SPA Annual Meeting Reviews
Session III: PEDx: Error Traps in Equity vs. Equality
Reviewed by Erin Williams, MD, FAAP
Texas Children’s Hospital
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Dr. Williams |
The Sunday morning Session III began with Erika Blacksher, PhD, John B. Francis Chair in Bioethics, at the Center for Practical Bioethics and Research Professor at the University of Kansas Medical Center who gave a power packed talk entitled “Error Traps in Equity vs. Equality”. In this presentation Dr. Blacksher ensured the audience would be proficient in the following objectives:
- Describing social determinants of healthcare.
- Distinguishing between equality and equity.
- Grasping and identifying strategies of equitable care that allow equal treatment and thus equal outcomes.
She began her presentation with the premise that in order to obtain equal treatment and equal outcomes in medicine, there must first be an orientation and understanding of equity. In other words, physicians must be cognoscente of patient differences and then be equipped with the right tools in order to have a good outcome.
She discussed the difference between equality and equity. Dr. Blacksher emphasized the importance of knowing that disparities exists amongst different races, genders, and socioeconomic statuses. She went on to state that people may require different bundles or amounts of resources to achieve equally good outcomes.
There are a variety of issues that lead to unequal treatment in healthcare. Dr. Blacksher spoke of a study by Baetzel and colleagues entitled, The Adultification of Black Children in Pediatric Anesthesia, which pointed to the fact that black children were treated less like children and more like adults by being given less premedication for preoperative anxiety and less parental presence for induction compared to Caucasian children. There are a multiplicity of reasons why such an event can happen. One of the main reasons may be due to implicit or unconscious bias, which speaks to the need for equity orientations for our physicians and nurses.
Dr. Blacksher encouraged the audience to look at the social determinants of health and pay attention to population data. She emphasized the importance of examining performance data and exploring our own unconscious bias by taking the Implicit Association Test. In order to best serve our patients and provide equitable care it is imperative to consider our patients’ differences when providing patient care. We must develop an “ecobiodevelopmental” framework and consider differential treatment based on differential need. Additionally, we must also work toward cultural humility and advocate for and with others in the community. By working toward these goals, we can begin to decrease the disparities in children’s healthcare.
Sources
Baetzel A, et. al. Adultification of Black Children in Pediatric Anesthesia. Anesthesia and Analgesia. 2019; 124 (4):1118-1123. doi: 10.1213/ANE.0000000000004274
