- Email: [email protected]
Disparity is Defined as “an Inequality or Difference”
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The opinions expressed here are not necessarily the opinions of the National Medical Association. Disparity is Defined as “an Inequality or Difference” To the Editor: I and other practicing physicians have addressed health care disparities among minority patients—and specifically African American patients—for many decades. Although numerous causes and remedies for the multitude of disparity issues that affect our patients have been proposed, published, and discussed, it is my observation that one significant solution is seldom mentioned or stressed. That is the concept of personal responsibility and personal awareness of one’s health problems and solutions. Type 2 diabetes is associated with obesity, lack of exercise, and poor dietary choices. After 27 years of practice, I know it is a rare patient that is not aware of these issues, yet I continually read that somehow this is primarily an “institutional racism” or systemic problem, lack of education, and lack of understanding by patients. I and many physicians believe that the main problem is lack of personal responsibility, the refusal of the patient to take responsibility for his or her dietary choices, exercise requirements, and lack of parental guidance for their children’s dietary choices at home and at school. Alcohol abuse, tobacco, and drug use are all personal choices in our society. Public policy statements, symposia, or written discourses on these problems will not begin to solve them unless the individual(s) involved takes an active interest in, and demonstrates willingness to understand their disease, change their lifestyle, and address an addiction to food, alcohol, tobacco, or drugs. Blaming the “system” has not and will not result in significant change and improve-
ment in obesity rates (they are increasing among all racial groups) and other addictions until patients themselves address their problem(s) in concert with their physician and health care providers. Personal responsibility is not a political mantra, but the key to healthier lifestyles and healthier patients. This concept is key to educating and treating our patients. Barry E. Breaux, MD [email protected] East Bay Eye Center Pinole, Calif.
Teaching Geriatrics in India…Reflections on the US Health Care System To the Editor: I was recently invited to be a guest lecturer for 2 weeks to teach geriatrics in India. Being the director of geriatric education at the University of Kansas Medical Center, I could not refuse the offer. I had the opportunity to teach at 2 medical schools: Kolkata Medical College in Kolkata, West Bengal, and at the Jawaharlal Nehru Memorial Medical College in Raipur, Chhattisgarh. I also had the privilege to speak at the Indian Geriatrics Society’s sixth annual national geriatrics conference, GERICON. Upon my return, I have to say that it was one of the most fulfilling trips I had ever taken and would highly encourage all of you to expand your expertise globally. With the current health reform debate, visiting another country and observing their health care system “in action” is an eye-opening and reflective experience. Geriatric medicine is, ironically, a young field both domestically and internationally. In the United States, it is expected that there will be more
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
than 70 million adults over age 65 by 2030.1 Therefore, geriatric training is slowly getting integrated into educational curriculums of medical school and residency programs. Fellowship programs are growing and are beginning to fill the huge need for geriatricians globally. Similarly, India is realizing its geriatric population surge and is preparing for 32% of its population to be over 65 by 2050.2 The Geriatrics Society of India began in the early 1980s and has since garnered the attention of physicians, nurses, politicians, and nonprofit organizations. The value of a geriatric-oriented training program is being appreciated by patients, families and health care providers alike. In a country where financial, class, and, ultimately, health care access disparities are broad, geriatric training has been a uniting thread that has tried to keep medical care on equal grounds. On first foot in India, I realized its initial daunting challenge: its population. With a population of more than 1.1 billion,3 more than 3 times the US population, it is truly incredible to think of how a country of this size coordinates their infrastructure for day-to-day living, let alone provides access to health care. The bustling food markets filled with fresh farm-picked produce lined almost every street, anxiously waiting to serve the hungry appetites of their customers. The Sealdah train station in Kolkata was full at all hours with thousands of businessmen, merchants, students, and children rushing to catch their train waiting on one of 17 tracks. Armed policemen roamed the station keeping a watchful eye on any suspicious behavior. Streets were always alive with the honks of topsy-turvy rows of moving cars, buses, rickshaws, and taxis weaving their way VOL. 101, NO. 12, DECEMBER 2009 1309
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The opinions expressed here are not necessarily the opinions of the National Medical Association. Disparity is Defined as “an Inequality or Difference” To the Editor: I and other practicing physicians have addressed health care disparities among minority patients—and specifically African American patients—for many decades. Although numerous causes and remedies for the multitude of disparity issues that affect our patients have been proposed, published, and discussed, it is my observation that one significant solution is seldom mentioned or stressed. That is the concept of personal responsibility and personal awareness of one’s health problems and solutions. Type 2 diabetes is associated with obesity, lack of exercise, and poor dietary choices. After 27 years of practice, I know it is a rare patient that is not aware of these issues, yet I continually read that somehow this is primarily an “institutional racism” or systemic problem, lack of education, and lack of understanding by patients. I and many physicians believe that the main problem is lack of personal responsibility, the refusal of the patient to take responsibility for his or her dietary choices, exercise requirements, and lack of parental guidance for their children’s dietary choices at home and at school. Alcohol abuse, tobacco, and drug use are all personal choices in our society. Public policy statements, symposia, or written discourses on these problems will not begin to solve them unless the individual(s) involved takes an active interest in, and demonstrates willingness to understand their disease, change their lifestyle, and address an addiction to food, alcohol, tobacco, or drugs. Blaming the “system” has not and will not result in significant change and improve-
ment in obesity rates (they are increasing among all racial groups) and other addictions until patients themselves address their problem(s) in concert with their physician and health care providers. Personal responsibility is not a political mantra, but the key to healthier lifestyles and healthier patients. This concept is key to educating and treating our patients. Barry E. Breaux, MD [email protected] East Bay Eye Center Pinole, Calif.
Teaching Geriatrics in India…Reflections on the US Health Care System To the Editor: I was recently invited to be a guest lecturer for 2 weeks to teach geriatrics in India. Being the director of geriatric education at the University of Kansas Medical Center, I could not refuse the offer. I had the opportunity to teach at 2 medical schools: Kolkata Medical College in Kolkata, West Bengal, and at the Jawaharlal Nehru Memorial Medical College in Raipur, Chhattisgarh. I also had the privilege to speak at the Indian Geriatrics Society’s sixth annual national geriatrics conference, GERICON. Upon my return, I have to say that it was one of the most fulfilling trips I had ever taken and would highly encourage all of you to expand your expertise globally. With the current health reform debate, visiting another country and observing their health care system “in action” is an eye-opening and reflective experience. Geriatric medicine is, ironically, a young field both domestically and internationally. In the United States, it is expected that there will be more
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
than 70 million adults over age 65 by 2030.1 Therefore, geriatric training is slowly getting integrated into educational curriculums of medical school and residency programs. Fellowship programs are growing and are beginning to fill the huge need for geriatricians globally. Similarly, India is realizing its geriatric population surge and is preparing for 32% of its population to be over 65 by 2050.2 The Geriatrics Society of India began in the early 1980s and has since garnered the attention of physicians, nurses, politicians, and nonprofit organizations. The value of a geriatric-oriented training program is being appreciated by patients, families and health care providers alike. In a country where financial, class, and, ultimately, health care access disparities are broad, geriatric training has been a uniting thread that has tried to keep medical care on equal grounds. On first foot in India, I realized its initial daunting challenge: its population. With a population of more than 1.1 billion,3 more than 3 times the US population, it is truly incredible to think of how a country of this size coordinates their infrastructure for day-to-day living, let alone provides access to health care. The bustling food markets filled with fresh farm-picked produce lined almost every street, anxiously waiting to serve the hungry appetites of their customers. The Sealdah train station in Kolkata was full at all hours with thousands of businessmen, merchants, students, and children rushing to catch their train waiting on one of 17 tracks. Armed policemen roamed the station keeping a watchful eye on any suspicious behavior. Streets were always alive with the honks of topsy-turvy rows of moving cars, buses, rickshaws, and taxis weaving their way VOL. 101, NO. 12, DECEMBER 2009 1309