A Health Equity Primer: Understanding and Addressing Inequities in Pediatric Orthopaedics

Abstract

Sociopolitical events in recent years including ongoing killings of Black Americans, violence against immigrants, and the COVID-19 pandemic have all shone a spotlight on the reality that we live in a society where an individual’s safety, health, and ability to access and receive quality medical care are contingent upon their socioeconomic circumstances and personal identities. These events have inspired both increased civic engagement addressing structural inequities in healthcare, as well as changes within modalities of care delivery, making this an opportune time to examine health inequities in pediatric orthopaedics and re-commit to working towards their reduction. In order to ensure that orthopaedic surgeons are best positioned to engage in such work, this paper will discuss health equity in pediatric orthopaedics to serve as a foundational primer to inform future equity-focused efforts. We will define health equity, equality, and intersectionality, and clarify the differences between these terms and their roles as lenses to better understand patients’ unique backgrounds and personal circumstances. Existing research on health disparities in orthopaedics will be reviewed with a focus on the ways in which race, ethnicity, insurance status, gender and sexuality, health literacy, language, nutrition and food availability, physical ability, and environmental and personal safety all impact the accessibility and quality of orthopaedic care. Beyond discussing existing disparities, the paper will detail tangible actions that clinicians can take to improve inclusivity and accessibility in clinical environments and patient encounters. By centering an intersectional approach to patient care and integrating equity-focused changes within clinical settings, surgeons can ultimately improve their interpersonal interactions with marginalized patients and increase both the quality of the care that they provide and patient trust in that care.

What’s New in Pediatric Orthopaedic Health Care Disparities?

“…In the pediatric orthopaedics community specifically, implementing screening programs in schools and developing pathways for under- or uninsured patients may help address the disparities still observed. Implementing specific protocols for certain diagnoses and explicitly asking patients about their barriers to care may also help to reduce disparities between individuals 18,37. Beyond insurance status, access to transportation, family and patient health literacy, and perhaps most critically, lack of education among both patients and parents remain at the core of disparate outcomes seen across various fields of pediatric orthopaedics.…”

“…Implementing specific protocols for certain diagnoses and explicitly asking patients about their barriers to care may also help to reduce disparities between individuals. 18,37 Beyond insurance status, access to transportation, family and patient health literacy, and perhaps most critically, lack of education among both patients and parents remain at the core of disparate outcomes seen across various fields of pediatric orthopaedics. Failure to educate families about their health perpetuates these inequalities and thus, should be considered a key area for targeted improvement.…”

“…Although these delays in care are most commonly associated with type of health insurance, lack of hospital resources, transportation barriers, and being a single-parent family may also contribute to these observed differences. 7,17,18 Delays in addressing meniscal injury put patients at risk for meniscectomy rather than repair, which in turn, may lead to early degenerative changes and inferior long-term outcomes. 8 Bram et al 16 found Black and Hispanic patients to be 2.2× more likely to undergo meniscectomy alongside ACL reconstruction as compared with White patients when controlling for other variables.…”

“…Johnson et al8 reported wait times between injury and initial evaluation to be 4.7× greater for uninsured patients and 2× greater for publicly insured patients as compared with commercially insured patients with meniscal tears. Although these delays in care are most commonly associated with type of health insurance, lack of hospital resources, transportation barriers, and being a single-parent family may also contribute to these observed differences 7,17,18. Delays in addressing meniscal injury put patients at risk for meniscectomy rather than repair, which in turn, may lead to early degenerative changes and inferior long-term outcomes 8.…”

CORR Insights®: High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

“…c Although generally intended to be oriented toward pediatric orthopaedic practice, this review article is excellent at breaking down the concepts within health equity in orthopaedic practice [7].…”