RGH - Exam 1 Terms

Racial disparities in health care

• Differences in health insurance coverage, access to care, and quality of care between racial groups.

• Black adults are more likely to report providers not believing them or refusing tests or pain medication.

Self-reflection / self-assessment

• "realistic and ongoing self-appraisal," a lifelong process of examining one's own biases

• Equating competence with completing past training sessions is called inadequate and potentially harmful.

Racism in health care

• The CDC defines ___ as structures, policies, practices, and norms that assign value and opportunity based on how people look.

• In the nurses study it includes "unintentional bias" or aversive racism: people who consciously value equality but hold unconscious negative beliefs.

Historical trauma and unresolved grief (HTUG)

• "the collective trauma exposure within and across generations, including interpersonal losses and unresolved grief.”

• ___ is the intervention built on this paradigm, selected as a Tribal Best Practice.

Evidence-based treatment (EBT)

• Empirically supported treatments shown to work in research.

• "Few ___ exist for AI/ANs," who are absent or underrepresented in clinical trials.

Gender identity sensitivity in health policy

• State nondiscrimination laws protecting sexual orientation and gender identity were linked to more disclosure and higher satisfaction with providers.

• The authors call for a "Health in All Policies" approach, since policymaking is itself a social determinant of health.

Women's Health Movement

• A movement that grew out of second-wave feminism in the 1960s–70s, aiming to improve health care for all women and end sexism in the health system.

• Called one of the best examples of grassroots advocacy creating change from the community to federal policy.

Our Bodies, Ourselves (OBOS)

• Often called the "bible of women's health."

• it used women's own embodied experiences to challenge medical dogma

• Written by the Boston Women's Health Book Collective

Training for pelvic exams

• Students historically practiced on anesthetized women without consent, cadavers, manikins, and prostitutes.

• These methods taught that the ideal patient is silent and passive.

• The Gynecology Teaching Associate (GTA) is both patient and instructor, teaching on her own body.

Cultural competency

• "a developmental process in which one achieves increasing levels of awareness, knowledge, and skills along a continuum, improving one's capacity to work and communicate effectively in cross-cultural situations."

• Tervalon describes the traditional view as mastery of a finite body of knowledge.

CLAS Standards

• National standards "intended to promote health, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations."

• There are 15, starting with the Principal Standard of effective, understandable, and respectful care.

Cultural humility

"The patient/provider relationship is inherently unequal – power imbalance." It "is a reflective process of understanding one's biases and privileges, managing power imbalances, and maintaining a stance open to others about aspects of their cultural identity that are most important to them." It is a "life long process."

Gender disparities

• Women were discriminated against in research in three ways: their diseases were studied less, they were excluded from clinical trials, and they were rarely senior investigators (Angell).

• Women also face more medical debt because of the pay gap and greater health care needs.

Sexism in health care

• Female medical students faced sexist comments, innuendo, and inappropriate touching.

• They coped through "denial and minimization," and the culture was reinforced by superiors and "institutional silence."

Tuskegee Study

• Government doctors promised free treatment for "bad blood" but withheld treatment from about 400 poor Black men with syphilis, even after penicillin.

• There was no informed consent, and the study ran 40 years.

Systemic racism

• Racism built into "structures, policies, practices, and norms."

• The CDC declared racism a serious public health threat.

• Disparities are driven by social determinants, and racism cuts across all of them.

Health disparities

• Healthy People 2020: differences in health "closely linked with social, economic, and/or environmental disadvantage."

• CDC: "preventable differences" experienced by socially disadvantaged groups.

Racial and ethnic disparities

• Black people fared worse than white people on 19 health measures and have a 4-year lower life expectancy.

• AIAN, Black, and Hispanic people had higher COVID infection, hospitalization, and death rates.

Decades of the Women's Health Movement

Table 1 milestones: 1969 Seaman; 1973 OBOS and Roe; 1977 FDA trial ban; 1980s setbacks plus NIH inclusion policy; 1990 ORWH; 1992 WHI; 1993 NIH Revitalization Act.

Gynecological exam

• The "activated patient" is a woman fully and equally involved in her own exam.

• This leads to more responsibility for her health and "high-level wellness."

Disparities for LGBT+ community

• Minority stress is chronic stress from stigma, discrimination, and concealment.

• Sexual minority women in states without nondiscrimination laws were less satisfied with their providers.

Women doctors

• Women in medicine have lower job satisfaction, unequal pay, and higher rates of sexual harassment and gender discrimination.

• Students became "too used to it."

Trans youth's health

• Being transgender "is not a mental illness but is, rather, a normal variation of human development."

• Puberty blockers are fully reversible, and a third (33.2%) of trans youth have attempted suicide.

• How parents respond is the "most significant marker of long-term health and well-being."

Trans men's health

• Trans men "were assigned a female sex at birth but have a male gender identity" and remain at risk for ovarian, cervical, and uterine cancers.

• "Screening should continue until the patient no longer has the screened organ."