If patients are from minority communities, finding a doctor-or
any health professional-may be difficult. According to a 1996 New England Journal of
Medicine article, co-authored by CHC member physician Kevin Grumbach, California
communities with high proportions of black and Hispanic residents were four times as
likely as others to have a shortage of physicians. In his subsequent research, Grumbach
has documented that those shortages extend to many of the health professions. Nurses,
nurse practitioners, and dentists are all harder to find in minority communities. So are
fully staffed hospitals. Grumbach's work has also noted that black and Hispanic physicians
are disproportionately responsible for care in these communities, but since the
dismantling of affirmative action in California, minority enrollment in medical schools
has declined. This deepens the already increased threats to health.
Such findings explain Grumbach's involvement with a community task force in the San
Francisco community of Bayview Hunters Point. The group addresses community concerns about
high rates of disease among community residents and environmental hazards in the
neighborhoods. "This is an attempt to get out of the ivory tower and engage a
community of people in examining their key health concerns," says Grumbach.
"It's helped empower the community...now we have to translate that into action."
As We Age
UCSF physician Eliseo Perez-Stable, director of the Center for Aging in Diverse
Communities (CADC), is also interested in improving the overall health of poor and
minority communities, particularly that of older residents.
Perez-Stable believes that disparities in health care are often characterized by
difficulties in cross-cultural communication between patients and health professionals.
His belief stems from a number of studies. He mentions one in particular on heart care
that found African-Americans were less likely to get bypass surgery and less likely to get
catheterization. For these particular procedures, the differences did not appear to be due
to disease severity or socioeconomic status. Perez-Stable acknowledges that one conclusion
would be racism, but says, "Discrimination alone seems too simple. Somehow the risks
and benefits of these procedures were not being adequately communicated or
To help alleviate the disparities-and understand better how health professionals
communicate cross-culturally-the CADC is determined to develop:
- Minority investigators, because minorities are underrepresented in much of the research
in health care, partly out of mistrust of the process.
- Effective measures of self-reporting, since the current methods for gathering
information from minorities tend to be less effective than they are for non-Hispanic
- Community outreach efforts that match investigators with community-based organizations
in order to increase the involvement of underrepresented communities in both research and
their own medical care.
Perez-Stable already has a formidable record of community health activism. He has
worked with the National Cancer Institute to develop a self-help guide for smoking
cessation and, in San Francisco, helped develop a program that encourages Latina women
over 50 to come back for second mammograms and pap smears. He also works with physicians
and case managers to help them understand some of the communication gaps they may
experience with minority populations.