Affordable Care Act not enough to conquer health disparities, national social work expert says

Comprehensive health insurance reform will increase overall access to physical and behavioral health care services in the United States, but it cannot by itself bring true health equity to the American people, a national health care expert told a Wayne State audience on March 26.

While identifying and eliminating health disparities has been a U.S. policy objective for more than 40 years, many Americans still suffer disproportionately from chronic and communicable diseases, addiction, material deprivation, and other social determinants of poor health, James Herbert Williams, dean and Milton Morris Endowed Chair at the Graduate School of Social Work at the University of Denver, told a full Spencer M. Partridge Auditorium. The Patient Prevention and Affordable Care Act of 2010 has increased the affordability, accessibility and quality of health care by expanding insurance to millions of America, but it cannot reverse prevailing attitudes and systemic clinical practices that have left disparities unchecked.

Williams, who delivered the Wayne State School of Social Work's eighth annual Diversity Lecture, said the national debate has too often pitted the deserving poor against the underserving poor, attributed poor health to behavioral patterns and genetics to the exclusion of other determinants, such as social circumstances and shortfalls in medical care. Moreover, the interactions between determinants of poor health - such as how living in poverty affects health behaviors, or how genetic propensity may affect nicotine addiction - have largely been neglected.

Williams identified several promising ways to reduce disparities with the aid of the Affordable Care Act, which encompasses an unprecedented array of critical diagnostics, treatments and therapies and prioritizes prevention and wellness. First, a concerted effort should be made to recruit and train minority health care professionals. Racial and minority populations experience lower treatment rates for behavioral health conditions in particular, Williams said, adding this is likely related to poor minority representation in the mental health care workforce.

Next, health care must be "integrated," not merely "coordinated" or "co-located." These latter paradigms merely encourage information-sharing or physical proximity between clinicians who nevertheless treat patients separately according to their respective areas of expertise. By contrast, said Williams, integrated care involves behavioral and physical clinicians working together as a team to design and implement a patient care plan. Integrated care may also occur at the organizational level, Williams said, spurring clinical practices to collaborate with social services agencies to adopt overall patient wellness strategies.

Finally, Williams said, policymakers must be willing to study and adopt culturally appropriate, innovative approaches used by lay people in the community to reduce and eliminate behavioral health disparities.

"Academia is notoriously good at saying, if it's not scientifically proven, we don't want to discuss it," Williams said. He stressed that "gray literature" - informally published reports of current practices - are a not-to-be-overlooked source of evidence-based practices.

Williams' address was preceded by remarks from Wayne State University President M. Roy Wilson, M.D., a health care researcher, practitioner and administrator who prior to joining Wayne State was deputy director for strategic scientific planning and program coordination at the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH). President Wilson praised the Affordable Care Act for granting this government body institute status - prior to the 2010 legislation it was a "center" - thereby giving it authority to plan, review, coordinate, and evaluate of NIH's minority health and health disparities research activities. He also underscored the importance of an interdisciplinary approach to health disparities reduction.

"We need different perspectives to make an impact," Wilson said.

The lecture also featured a post-address panel discussion. Participants included keynote speaker, James Herbert Williams; Jamie Mitchell, Wayne State assistant social work professor; Wassim Tarraf, assistant research professor at Wayne State's Institute of Gerontology; and moderator, Kathryn M. Smolinski, director of Wayne Law's Legal Advocacy for People with Cancer Clinic and adjunct assistant professor. The panelists addressed ways in which social workers can bring collaborative partners to the table discussion of policy change and impact the Affordable Care Act will have on patients and professionals alike.