Disparities in healthcare related to race or socioeconomic factors are widely understood to be a problem worldwide, but dealing with this problem has proven challenging for most healthcare professionals, including laboratorians. AACC is taking steps to change that with the formation of a new division dedicated to forging progress on healthcare disparities.

The Health Equity and Access Division was formed this year to lead the integration, promotion, and advocacy for inclusion and diversity in laboratory medicine with focus on equitable access to appropriate clinical laboratory testing for all, explained Octavia Peck-Palmer, PhD, chair of the division and associate professor of pathology and critical care medicine at the University of Pittsburgh School of Medicine.

The new division seeks to enhance and contribute to the AACC community in several targeted ways, including but not limited to: examination of the global impact of systemic racism and bias on the practice and delivery of medicine; promotion of inclusion and participation in the science, practice, and policymaking of laboratory medicine for minorities, LGBTQ+ individuals, low socioeconomic status individuals, institutionalized individuals, and those who many not self-identify as a member of these groups; and delivery of educational activities and member-developed scientific articles related to health disparities, population health, history, and ethics of medicine.

“Our call to action says that clinical labs can be impactful in identifying and reducing health disparities,” Peck-Palmer said. “Labs generate a vast amount of data that we can analyze to determine specific variables we can target. As laboratorians, we can make a real impact on reducing health and healthcare disparities.”

Spurred by Survey

Formation of the new Health Equity Access division was spurred in part by a survey that Peck-Palmer and two colleagues conducted in 2020, results of which were published in an article in the January issue of the Journal of Applied Laboratory Medicine.

The researchers surveyed 215 racially diverse laboratorians and non-laboratorians about their perceptions of health disparities in healthcare and the role that lab medicine could play in dealing with these disparities. The Centers for Disease Control and Prevention defines health disparities as “preventable  differences  in the  burden  of  disease,  injury,  violence, or  in opportunities to  achieve  optimal health  experienced by socially disadvantaged racial, ethnic, and other population groups and communities.” While the causes of health disparities are multifactorial, survey respondents identified socioeconomic status and systemic racism/prejudice as the top two reasons why health disparities exist.

Survey participants were given 11 health issues and asked to choose the top five they felt could be addressed by their field or profession. The most common issue selected by respondents was “unconscious bias in providing healthcare (including access to testing, test development, offering, and interpretation.)” Other issues identified in order of importance: underrepresentation of minorities in laboratory medicine/leadership, racial disparities and inequalities, economic access to care, and underrepresentation of minorities in clinical trials and laboratory validations.

Both laboratorians and non-laboratorians identified data generation and establishment of appropriate reference intervals as the top two tools that could impact health disparities. In fact, some healthcare professionals have argued for complete removal of race-based reference intervals in testing, saying they often result in misdiagnosis. The most common strategy recommended by survey participants was “using laboratory data to proactively track those with chronic diseases in cooperation with their healthcare providers to prevent acute events.”

While decades of work have focused on reducing health disparities in the U.S. and globally, the COVID-19 pandemic has highlighted the detrimental effects of health disparities on vulnerable populations, Peck-Palmer said, noting that the pandemic has disproportionately affected Black and Hispanic people with both higher rates of critical illness and higher death rates compared to white or Asian people.

“Now is the time for laboratory medicine to collectively evaluate the impact that the discipline can have on reducing health disparities and improving the quality of life for humanity,” Peck-Palmer and her colleagues wrote in the survey report. “Laboratory medicine continues to demonstrate its value beyond producing a single clinical test result in a point in time to querying historical test information and identifying gaps in health history and follow-up care.”

According to the report, the clinical laboratory can have an impact by: identifying the disparities that are amenable to interventions by laboratory medicine; determining the specific variables to target what will have a direct impact on the health disparities; developing a plan to address the specific variables in a standardized and systematic manner; and identifying governmental, professional societies, state, local, community-based initiatives, and private entities to partner with for significant impact.

All Welcome to Join

All AACC members are invited to join the Health Equity and Access Division, which just recently held its first meeting. Members are now focused on developing initiatives for 2022, including poster presentations, webinars, and a break-out program for next year’s AACC Annual Scientific Meeting.

Information about the Health Equity and Access Division is available at www.aacc.org/community/scientific-divisions/health-equity-and-access.