Dr. Jessica Shepherd and Amy Morin, LCSW
The Equity Issue

A Physician and Therapist Talk Disparities in Healthcare

As a mental health site, Verywell Mind's focus is on just that—mental health. When we think and talk about disparities in care, we are also thinking about communities who have less access to treatment and face greater stigma around seeking treatment for a mental health issue. We are thinking about those who may seek treatment, but receive therapy that isn't culturally sensitive. And as a therapist, I'm personally acutely aware of these issues.

But such disparities are not limited to mental health. Many of these hurdles exist for those seeking physical healthcare, and it can be just as detrimental to someone's overall health. The poor outcomes of inadequate healthcare can, in turn, lead to feelings of depression, stress, and anxiety that can make treatment even more complicated for some individuals.

The power of the mind-body connection is such that mental health issues can put you at a greater risk of physical health concerns, and vice versa. Poor outcomes in either area can have adverse effects on your entire health picture.

To discuss some of these inequities, I spoke with Dr. Jessica Shepherd, a board-certified OB-GYN and chief medical officer of our sister site, Verywell Health.

More Than Just an "Access" Problem

Dr. Shepherd sees many of the same issues with access to physical care in Black communities that we see on the mental health side, but notes larger systemic issues. "When it comes to barriers in treatment, the obstacle starts before getting to treatment," she says. "There are numerous studies that show that although African Americans are living longer and have more insurance coverage than in the past, they still have higher numbers of chronic diseases and morbidity due to their illness."

Dr. Jessica Shepherd

The shortages in resources, as well as healthcare providers, contribute to the challenges in health care that plague these communities.

— Dr. Jessica Shepherd

Essentially, even when treatment is more readily available, that doesn't mean the inequities are instantly solved. "The life expectancy is also lower than other racial and ethnic groups, outlying more of an issue than just treatment," Dr. Shepherd says. Systemic issues affect access to treatment, but also the quality of treatment itself.

As part of its Health Divide series, for example, Verywell Health noted that Black women get breast cancer at twice the rate of White women and are 40% more likely to die from the disease. Other research shows that African-American women are three times more likely to die from pregnancy-related causes than White women, and the infant mortality rate for African Americans is twice that of White infants.

The issue even extends into the realm of medical research, where research shows that BIPOC communities are often underrepresented in clinical trials, which can have far-reaching effects on the efficacy of treatments.

Access to healthcare and access to quality healthcare are two different things.

COVID-19: Disparities in Focus

Dr. Shepherd says the pandemic has highlighted—and in many cases exacerbated—these issues. "Think of the number of deaths and hospitalizations as well as access to resources," she says. "The shortages in resources, as well as health care providers, also contribute to the challenges in health care that plague these communities." CDC data shows that Black people and Hispanic or Latino people are hospitalized for COVID-19 at over twice the rate of White people across most age groups.

"There remain a significant number of social factors that are determinants of health and include poverty, income inequality, and food insecurity," Dr. Shepherd says. All of these issues and more combine to create poorer health outcomes even before an individual has a chance to seek treatment.

Dr. Jessica Shepherd

When it comes to barriers in treatment, the obstacle starts before getting to treatment.

— Dr. Jessica Shepherd

Unsurprisingly, there is no single easy solution to a systemic issue. "The disparities in healthcare need to be addressed from a systems-based perspective," Dr. Shepherd says, "and we need to address the racism in healthcare as it continues to create a gap in marginalized groups."

A Multi-Layered Approach Is Needed

She adds that access to improved care and outcomes may in part come with increased understanding and acknowledgment of the issues facing some of these communities, as well as increased representation.

"There are areas to address in physician-patient relationships, as well as communication and access—to best practices and technology," she says, "and also representation within the healthcare leadership as well as an increase in providers that are people of color."

Only about 5% of physicians are Black or African American, and only 6% identified as Hispanic. These figures are seen on the mental health side as well, with only 4% and 5% of psychologists in the U.S. workforce identifying as Black or Hispanic. To put that in perspective, the U.S. population is about 14% Black and about 18% Hispanic or Latino.

Some of the stigma or anxiety around treatment and mistrust in the medical establishment that can exist within some communities may be eased with better representation across medical fields, especially in more diverse areas.

Bridging the Gap With Technology

Dr. Shepherd has seen one benefit of the COVID-19 pandemic—the rise in telehealth. We've seen an explosion in the teletherapy space to help increase access to mental health providers, and these benefits can cross over to the physical health side of things as well.

"Telehealth can help decrease the gap in healthcare by allowing it to be more accessible," she says. "This provides a way for patients to benefit from remote services while promoting effective and convenient treatment and management plans."

While it's not a cure-all, the ability to meet with a healthcare provider without taking hours out of a workday or having to figure out child care, for example, may go a long way to putting individuals on a path to treatment in situations where they previously may have not received adequate care.

A Word From Verywell

In 2021, a Verywell Mind survey showed that while Americans understand equally the importance of both physical and mental health, they are less likely to take action to improve the latter. That lack of action can have devastating effects.

Folks seem more likely to address physical health concerns, which often directly impact daily life. However, when action still leads to subpar care and continued poor outcomes—as it too often does for BIPOC individuals seeking treatment—the results can be frustrating at best and fatal at worst.

As Dr. Shepherd says, folks shouldn't have to worry about receiving a certain level of care based on where they live, how much money they have, and especially what they look like. This is what we mean when we talk about equity in healthcare, and these ongoing disparities are but a small piece of the overall picture of systemic racism in the United States.

As individuals, as healthcare providers, and as a society, we all have to do what we can to work toward more equitable outcomes for anybody facing a health problem, be it physical or mental.

8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ohrnberger J, Fichera E, Sutton M. The relationship between physical and mental health: A mediation analysis. Soc Sci Med. 2017;195:42-49. doi:10.1016/j.socscimed.2017.11.008

  2. CDC. Table 15. Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin: United States, selected years 1900-2016.

  3. Petersen EE, Davis NL, Goodman D, et al. Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68:762–765. DOI: doi:10.15585/mmwr.mm6835a3.

  4. U.S. Department of Health and Human Services Office of Minority Health. Infant Mortality and African Americans.

  5. Flores LE, Frontera WR, Andrasik MP, et al. Assessment of the inclusion of racial/ethnic minority, female, and older individuals in vaccine clinical trialsJAMA Netw Open. 2021;4(2):e2037640. doi:10.1001/jamanetworkopen.2020.37640

  6. CDC. Disparities in hospitalizations.

  7. Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019.

  8. Lin L, Stamm K, Christidis P. How diverse is the psychology workforce? American Psychological Association. 2018;49(2):19.

By Amy Morin, LCSW
Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.