Author: Jay Crosson, MD
Trust in health care systems is necessary to address racial disparities in hypertension control
The Kaiser Permanente Health Care Program has historically had a special relationship with the African-American community. Part of this relationship dates back to the early years of World War II. In January 1942, as the American merchant marine fleet was being decimated by Axis submarine attacks, President Franklin Roosevelt called upon the industrialist Henry J. Kaiser to rapidly organize to produce replacement ships, which later became known as “Liberty Ships.” By June, Kaiser had organized a force of over 90,000 workers and was producing ships in Oakland and Richmond, California and Vancouver, Washington.
Many of these men and women were African-Americans who had migrated from the South in search of work. They weren’t eligible for military service at the time, and Kaiser was seen as trusted figure among working people. In the end, these ships and the people who produced them were vital to our ultimate victory in the war.
In recent years, Kaiser Permanente intensified its focus on control of hypertension. Hypertension and its sequelae are more common among African-Americans, especially men. And most studies have shown poorer control of blood pressure among African-Americans than in other racial groups. In seeking to address this disparity among its own members, Kaiser Permanente needed to deal with the prevalence of mistrust of American health care among African-Americans, particularly because memories of the Tuskegee “experiments” persist.
In 2000, Kaiser Permanente developed a large-scale program to improve blood pressure control for all of its members. By 2010, despite great general progress, it was evident that even in Kaiser Permanente’s pre-paid system, African-American members still had lower control than members of other racial groups. So in 2010, Kaiser Permanente instituted the Equitable Health Care Outcomes Program (ECHO). One of the first priorities was to once again address the disparity in hypertension control for African-American members. ECHO is a multi-part program, one aspect of which is outreach to the African-American community through education and culturally appropriate trusted communication techniques. By 2014 the disparity in hypertension control had been halved: from 8.1% to 3.9%. An independent analysis of preventive services in Medicare Advantage plans, published in the same year, showed no racial disparity in hypertension control in Kaiser Permanente. This was not the case in the other plans studied.
There are already indications that hypertension control levels among all racial groups slipped during the COVID-19 pandemic. Equally worrisome are reports that COVID-19 vaccine acceptance among African-Americans is low, again because of distrust of the heath care system. Now is the time to begin anew, to organize systematic coordinated care and communication processes tailored to the African-American community to increase their trust in our health systems. We must replace the toxic legacy of Tuskegee with new examples of health care equity for all, and embed equity in our shared consciousness and consciences.
Dr. Crosson worked as a practicing physician and executive for Kaiser Permanente for 35 years, including 10 years as the Executive Director of the Permanente Federation, the national physician component of Kaiser Permanente. He subsequently served as a Group Vice President of the American Medical Association and as Chairman of the Congressional Medicare Payment Advisory Commission (MedPAC).