In a recent blog post, I wrote about the AAPA Health Disparities Work Group’s efforts to create a four-dimensional approach to understanding and then addressing health disparities. This framework asserts that racial and other cultural health inequities occur within four realms: access to care, systems quality, provider attitudes/cultural competency, and social determinants.

Access to care is often mistakenly thought to be the primary cause of unequal health. If we could just get all of our unfortunate patients without access to care plugged in to our clinics and hospitals, then they’d have the same health as the rest of us.

But it becomes clear that this is just myth by looking more closely at the four dimensions. For example, what happens when patients have access to care, but the system within which they are being seen is subpar? The likely results will be continued unequal burden of disease.

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How about when patients access care equally, but when some are subject to the evaluation and treatment decisions of biased providers? Again, it’s highly unlikely that health equity will result from a setting where biases go unchecked.

And what of the situations where patients have access to high quality systems and to culturally sensitive providers, but certain patients are being ground to dust in their communities by poverty, racism, violence and lack of nutritional food availability?

Even the finest clinic in the world can’t fix patients who are subjected to the subpar living conditions that affect so many American citizens. While access to care is a key component in leveling the health disparities playing field, failure to integrate other dimensions may undermine opportunities to make real progress.

Next week, we’ll look at the how systems quality matters, as well as the limitations of systems quality in fixing racial and ethnic health disparities and inequities.

Jim Anderson, MPAS, PA-C, ATC, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.