June 29, 2020
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
In medicine, racial and economic differences determine both the quality and the type of health care an individual receives, and the disparities in health outcomes between whites and people of color are exceedingly stark. This is true across the field—from conventional medicine to Functional Medicine and beyond. It is true, and it is unacceptable.
The disparities between health, wealth, and race aren’t new, but for the first time, they will inform the work of The Institute for Functional Medicine (IFM). Closing the gap begins by examining the core values of IFM and our mission to ensure the widespread adoption of Functional Medicine. This mission, perhaps once loosely defined, has become clear. It does not mean to ensure the adoption of Functional Medicine for those who can afford it; it does not mean Functional Medicine for the elite or those who have been born with a certain skin color. It is all encompassing. IFM’s mission is to ensure the widespread adoption of Functional Medicine for all.
Why now? One might attribute this transformation to COVID-19 or to Black Lives Matter, and certainly, these two cataclysmic events have propelled IFM’s thinking forward. Within a matter of just a few months, COVID-19 has forged its way into the very structure of American life—changing everything from how we socialize with each other to how we conduct our business to how we care for our sick. In health care, the flaws that have been apparent for decades are amplified in this environment, particularly inequities in access to care. The system is irrevocably broken, and in today’s environment, the cracks and the fissures are bigger than ever. Inadequacies are laid bare, and they are undeniable in their form. And so truly, why now? Simply put, because the time is long overdue. It is time to be bold and take decisive action to ensure that a zip code, the accumulation of wealth, or the color of one’s skin is not a determinant of one’s health.
COVID-19 has turned the spotlight on public health issues, and in particular, the public health crisis of racism. It did so by highlighting the root cause—the social determinants of health. We know that the disparities seen in health and health care are not the result of personal health and lifestyle choices alone. “They are [also] iatrogenic,” writes Darrell M. Gray et al in Nature Reviews.1 “Implicit biases—unconscious stereotypes shaped by learned associations that inform understanding and decision-making—can negatively influence patient-provider communication and result in worse healthcare outcomes…Such biases compound the challenges that vulnerable populations already face.”1
Social determinants of health often start before birth, in the prenatal period of previous generations through epigenetics, and are complicated by a lack of availability of healthy food, a lack of access to equitable health care and a lack of trust in the healthcare system. The medical literature shows that people of color are less likely to receive preventive health services, and that they experience poorer quality medical care than whites.2 Middle-aged Black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their white counterparts.3 Despite the fact that minority groups will become the majority nationwide within 30 years,4 13.8% of Blacks report having fair or poor health compared with 8.3% of non-Hispanic whites.5 Additionally, adults living in poverty are more than five times as likely to report only fair or poor health compared to adults with incomes four times or higher than the Federal Poverty Line.6
For certain, those who need Functional Medicine the most are not receiving this care. Many of those who are the most susceptible to COVID-19 are also facing chronic disease; these qualities encapsulate the essential worker—those at the front-line who cannot work from home. Statistics show that minority populations in the US disproportionally make up essential workers.7 According to Sharrelle Barber of Drexel University Dornsife School of Public Health, as reported in an April 2020 edition of the Lancet, the pre-existing racial and health inequalities already present in the US are being exacerbated by the COVID-19 pandemic. These front-line workers typically don’t have the privilege of “staying at home,” said Barber.7 Essential workers, almost by definition, cannot distance themselves from the public. Grocery store and restaurant staff, healthcare practitioners, delivery drivers, factory and farm workers, and more are risking their lives to protect and bring comfort to others—at a great risk to themselves and their families.
In light of this reality, and in an effort to boldly confront racial and ethnic disparities in medicine, IFM is listening to the clinical experts and visionaries who are already on the path to transforming health care in America. Tracy Gaudet, MD, a recognized leader in the evolution of health care and the executive director of the Whole Health Institute, Bentonville, AK, spoke recently at IFM’s Annual International Conference (AIC). She explained that healthcare reform cannot be a superficial softening of the edges; it’s radical. It requires radical change, and it is devastatingly important.
At IFM, we believe that health and vitality are essential to the human spirit, and our vision is to advance the highest expression of individual health. To fulfill this vision, in addition to ensuring diversity of our leadership at executive levels, IFM will:
- Support the development of competent, confident practitioners to treat all patients
- Ensure access to culturally sensitive, applicable Functional Medicine education and training for all practitioners
- Ensure the viability of Functional Medicine through research, advocacy, and education for practitioners and patients.
To truly meet our mission of the widespread adoption of Functional Medicine, our evolved focus is on access to care. We commit to being intentional in our approach. We will ask questions about why clinicians of color are not attending our courses. We will discover why patients of Functional Medicine are not diverse, and we will work to change that reality. We will uncover the reasons why the population who could benefit the most from a Functional Medicine approach, including essential workers and their families, aren’t aware of or aren’t able to access this kind of care. What can we do to build trust between the Black community and the healers? Functional Medicine is built on the foundation of trust—a trust rooted in the patient-practitioner partnership—a unique, deeply connected relationship that, at its core, ensures the greatest progression and expression of individual health for all people.
To do this critically important work, we will find partnership in clinicians and others from across the field to help inform and implement our decisions and our direction. Driving systems change requires a village of diverse thinkers, innovative disruptors, and risk takers. IFM is fortunate to have many of these types of leaders among us already, but we need so many more, especially leaders of color.
On behalf of the IFM Board of Directors, faculty, and staff, Functional Medicine stands firm in the statement—Black Lives Matter. We are committed. And we look forward to moving this work forward with you.
- Gray DM 2nd, Anyane-Yeboa A, Balzora S, Issaka RB, May FP. COVID-19 and the other pandemic: populations made vulnerable by systemic inequity. Nat Rev Gastroenterol Hepatol. Published online June 15, 2020. doi:1038/s41575-020-0330-8
- Hostetter M, Klein S. In Focus: Reducing racial disparities in health care by confronting racism. The Commonwealth Fund. Published September 27, 2018. Accessed June 29, 2020. https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confronting
- Quiñones AR, Botoseneanu A, Markwardt S, et al. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One. 2019;14(6):e0218462. doi:1371/journal.pone.0218462
- National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. National Academies Press; 2017. doi:17226/24624
- Berchick ER, Hood E, Barnett JC. Health insurance coverage in the United States: 2017. US Census Bureau. Published September 12, 2018. Accessed June 26, 2020. https://www.census.gov/library/publications/2018/demo/p60-264.html
- Oates GR, Jackson BE, Partridge EE, Singh KP, Fouad MN, Bae S. Sociodemographic patterns of chronic disease: how the mid-south region compares to the rest of the country. Am J Prev Med. 2017;52(1S1):S31-S39. doi:1016/j.amepre.2016.09.004
- Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-1244. doi:1016/S0140-6736(20)30893-X