The Massachusetts Medical Society (MMS) wishes to be recorded in support Senate
bill 660, An Act requiring the Office of Health Equity to examine health
disparities including disability status and gender in five years.
The MMS is a professional association of over 25,000 physicians and medical students and advocates on behalf of patients for a better health care system, and on behalf of physicians, to help them to provide the best care possible. The Medical Society believes that health care is a human right and maintains a long-standing policy to strive for universal access to health care and nondiscrimination in health care settings for all people. MMS applauds the establishment of the Office of Health Equity (OHE) in the Executive Office of Health and Human Services and the incorporation of the Health Disparities Council as an on-going advisory body to the Office of Health Equity and fully supports the work of the OHE. Consistent with OHE’s charge, supporting the elimination of racial and ethnic disparities in health care is an issue of high priority for MMS, as it has long been clear from the medical literature that racial and ethnic minorities in the United States are at greater risk of death and disease from a variety of illnesses, and that they often do not receive the same quality of health care as do other patients.
Of parallel importance to MMS is addressing disparities in health and health care relative to other affected groups, which is why we write today in support of Senate bill 660, which will expand the scope of the charge of OHE to include disparities in health and health care based on gender and disability status. Health and health care disparities occur across many dimensions and are not mutually exclusive, often interacting in important ways. For example, breast cancer disproportionately impacts women and regular mammograms are the best way to detect breast cancer early, when it is more easily treatable. Studies show that women with disabilities are less likely than women without disabilities to have received a mammogram during the past two years.[1]
Additionally, according to the Kaiser Family Foundation, women are more likely than men to experience barriers to accessing health care due to cost.[2]
In Massachusetts, women of color are even more likely than White women to report an inability to see a doctor due to cost, with 17% of Hispanic women and 11% of Black women reporting they did not see a doctor in the last 12 months due to cost, compared to just 7% of White women.[3]
In 2013, the Disability, Health and Employment Unit, at the University of Massachusetts Medical School (UMMS) conducted an assessment of the health needs of people with disabilities to provide comprehensive information on the unmet public health needs and priorities of the disability community in Massachusetts.[4]
The primary findings of a data analysis of the 2011 Massachusetts Behavioral Risk Factor Surveillance System showed significant differences in health among people with disabilities compared to those without disabilities in Massachusetts. Adults with disabilities were more likely to report poor physical and mental health, chronic conditions like diabetes and asthma, being current and lifetime smokers, lifetime sexual violence and unintentional falls. In-depth qualitative data collected from personal interviews showed the most significant health concerns facing people with disabilities in Massachusetts included communications barriers, cultural competency in care through a disability lens, and issues related to an inaccessible, fragmented health care system, including a lack of coordination in the delivery of health care and other services for people with disabilities.
The Medical Society is committed to working for the best possible health care for every patient in the Commonwealth regardless of racial identification, national or ethnic origin, sexual orientation, gender identity, religious affiliation, disability, immigration status, or economic status. In addition to including gender and disability status within the scope of OHE’s charge, MMS would also suggest further consideration of the inclusion other groups in OHE’s charge that may be at higher risk for health conditions and experience poorer health outcomes compared to other groups, including socioeconomic status, sexual orientation, gender identity, or geographic location. Disparities in health and health care not only negatively impact the groups facing disparities but have broader implications for overall quality of care and population health and can result in unnecessary costs. One analysis cited by the Kaiser Family Foundation estimated that health care disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year.[5]
Addressing health and health care disparities across different groups is not only imperative from a social justice perspective, but from a broader, systems-based perspective to improve population health outcomes and quality of care overall. Expanding the scope of the charge of OHE would allow the office to broaden their research and more deeply understand the complex interactions of health and health care disparities across different groups and within subgroups of populations. For these reasons, MMS supports the favorable reporting of S660.
[1]
Courtney-Long E, Armour B, Frammartino B, Miller J. Factors associated with
self-reported mammography use for women with and women without a disability.
Journal of Women’s Health. 2011; 20:1279-1286.
[2]
https://www.kff.org/womens-health-policy/fact-sheet/gender-differences-in-health-care-status-and-use-spotlight-on-mens-health/
[3]
https://www.kff.org/womens-health-policy/state-indicator/percent-of-adult-women-who-did-not-see-a-doctor-in-the-past-12-months-due-to-cost-by-raceethnicity/?currentTimeframe=0&selectedRows=%7B%22states%22:%7B%22massachusetts%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
[4]
Health Needs Assessment of People with Disabilities in Massachusetts, 2013,
UMass Medical School, available at https://www.mass.gov/files/documents/2016/07/xj/needs-assessment-report-for-health-and-disability.pdf.
[5]
Ani Turner, The Business Case for Racial Equity, A Strategy for Growth,
(W.K. Kellogg Foundation and Altarum, April 2018), https://altarum.org/publications/the-business-case-for-racial-equity-a-strategy-for-growth
