Printer Friendly Email a Friend PDF

Acupuncture Today – October, 2021, Vol. 22, Issue 10

The Acupuncturist's Role in Overcoming Disparities in Care

By Carie Martin-Fulciniti, MSAc

COVID-19 is not the only pandemic that America is experiencing. Racism,1 ableism, elitism, white supremacy,2 sizeism,3 ageism, sexism, xenophobia, and the gender-binary4 that currently exist in the medical system and society are themselves perpetuating many of the issues that as practitioners we currently treat.

Discrimination is not always overt, causing many of us to misunderstand its effects or miss it outright. Policies such as food deserts,5 predictive policing,6 mass incarceration,7 environmental injustice,8 "urban redevelopment,"9 and even the BMI10 are having similar effects on health, longevity and quality of life.

A Flawed System at Work

The Western system we are considering integration with is built on patriarchal, white, binary, Eurocentric ideas around health, leading generations of physicians, practitioners and patients who have assumed these biases,11 often unknowingly.12 It affects care provided and received, and manifests itself in different ways – from weathering13 (the toll taken on the health of marginalized people from chronic and systemic discrimination) to rates of medical malpractice14 people of color experience disproportionately to whites.

unity - Copyright – Stock Photo / Register Mark Medical technology is not equipped to be universally applied, rendering it expensive and often unhelpful for diagnostics in those communities for which it is of little use;15 and biomedicine is also falsely enamored with metrics and measures like scans and bloodwork, giving us information that translates poorly off of paper into an understanding of people's chief complaints.

Also of consequence is what happens to the Affordable Care Act.16 If the health conditions from which these communities are suffering (due in part to how they are treated by social, legal, criminal justice, medical, housing, and economic systems) are then used to further disempower or discriminate against them, then politicians will have succeeded in closing the loophole for corporate entities, with disastrous consequences for the individuals most at risk.

Our cost-prohibitive, capitalistic, privatized insurance market is balanced precariously on the backs of ill-equipped providers, and regulated by tightly controlled access to education,17 resources,18 support, high-quality care,19 preventative medicine,20 and public health21 services – critically important to understanding marginalization in healthcare due to race or poverty.

It's not working. People are in pain, addicted to opioids,22 dependent on medications to control symptoms without addressing the root cause of disease, increasingly taking antidepressants,23 and the looming economic recession and mental-health crises of the COVID pandemic have yet to show their depths. We need societal, structural and holistic responses to these issues that we, as practitioners of Chinese medicine, are able to provide.

Our Responsibility and Opportunity

But until we make it part of our medicine's mission to decolonize and desegregate systems and institutions,24 we too risk continuing to perpetuate harm for marginalized patients, people and providers of all kinds. In addition to honoring the individual, we need to understand the predisposition certain populations have in terms of genetic and cultural indicators of disease, without using these differences to further disenfranchise them.

Many of us have come to this medicine due to experiencing marginalization ourselves. And all of us have treated patients who have received subpar or medically negligent care due to skin color, socioeconomic status, cognitive and physical ability,25 or sexual orientation.26 Although it's yin, yang, qi and blood circulating throughout us all, our patient's makeup also includes factors like poverty and prejudice. Intersectional issues, like being a woman, immigrant or "queer," make it essential to understand administering culturally appropriate care.27

We can be leaders in providing community-forward solutions - our medicine shows us the way. But we have to acknowledge injustice in order to correct it and engage in these conversations in order to do so.

At its best, Eastern medicine has room for it all. It is safe,28 effective29 and empowering for the people we treat. However, even with thousands of years of quantifiable results, we are still not being called into the conversation about how to deliver better health care in America for many of the same reasons people are being discriminated against. Barriers to inclusion in the discussion of how to re-imagine medicine in America have to do with a lack of public awareness about what the practice of Chinese medicine entails, restricted access (in the form of affordability and lack of representation), and a general lack of consensus among providers about what our role in response to these disparities truly is.

We Can Help Restore Balance

In Chinese medicine, we learn that if any part of the system is affected, the system as a whole is affected. Balance must be restored. Because we have assumed the role of leadership in our businesses and communities, the onus is on us as providers to meet the needs of the marginalized and uphold our code of ethics30 through providing truly objective and affirmative care to the public at large.

Our regulatory and educational institutions must respond in the form of more comprehensive education in these areas, and practitioners need to commit to continued training and the development of resources that help us reach and treat these communities.

Moving forward as a field, we need better representation on the practitioner, policy and leadership levels31 or our medicine will continue to only reach the privileged few who can afford treatment, or see themselves reflected in it. This includes

  • Updating paperwork, signage and language to be gender-inclusive
  • Cultivating a referral list of colleagues who are competent in issues facing marginalized individuals
  • Making efforts to promote and lift up minority practitioners and voices
  • Supporting places like community acupuncture clinics

It also means asking ourselves not only if we are equipped to treat a patient given our intersectionality with a discriminatory system, but also to look honestly and objectively at the ways in which we might be perpetuating it. And it means advocating for our medicine in a way that does not commodify its true origins,32 instead honoring the ancestors and lineages who have kept it alive.

Let's Invest in Doing the Work

Diversity in thought, experience and background leads to more creative solutions for our patients, new breakthroughs in our medicine's application, and a larger number of people we can respectfully serve - increasing the social reach of our medicine, as well as the economic impact for us as practitioners. By investing in doing the work, we have an opportunity to not only carry forward this ancient art, but also to meet the crisis in health care with confidence, and show people what a truly inclusive and accessible system of medicine can look like.

References

  1. Karlsen S, Nazroo JY. Relation between racial discrimination, social class, and health among ethnic minority groups. Am J Public Health, 2002 April;92(4):624-631.
  2. Ruane M. "A Brief History of the Enduring Phony Science That Perpetuates White Supremacy." The Washington Post, April 30, 2019.
  3. Phelan SM, Burgess DJ, Yeazel MW, et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev, 2015 Apr;16(4):319-326.
  4. Scandurra C, Mezza F, Maldonato N, et al. Health of non-binary and genderqueer people: a systematic review. Front Psychol, 2019;10:1453.
  5. Food Insecurity. Healthy People 2020, Office of Disease Prevention and Health Promotion.
  6. Ensign D, Friedler SA, Neville S, et al. "Runaway Feedback Loops in Predictive Policing." Proceedings of the 1st Conference on Fairness, Accountability and Transparency. PMLR, 2018;81160-171.
  7. "Mass Incarceration as a Public Health Issue." In: The Effects of Incarceration and Reentry on Community Health and Well-Being: Proceedings of a Workshop. Washington, DC: National Academies Press, 2019.
  8. "Flint Water Crisis Fast Facts." CNN Editorial Research, updated Jan. 14, 2021.
  9. Bailey P. "Housing and Health Partners Can Work Together to Close the Housing Affordability Gap." Center on Budget and Policy Priorities, Jan. 17, 2020.
  10. Vaughan CA, Sacco WP, Beckstead JW. Racial/ethnic differences in body mass index: the roles of beliefs about thinness and dietary re-striction. Body Image, September 2008; 5(3):291-298.
  11. Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci  (USA), 2016 Apr 19;113(16):4296-4301.
  12. Sakran JV. "Racism in Health Care Isn't Always Obvious." Scientific American, July 9, 2020.
  13. Geronimus A, Hicken M, Keene D, et al. "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health, 2006 May;96(5):826-833.
  14. Fact Sheet: Race & Medical Malpractice. New York Law School, Center for Justice and Democracy, July 2008.
  15. Moran-Thomas A. "How a Popular Medical Device Encodes Racial Bias." Boston Review, Aug. 5, 2020.
  16. "Sabotage Watch: Tracking Efforts to Undermine the ACA." Center on Budget and Policy Priorities, July 22, 2020.
  17. Picker L. "The Effects of Education on Health." National Bureau of Economic Research, March 2007.
  18. Philips BU, Belasco E, Markides KS, et al. Socioeconomic deprivation as a determinant of cancer mortality and the Hispanic paradox in Texas, USA. Int J Equity in Health, 2013;12:26.
  19. Health Care. Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda. National Research Council (US) Panel on Race, Ethnicity, and Health in Later Life; Bulatao RA, Anderson NB, editors. Washington, DC: National Academies Press, 2004.
  20. Lorant V, Boland B, Humblet P, et al. Equity in prevention and health care.  J Epidemiol Community Health, 2002 Jul;56(7):510-6.
  21. Geana MV, Greiner KA, Cully A, et al. Improving health promotion to American Indians in the midwest United States: preferred sources of health information and its use for the medical encounter. J Community Health, 2012 Dec; 37(6):1253-1263.
  22. Silvia MJ, Kelly Z. The escalation of the opioid epidemic due to COVID-19 and resulting lessons about treatment alternatives. Am J Manag Care, 2020;26(7):e202-e204.
  23. Wehrwein P. Astounding increase in antidepressant use by Americans. Harvard Health Blog, March 6, 2020: www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624.
  24. Newkirk VR. "Why American Health Care Is Still Segregated." The Atlantic, June 24, 2020: www.theatlantic.com/politics/archive/2016/05/americas-health-segregation-problem/483219/.
  25. Ali A, Scior K, Ratti V, et al. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLoS One, 2013;8(8):e70855.
  26. Mirza SA, Rooney C. "Discrimination Prevents LGBTQ People From Accessing Health Care." Center for American Progress, Aug. 13, 2019.
  27. McElfish PA, Long CR, Rowland B, et al. "Improving Culturally Appropriate Care Using a Community-Based Participatory Research Approach: Evaluation of a Multicomponent Cultural Competency Training Program, Arkansas, 2015–2016." Centers for Disease Control and Prevention, Prevent Chron Dis, Aug. 3, 2017.
  28. Vincent C. The safety of acupuncture. BMJ, 2001 Sep 1;323(7311):467-468.
  29. Xiang A, Cheng K, Shen X, et al. The immediate analgesic effect of acupuncture for pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2017;2017:3837194.
  30. NCCAOM Code of Ethics, January 2016.
  31. Smedley BD. "Increasing Racial and Ethnic Diversity Among Physicians: An Intervention to Address Health Disparities?" In: The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions: Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W.Nickens, M.D. Washington, DC: National Academies Press, 2001.
  32. Lin SY. "White People are Commodifying Chinese Medicine Just Like They Did With Yoga." Wear Your Voice, March 14, 2018.

Carie Martin-Fulciniti is an acupuncturist, clinic owner, activist, and doctoral candidate in Seattle, Wash., treating a diverse body of patients from backgrounds of all kinds. Passionate about equity in society and medicine, Carie is starting law school in the fall of 2021 in order to better understand health care policy and better advocate for marginalized communities everywhere, acupuncturists included.


To report inappropriate ads, click here.