insights

                                                                                                                                                                                                                     Read time 4 minutes

Racial, cultural, economic, and social barriers impede access to healthcare services and resources for many patients in the United States. At IFM’s 2021 Annual International Conference (AIC), subject matter experts will explore perspectives regarding social needs of health, discrimination, and equal access to quality health care. From the impact of implicit biases and health disparities to racial healing and recognizing opportunities to promote inclusion, several AIC presentations will address the essential topic of health equity:

• Gail Christopher, DN – Our Opportunity for Creating a More Fair and Just World: Racial Healing, Equity, and Transformation
• Clancy Harrison, RD – Addressing Food Access and Insecurity
• David Williams, PhD – COVID-19: A Tutorial on Racism
• Shanta Zimmer, MD – Uncovering Implicit Bias and Microaggressions

See the AIC 2021 schedule for a complete list of presentations and speakers.

Social Determinants and Needs of Health & Chronic Disease

Recognizing the social determinants and social needs of health for an individual patient and any barriers they experience is vital for patient-centered care, understanding the complete scope of a patient’s health, and informing optimal prevention and treatment strategies. Social determinants of health are the conditions of the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. For example, access to nutritious food is a social determinant of health, and insufficient access has been associated with negative health outcomes, including an increased vulnerability for micronutrient deficiencies¹ and a higher probability of developing obesity, diabetes, and hypertension.^2,3

In addition, environmental factors such as the quality of a patient’s physical environment may negatively impact the development of robust immune resilience. Toxicants such as heavy metals and pesticides, ambient pollutants, and other endocrine-disrupting chemicals have been associated with immune system imbalances,^4-6 and disproportionate exposure levels have been reported for under-served populations in the US.^7,8

Race, Health Disparities, and Healthcare Access

Healthcare barriers are prominent for Black, Indigenous, and People of Color (BIPOC) at the same moment that BIPOC communities are disproportionately afflicted with some chronic and infectious diseases.^3,9,10 For example, studies have found that Black and Hispanic populations experience higher rates of SARS-CoV-2 infection and COVID-19–related mortality compared to white populations, with differences in healthcare access potentially driving the increased rates.¹¹ The burden of cardiovascular disease (CVD) is also higher for Black populations in the United States. Black communities experience a greater risk of developing, and a two to three times greater chance of dying from, heart disease than white counterparts.^12-14 Social conditions such as chronic stress, racial residential segregation, and discrimination have all been suggested to impact CVD risk.^15,16

In addition, research suggests that BIPOC communities disproportionately experience chronic stressors,¹⁷ yet disparities in the use of mental health services have been reported, with Black, Hispanic, and Asian adults receiving less mental health care than white adults.¹⁸ According to recent data from the Centers for Disease Control and Prevention, pandemic-related worries of possible job loss, obtaining needed health care, food insecurity, and housing instability may compound the already elevated risk of chronic stress in BIPOC populations.¹⁹

Clinical Applications

For the prevention and treatment of chronic disease, a functional medicine intervention may include a range of practical and consistent steps to modify lifestyle factors and enhance a patient’s healthful habits. Awareness of personal biases, health disparity impacts, and a patient’s unmet social needs of health help inform strategies for healing.

Collaboration and trust between a patient and practitioner are essential to supporting a patient’s health journey. This therapeutic connection is established through small yet vital clinical skills such as clarifying elements of a patient’s timeline and prioritizing patient-centered care. In addition, social determinants of health are potential antecedents and mediators of physiological dysfunction in the functional medicine matrix model. Access barriers, cultural background, primary language, and traditional lifestyle are all components to consider when co-developing sustainable treatment plans. These factors may help inform nutrition-based therapies; for example, modifying therapeutic food plans so that they are more accessible to the patient. In addition, approaches that include health coaching, group visits, or telemedicine may become relevant options to address cost, transportation, or distance challenges while offering personalized health support.

Learn more about health equity and the impact on patient outcomes from subject matter experts at IFM’s 2021 AIC.

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Immune Resilience and Under-served Populations

Expanding Access to Functional Medicine in Vulnerable Communities

References

1. Drake VJ. Subpopulations at risk for micronutrient inadequacy or deficiency. Linus Pauling Institute, Oregon State University. Published March 2018. Accessed March 12, 2021. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/subpopulations-at-risk
2. Nagata JM, Palar K, Gooding HC, Garber AK, Bibbins-Domingo K, Weiser SD. Food insecurity and chronic disease in US young adults: findings from the National Longitudinal Study of Adolescent to Adult Health. J Gen Intern Med. 2019;34(12):2756-2762. doi:10.1007/s11606-019-05317-8
3. Office of Disease Prevention and Health Promotion. Food insecurity. Updated October 8, 2020. Accessed March 12, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/food-insecurity
4. Nowak K, Jablonska E, Ratajczak-Wrona W. Immunomodulatory effects of synthetic endocrine disrupting chemicals on the development and functions of human immune cells. Environ Int. 2019;125:350-364. doi:10.1016/j.envint.2019.01.078
5. Mokarizadeh A, Faryabi MR, Rezvanfar MA, Abdollahi M. A comprehensive review of pesticides and the immune dysregulation: mechanisms, evidence and consequences. Toxicol Mech Methods. 2015;25(4):258-278. doi:10.3109/15376516.2015.1020182
6. Glencross DA, Ho TR, Camiña N, Hawrylowicz CM, Pfeffer PE. Air pollution and its effects on the immune system. Free Radic Biol Med. 2020;151:56-68. doi:10.1016/j.freeradbiomed.2020.01.179
7. Ruiz D, Becerra M, Jagai JS, Ard K, Sargis RM. Disparities in environmental exposures to endocrine-disrupting chemicals and diabetes risk in vulnerable populations. Diabetes Care. 2018;41(1):193-205. doi:10.2337/dc16-2765
8. Nardone A, Casey JA, Morello-Frosch R, Mujahid M, Balmes JR, Thakur N. Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. Lancet Planet Health. 2020:4(1):e24-e31. doi:10.1016/S2542-5196(19)30241-4
9. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on Black communities. Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003
10. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among Black patients and white patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686
11. Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Ann Intern Med. 2020;174(3):362-373. doi:10.7326/M20-6306
12. Safford MM, Brown TM, Muntner PM, et al. Association of race and sex with risk of incident acute coronary heart disease events. JAMA. 2012;308(17):1768-1774. doi:10.1001/jama.2012.14306
13. Havranek EP, Mujahid MS, Barr DA, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873-898. doi:10.1161/CIR.0000000000000228
14. Carnethon MR, Pu J, Howard G, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136(21):e393-e423. doi:10.1161/CIR.0000000000000534
15. Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300-309. doi:10.1037/0278-6133.22.3.300
16. Kershaw KN, Diez Roux AV, Burgard SA, Lisabeth LD, Mujahid MS, Schulz AJ. Metropolitan-level racial residential segregation and black-white disparities in hypertension. Am J Epidemiol. 2011;174(5):537-545. doi:10.1093/aje/kwr116
17. Brown LL, Mitchell UA, Ailshire JA. Disentangling the stress process: race/ethnic differences in the exposure and appraisal of chronic stressors among older adults. J Gerontol B Psychol Sci Soc Sci. 2020;75(3):650-660. doi:10.1093/geronb/gby072
18. American Psychiatric Association. Mental health disparities: diverse populations. Published 2017. Accessed March 12, 2021. https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts
19. McKnight-Eily LR, Okoro CA, Strine TW, et al. Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic — United States, April and May 2020. MMWR Morb Mortal Wkly Rep. 2021;70(5):162-166. doi:10.15585/mmwr.mm7005a3