Q&A: MPCA health equity director points out role of implicit bias in health care

Debbie Edokpolo is the director of health equity and social justice at the Michigan Primary Care Association (MPCA). She was originally the deputy health officer for the Ingham County Health Department. 

Edokpolo will be speaking on the topic of racism as a public health issue at our 2022 Michigan State of Reform Health Policy Conference on April 21st in Lansing. 

In this Q&A, Edokpolo discusses the effect of implicit bias on health care and some of the state’s efforts to reduce health disparities. 

 

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State of Reform: What are you spending your mental energy on nowadays? What is the most important thing happening right now in health care in Michigan and what is being done to reduce health disparities?

Debbie Edokpolo: “Racism continues to impact the health of many, especially when you look at health disparities and who is affected. It is people of color and other marginalized groups. My role is to bring an awareness of racism and the many other ‘isms’ that continue to advantage some and disadvantage others. 

Currently, [I’m] working with others on our team to look at the importance of recognizing implicit bias in health care as a driver of poor health outcomes and health disparities. We are working on bringing an awareness of what it means to have health equity. 

[The] Robert Wood Johnson Foundation said, ‘Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.’

There is much more we must do to ensure all the opportunities to be healthy.”

SOR: The pandemic heightened racial disparities in health care in Michigan and around the country as well. Now that this is more in the public eye, how can we use this moment to create lasting and sustainable change in the state and country?

DE: “I do think it’s important—and it sounds really simplistic—to think about our history as a country, where we’ve come from, and how it might lend itself to our implicit bias. We need to look at our history of how we care for one another or for those who may not look like you or someone else who might be different and use this to reflect upon that and to think about how we might make changes that value our people. 

The changes that need to happen aren’t just at a personal level, but it’s also at the institutional level in our organizations and our policies and practices. We need to reflect on how we really make changes that value people.”

SOR: What are you seeing are the biggest disparities happening right now in Michigan primary care?

DE: “When you look at Michigan and other places, you look at chronic diseases like diabetes, high blood pressure, and infant mortality rates. Those disparities exist for many people of color. That looks different depending on where you are, who you are, and your socioeconomic status. But we know that these disparities exist.”

SOR: Can you expand more on how implicit bias intersects with health care in Michigan?

DE: “So I think that health care professionals are like the rest of us. We all have implicit bias. We are all a part of this American culture. So, implicit bias shows up because we have these stereotypes of how we think a person or the patient who is before us can care for themselves. I think implicit bias shows up in care, not only from the provider side, but from the individual side. 

Patients think things about the providers from their own history or things that they’ve heard like, ‘They don’t really care about me.’ So, that impacts how the provider treats the patient and then how the patient receives what the provider is saying. It has an impact at the end on their outcome.

I really say kudos to Governor Whitmer. It was really good that the governor and [her] committee came up with the [idea of] asking providers to have some training around implicit bias. You can even be committed to wanting to do the right thing and [bias] can still show up.”

SOR: What do you think the state can do to help reduce disparities in health care?

DE: “I think the expansion of Medicaid was really important because it gave access to more people in Michigan. I think health insurance paying for virtual visits is really important. However, I think we need to build it out to really ensure that more people have access. 

So I think that we are doing some positive things in Michigan to address some issues that could help in reducing health disparities, and recognizing that clinical care is only a small portion of our health disparities. There are those social determinants of health that also play a role in health disparities, too. I just think that there is a bigger conversation that needs to happen. It’s bigger than just one or two people. This takes all of us to resolve and we can do it, but will definitely take us looking at all of our institutions and our structures as well as our own personal beliefs and attitudes.”

This interview was edited for clarity and length.