in Diabetes” and about how clinicians can overcome these obstacles to care. 

This year’s Endocrine Society’s always highly anticipated Clinical Endocrinology Update symposium takes place virtually from Friday, September 10 through Sunday, September 12, where leading experts will present new findings and how these translate to the point of care.

Endocrine News is getting an advance peek into one such presentation, from our conversation with Rocio I. Pereira, MD, chief of Endocrinology at Denver Health, associate professor of medicine at the University of Colorado, Division of Endocrinology, Metabolism, and Diabetes, and the founder and director of the Vuela for Health lifestyle intervention program for Latino immigrants. Pereira will be discussing healthcare disparities in diabetes.

Endocrine News: Let’s start with what got you interested in health disparities in diabetes.

Rocio “Ro” Pereira: I started learning about health disparities during my first year of medical school. I was paired with a preceptor who was an internist at one of the primary care clinics at Denver Health, our local safety net hospital system. Working at that clinic, I started learning about health disparities, particularly as they relate to diabetes and obesity and realizing that our minority patients — especially Latino and black patients — tend to have more diabetes and their diabetes tends to be less well controlled. This got me thinking about why that is and what we can do about it. I’m a Latina physician and bilingual so I saw a lot of the Spanish-speaking patients and some of the more recent immigrants. In particular for that population, I realized also that they have a lot of challenges in accessing healthcare.

EN: Including language.

RP: Including language, exactly.

There is bias built into our healthcare system, and although sometimes we as individuals might not be able to change that, there are things that we can change as individuals to improve the overall culture of healthcare for our patients and to work with them to overcome those barriers that have resulted from both social determinants of health and societal bias and systemic racism.

EN: So, you are in a really good position to help them overcome some of those barriers. Tell me a little bit about the session you are going to present at this year’s Clinical Endocrinology Update in September.

RP: I’ve been thinking a lot about this presentation because I want it to be actionable. I want to provide useful information for physicians in practice who are seeing patients and wanting to make a change or bring about change and make a difference in health disparities with their patients. I want to be to be able to give some actionable steps for those physicians.

I’m planning to start with some background to review the current state — the problem with disparities and the prevalence of diabetes in the different populations and then that disparity compared to non-Latino whites. Then I’m going to talk a bit about causes and touch on how we as physicians think about first, the biology; then, the genetics and molecular mechanisms; and then, the behaviors that go into all these diseases. We’re not really used to thinking about the social determinants of health and how they have the most impact on these disparities.

In the third part, I will talk about best practices in addressing health disparities as an endocrinologist and as a diabetologist in particular. What can we as individuals do in our systems and in our practices to change or encourage change regarding the systemic bias that is built into our systems? But also, as individual practicing physicians caring for patients one on one, what can we do to keep this in the back of our minds and to do the best that we can to address this issue?

EN: That sounds wonderful. Which social determinants of health impact diabetes?

RP: It’s really all of them, and they impact all of healthcare. Food and housing insecurity are probably uppermost, but then there is economic inequity that leads to people not being able to afford copays for visits or transportation, for example. So, I’ll go through the larger categories of the social determinants of health and then I’ll focus on that healthcare piece and what we can do in healthcare.

I hope that attendees will learn some useful best practices and tools and that they will feel motivated and empowered to work toward culture change to support health equity.

EN: Systemic and individual change. What are some of the key points you’re going to make about how to effect those kinds of changes?

RP: One key point is that we can all, each of us, do something to address health disparities whether or not we’re in a position where we’re affecting large systems. There is bias built into our healthcare system, and although sometimes we as individuals might not be able to change that, there are things that we can change as individuals to improve the overall culture of healthcare for our patients and to work with them to overcome those barriers that have resulted from both social determinants of health and societal bias and systemic racism. Things that we can all do are examine processes through an “equity lens” to see where they might not be working for people of color, become more aware of our own biases (we all have them), and use effective communication tools such as motivational interviewing to help us identify non-medical barriers our patients might be facing.

As individual practicing physicians caring for patients one on one, what can we do to keep this in the back of our minds and to do the best that we can to address this issue?

EN: This is a very positive message for both clinicians and patients. Clinicians may find new ways to facilitate access to clinical care, and patients will have better outcomes when their access to care improves. What do you hope attendees will take away from your session?

RP: I hope that attendees will learn some useful best practices and tools and that they will feel motivated and empowered to work toward culture change to support health equity.

Horvath is a freelance writer based in Baltimore, Md. She wrote the July issue’s cover story discussing how exposure to endocrine-disrupting chemicals can have effects on the offspring as well the mothers.