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. Key Concepts: • Engaging in health equity related work in pediatric orthopaedics requires an understanding of the differences between equity and equality and an intersectional approach to understanding patient identities and circumstances. • Existing research within orthopaedics has demonstrated disparities in care access and surgical outcomes dependent on a patient's race, language, insurance status, and level of health literacy. • Beyond just demonstrating the existence of health inequities, future research within orthopaedics should assess the efficacy and impact of tangible interventions aimed at reducing health disparities within orthopaedic settings. • Orthopaedic surgeons should adopt a multifaceted approach to inequity-reduction that centers principles of equity and intersectionality interpersonally in patient interactions, logistically at the level of clinic scheduling and accessibility, and macroscopically through advocacy work at the local and national levels.