Health equity, as defined by The Robert Wood Johnson Foundation, means that “everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” The first step to obtaining equity in neurologic care is identifying health disparities, work that was recently undertaken by Altaf et al. This group of researchers analyzed the national state of equity in neurologic care using data from the 2006–2013 Medical Expenditure Panel Survey (MEPS), a nationally representative household survey, which queries medical conditions as well as medical expenditures, including outpatient and inpatient visits. After adjustment for socio-demographics, insurance status, health status, and self-reported neurologic diagnosis, the researchers found that black participants were nearly 30% less likely to see an outpatient neurologist and Hispanic participants were 40% less likely to see an outpatient neurologist compared to white participants.
As the authors discussed, there are a number of limitations to this work, including the reliance on self-reported surveys, which may introduce response and recall bias. Additionally, the assumption that all racial and ethnic groups have the same neurologic need is unlikely to hold true. For example, blacks have higher incidence of stroke, and greater post-stroke disability than whites, suggesting that certain populations have a need for greater healthcare utilization. Finally, research has not determined when or whether encounters with a neurologist result in better, neutral or worse health outcomes
Despite these limitations, Altaf et al. took the important first step of beginning the exploration of racial disparities in neurologic care. I look forward to their continued work as they dive deeper into this topic. As the nation is contemplating healthcare reform, it is important to keep in mind that health equity requires additional resources to the populations who face the greatest social and health challenges, not the reduced efforts as currently proposed.