Expert Interview Part 2: Racial Disparities Amid COVID-19

July 14, 2020

In part 2 of our interview, Dr. Cheryl Wisseh, PharmD, MPH, zone 5 director, NPhA, dives into the forces that bring about racial disparities, and offers pharmacy and health system-centered solutions.

Drug Topics®: Hi, this is Gabrielle Ientile with Drug Topics®.

Today I'm going to be speaking with Dr. Cheryl Wisseh, PharmD, MPH and zone 5 director of the National Pharmacists Association (NPhA) about their commitment to racial equality and dismantling racism within healthcare.

What do you see as the importance of pharmacies and pharmacists in addressing racism in healthcare and supporting the Black Lives Matter protests?

Wisseh: It has to do with our code of ethics as pharmacists, and 1 of the tenets in our code of ethics is that a pharmacist serves individual community and societal needs. So pharmacy and public health do have an intersection in their shared goals to promote the health of individuals, communities and society overall.

Racism in all its forms - structural, institutional, interpersonal, or even internalized - is a public health issue, so since it has negative impacts on the health of individuals and communities of color and society overall, then that means it becomes a pharmacy issue, because pharmacy has that shared goal with public health.

There's another tenet within our code of ethics that also says, as a pharmacist, we seek justice and the distribution of health resources. So delving a little bit deeper into structural racism, for instance, in order to understand structural racism, you need to know that American society in and of itself has racial discrimination built into the foundation. So it's in all of the social structures and systems, so housing, education, employment, wage earnings, credit approval and attainment, media, and most importantly, healthcare. Over time, you have this discrimination that is compounded within these systems and leads to that reinforcement of discriminatory beliefs, values that are discriminatory, and then inequitable distribution of the resources that are within the system.

In thinking of all of that, as pharmacists, if we’re seeking justice, like that tenet says, in the distribution of healthcare resources, since structural racism also affects the healthcare system, we need to address these forces of structural racism, because it places 1 group, white Americans, at an unfair advantage, and then Black Americans and other like non-Black people of color at disadvantage.

For instance, you have the example of medication availability and pharmacy deserts. You have the literature in pharmacies showing that there's limited access to community pharmacies - the actual establishment - services, and commonly used medication based on racial segregation.

In recognizing that there's this unearned privilege that’s in this system, pharmacists must emphasize with the plight of black Americans and strive to truly understand what it means when it is said that all Black lives matter, because for centuries, there have been human suffering on the part of Black Americans in the United States.

And that also leads to another part of our oath that we take as pharmacists, that I will consider—the welfare of humanity and relief of suffering—my primary concern. So it kind of is built into our code of ethics and our oath and we should aim and must live up to that oath, when we take it, because we do take it.

Drug Topics®: You mentioned a lot of the systemic and structural forces that work on healthcare. Can you mention also some of the ideological factors of racism that are present in healthcare as well?

Wisseh: In regards to that ideological factors of racism and health care, once again, it goes back to the ideology of white supremacy and discrimination that's built within the foundation of the United States and in every system that we see in regards to the social determinants of health (SDOH).

Within healthcare, when you see this ideology, it can be in what is known as provider concordance. So when you have, let's say, an African American patient and then an African American provider that racial concordance, so generally African American patients with African American physicians are more likely than African American patients with non-minority providers to rate their physicians as excellent and providing health care, treating them with respect, explaining their medical problems, listening to their concerns, being accessible. And this was found in the Institute of Medicine’s report on unequal treatment.

They also found that Hispanic patients with Hispanic positions also were more likely to be satisfied with their overall health care due to that ethnicity. In the state of California, there was a study that looked at physician practices in regards to patient caseload by race and ethnicity. And it showed that half of African American providers and Hispanic providers’ patient load were African American and Hispanic respectively. And that's good, right? However, African American and Hispanic physicians make up only 6% of the total physician workforce. So that presents a problem.

So when you think about education, the system of education now, which also has this structural racism within it, from pre-kindergarten all the way to what would be the completion of medical school or other health care, professional, school and training, there are many very racial and ethnic and socioeconomic barriers that would impede someone who is a minority, or who could be a minority position or healthcare provider, from getting to that point. So, this in turn will contribute to lower numbers of minority physicians.

If you have less provider concordance just because you have a lack of minority health care providers, patients might not be receiving that optimal care and health care they deserve. Because once again, they're reporting that that concordance is very important to them.

Another way that you see this ideology show up is through medical mistrust. African Americans are more likely to believe that racial discrimination is common in doctors’ offices, and are more likely to mistrust the healthcare system. And this is due to unethical practices from the scientific and the medical community against minorities. So you have things such as sterilization of women without their consent, so women of color, whether they're Black, Native American, Latino. Another example would be the Tuskegee syphilis study, which there was definitely some cruelty regarding that natural progression of syphilis looking at that in Black males.

So with all of that put together it compounds that medical mistrust, which once again has that root in that systemic racism in that ideology. And then lastly, of course, there's implicit bias. So thinking about how physicians view patients and there are studies that show that physicians would favor their white patients or their black patients and maybe even think that black patients have less compliant behavior than white patients. So it's set in there within healthcare in and of itself.

Drug Topics®: What do you hope that the joint statement will lead to? There are several things that it mentioned in improvements in health care. So can you kind of speak to some of those?

Wisseh: I sure can. So I think I touched on it in the beginning when you asked about the key point, so bringing it full circle, so really a multifaceted approach at shining a light on structural racism, educational initiatives to kind of get everybody at a level understanding, if you will, because history is delivered different around our country and sometimes maybe a little bit rose-colored, and then just through capacity building through different tasks for us in these different organizations, so that we can face the problem that is at hand, maybe even programs and interventions that intentionally embed ways that we can deconstruct these systemically racist thoughts, beliefs and even practices, that are in pharmacy.

So more specifically with patient care and workplace practices, we hopefully can create pharmacists training programs that intentionally address the SDOHs and require an interdisciplinary approach, because it's not going to take only pharmacists. We need physicians, we need nurses, we need respiratory therapists, we need public health professionals. So it's going to take that interdisciplinary approach. So just continue to shine that light and give that historical view on structural racism and incorporating SDOHs in the technician’s or pharmacist’s role at all aspects.

So if you're in the community, if you're noticing something about a patient has to do with their socioeconomic status, or it might be something with the community context within the family that they live in, to be able to have those resources to provide whole person care in regards to student pharmacist education, and we do have these within different institutions of pharmacy education, courses that shine a light on structural racism as a pharmacy and a public health issue.

So just like we teach our students about diseases and conditions, how to treat them, we should treat structural racism. In this case, it is the nation's disease. And the critical thinking question becomes, "how do we work together to cure and eradicate it?" Then also in regard to admissions and leadership opportunities, being able to garner diverse, equitable and inclusive initiatives and ensure leadership, selection, grant awarding, hiring practices, have diverse stakeholders and board members and search committees and admissions committees, so that all our representatives have a seat and a voice at the table.

Drug Topics®: And then for NPhA specifically, what do you see as the next steps being?

Wisseh: NPhA is definitely taking steps in regards to addressing racial injustice.

We have a working group that is looking at racial trauma, racial justice and injustice and just anti-racism in general. So we're hoping to share the experiences of African American pharmacists while in the actual profession and practice. So this is something that's looking at the intersectionality of race and the privileged status that might come with attaining a level of education that a pharmacist has. So how do these 2 groups interact and what are our lived experiences?

We're definitely taking a closer look at discrimination, how it can be measured, and how this measurement might inform future policies within the profession. Whether it's measured in those of us working as pharmacists, pharmacists, technicians, or across all of the different practice areas or even patients and then educational initiatives, we're trying to plan some of these toward just educating the profession regarding structural racism in the past and in the present, and then what we can do in the future to eradicate it, if you will.

Drug Topics®: And that's all the questions I have, are there any other things that you want to touch on or major takeaways that you want to leave with?

Wisseh: Every organization has its niche, if you will. And this being our main niche, looking at minority pharmacists and our mission being the under representation of minority pharmacists and other health care professionals and healthcare in general and championing minority health. It’s just beautiful to see all the organizations together at this table working to recognize that this does exist—structural racism—and wanting to be a part of something bigger than themselves with the organization to address this issue. So I think it was a major win for all of us as organizations and it was great to spearhead that and have that concern and that support from all the other organizations.

Drug Topics®: Dr. Wisseh, thank you so much for joining me today and your continued work during this time as well.

Wisseh: Thank you so much for having me. I enjoyed speaking about this and I appreciate you, giving NPhA the platform to discuss these very critical issues at hand.