New England Journal of Medicine and my article, "Beyond Diversity— Time for New Models of Health." It is all about leadership.

Although I had collected data for my dissertation in the US, Colombia, and Brazil, my committee told me not to use the word culture as culture was not a relevant variable. That was over 40 years ago. Fast forward to the summer of 2021 when I submitted an article to JAMA. One of the comments in the rejection was, "The section on cultural themes does not make sense."

It was not the first time I heard that comment so I submitted my article to New England Journal of Medicine (NEJM). The thoughtful editors had specific questions and very helpful, insightful suggestions. They accepted my article for publication and here is the link to the online version, "Beyond Diversity— Time for New Models of Health." The print version is in the New England Journal of Medicine, Volume 386:6, February 10, 2022, Pgs 503-505.

But this is not about my article, it is about how an institution and its leadership leads. NEJM is an example of leading through words and actions.  The closing sentence of NEJM's October 7, 2021 editorial "Striving for Diversity in Research Studies" clearly stated, "From this perspective, diversity in research isn't simply a matter of social justice. It's a critical part of learning how to improve the health of every person." NEJM's actions were to outline new requirements for future submissions for publication that included a supplementary table on the representativeness of study participants. Words and actions. 

I am hopeful that my article will be widely read and stimulate healthy discussions. Consultant driven solutions, e.g., an organizational theory of change, setting up DEI committees, or appointing a Chief Diversity Officer, may create activities but are rarely the solution for meaningful outcomes.

Change happens through leadership and that starts with each one of us.

Uninsured ER Overcrowding . . . It’s a Myth

Perhaps the most frequent scapegoat for the crisis in our health system is the uninsured.  For decades the litany of attacks on the uninsured has been they are overcrowding emergency rooms and using scarce resources because they do not go in for regular ongoing care.  But buried in today’s newspapers, ensuring that it will get scant attention, was reporting on new research released by the Journal of the American Association (JAMA) that turns conventional wisdom on its head.

The study found that the uninsured are less likely than those with insurance to use emergency rooms.  In fact, while 17% of persons in our country are uninsured, they only represent between 10% to 15% of emergency room visits.

When you talk to people who are uninsured they tell you that they do everything they can to take care of themselves; after all not everyone gets sick leave.  They also avoid emergency rooms because they are already living at the edge and are concerned that the costs they incur from an emergency room visit will push them off the precipice to which they are clinging.

According to the JAMA study, insured patients represent the majority of increased use of emergency rooms over the past decade.   So while providing health insurance to those who cannot afford it is critical, it does not go far enough to make our health system what we know it should be.  Access is about more than having coverage.