Imagine your child has broken a bone. You head to the emergency department, but the doctors won't prescribe painkillers. This scenario is one that children of color in the U.S. are more likely to face than their white peers, according to new findings published in The Lancet Child & Adolescent Health.
Researchers reviewed dozens of recent studies looking at the quality of care children receive across a wide spectrum of pediatric specialties. The inequities are widespread, says Nia Heard-Garris, a researcher at Northwestern University and a pediatrician at Lurie Children's Hospital of Chicago, who oversaw the review.
"No matter where you look, there are disparities in care for Black Americans, Hispanic, Latinx, Asian Americans — pretty much every racial and ethnic group that's not white," she says.
Heard-Garris says there are lots of examples of inequalities across specialties. The review found children of color are less likely to get diagnostic imaging and more likely to experience complications during and after some surgical procedures. They face longer wait times for care at the emergency room, and they are less likely to get diagnosed and treated for a developmental disability.
The strongest disparity evidence was found in pain management. Kids of color are less likely than their white peers to get painkillers for a broken arm or leg, for appendicitis or for migraines. "Those are some really severe examples of how this plays out," says Dr. Monique Jindal, an assistant professor at the University of Illinois Chicago and one of the authors of the review.
The researchers looked only at studies that included children who had health insurance, "so we cannot blame the lack of insurance for causing these disparities," Heard-Garris says.
Compiling evidence of health inequities from across a wide array of pediatric specialties was a "tremendous" undertaking, says Dr. Monika Goyal, associate chief of emergency medicine at Children's National Hospital in Washington, D.C., who was not involved in the research review.
"They have really done an amazing job in painstakingly pulling together the data that really highlights the widespread pervasiveness of inequities in care," says Goyal, whose own research has examined disparities in pediatric care.
Researchers say the causes of the inequities are wide-ranging but are ultimately rooted in structural racism, including unequal access to healthy housing and economic opportunities, disparate policing of kids of color and unconscious bias among health care providers.
"Anyone who has their eyes open knows that the disparities exist. Where we're really lacking is talking about tangible solutions," says Jindal, who was the lead author on a companion paper that offered policy recommendations to counteract these widespread disparities in pediatric care.
These solutions may ultimately require sweeping policy changes, Jindal says, because "we cannot have high-quality health care or equitable health care without addressing each of the policy issues with the other sectors of society," Jindal says.
But sweeping policy changes could take a long time, and some, like instituting universal health care, have proved politically unfeasible in the past. Some low-hanging fruit could be tackled at the state level, Jindal says, such as instituting continuous eligibility for social safety-net programs such as SNAP, Medicaid and CHIP, so that children don't face losing insurance coverage and food assistance for administrative reasons.
In the meantime, Heard-Garris says health care providers should take some immediate steps to check their own practices for biases.
"Even if you are the most progressive provider, you're still going to have things that are blinders," she says. Make sure you check on those, challenge them, learn more, push yourself, review your own charts, Heard-Garris advises.
This story was edited by Jane Greenhalgh.
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