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EXPERTS have warned that discrimination is magnifying health care gaps for various patient groups, including Indigenous Australians and obese patients, after US research showed that stereotyping patients can contribute to disparities in health outcomes.
The observational study of 1479 older adults found 17% had experienced a health care stereotype threat (HCST) with respect to one or more aspect of their identities. (1)
The researchers wrote that their study showed HCST existed in relation to aspects of social identity beyond race and ethnicity. The prevalence of specific types of HCST ranged from less than 2% for race/ethnicity and gender to 8.3% for age and weight.
They wrote that those reporting one or more types of HCST were more likely to exhibit poorer self-rated global physical and mental health, and be diagnosed with hypertension and depressive symptoms. They were also less likely to receive preventive health care, as they had lower odds of receiving the influenza vaccine compared with those who reported no threat.
HCST was associated with greater distrust of physicians and dissatisfaction with health care.
Associate Professor Samantha Thomas, associate professor of public health at Deakin University, said stigma and stereotyping impacted on the way obese patients interacted with the health system.
“We have heard from people … who will defer going to a medical practitioner or specialist for treatment, and particularly preventive health checks, like breast exams and Pap smears”, she told MJA InSight.
“One of the things that drive that is embarrassment but also previous negative experiences with health care professionals and the concern that those experiences will be repeated.”
Professor Thomas said obese patients sometimes found that health practitioners related all health issues back to their weight.
While acknowledging that health care practitioners were often encouraged to use every opportunity to help patients with weight loss, Professor Thomas said these well intentioned efforts could sometimes reinforce the stigma experienced by patients.
“We put so much emphasis in our public discourse on the relationship between weight and health and a lot of the advice and the support that’s given to people who are obese or overweight is done with the best intentions, but may not be received that way”, she said.
Dr Roxanne Bainbridge, senior research fellow at James Cook University, said the term “healthcare stereotype threat” was really just a way of dressing up less palatable terms like discrimination and racism.
Dr Bainbridge said this was “absolutely” an issue for Indigenous Australians in their interactions with the health care system and a massive shift in mindset and behaviours was required to address this complex problem.
“You hear about non-compliance, poor follow-up, late presentation, underutilisation of care and … mistrust in the medical profession, but … it’s no surprise when you have had a history of colonisation and you have that perpetuated in your health care system”, said Professor Bainbridge, who coauthored an Australian Institute of Health and Welfare report on cultural competency in delivering health services to Indigenous people. (2)
Dr Bainbridge recounted the case of an Indigenous community Elder, who was refused the use of a wheelchair because he already had one at home that had belonged to a late family member. The young allied health professional had no idea that this was culturally insensitive, she said.
She said such examples stemmed from a lack of understanding and training and the continued dominance of Western biomedical models of care. “I am not being critical of the medical profession, but we need to change if we want to change outcomes. We can’t continue to do what we have been doing; it’s not working.”
Dr Bainbridge said that in addition to discussing cultural competency in universities, high-level polices that regulated for culturally competent care were needed. She said both the US and New Zealand had such policies.
Professor Thomas said recognising the impact that past experiences of stigma could have on people’s interaction with the health care system was important.
She said that in a series of qualitative interviews conducted with obese patients, one patient had remarked: “Sometimes health professionals focus on the wrong ‘w’; they focus on ‘weight’, not on ‘wellbeing’.”
“We need to challenge these stereotypes — that people who are obese are lazy and uneducated and just need to be told what to do. They need to be treated with the same respect that we would offer to all patients”, Professor Thomas said.
2. AIHW
(Photo: Goodluz / shutterstock)
It is interesting that weight mention can be thought discriminatory, realising that perception is in the eye of the beholder. It is a long term question and attitude.
Sensitivity is important in patient dealings, but so is addressing whatever problem, so where does patient over-sensitivity on the issue of overweight leave any caring doctor? Even if the patient originally accepts their patient doctor interaction about overweight, later discussion with a friend or family may disturb that.
Doing one’s best for thae patient is my attitude, but the article is quite discouraging in that context.
Perhaps research about patient confidence and tendency to overweight, as to which is chicken & which is egg could help? Certainly ignoring overweight is not helpful toward better health. Acknowledging that drugs used to treat mental illness and other factors are involved in weight gain, there is still morbidity associated to consider. The whole person is needing best treatment, where to draw any line is not easy.
1) “Workcover / TAC / Motor accident patients always do badly” – sterotypyping based on anecdotal and some published work.
2) “Compensable patients cannot get better till the compensation case is settled”
3) It wasn’t that long ago (1995) that Aboriginal petients were placed on the open balcony away from the ‘regular’ patients at Dubbo Base Hospital.
This is a good article, but has neglected to mention the enormous issue of people with physical, intellectual and psychiatric disabiities, who are often told “more assertive treatment is not indicated in … er … the context of your other problems.” This is something that I unfortunately have had personal familly experience of.
This decision is often made based on the erroneous assumption that people with a disability necessarily have a poorer quality of life. Some medical staff privately think that extending the life of a person with a disability is not worthwhile. Actually it is actually just plain old disability discrimination, dressed up in medical jargon in order to overwhelm the unsuspecting patient. It is against the law.