LESLIE HAUSMANN, PHD
For individuals who have served in the U.S. Armed Forces, accessing appropriate health care is vital to life after service. Disparities exist in veterans’ health as they do in other populations. The key to eliminating disparities in veterans’ health is knowing what they are and how best to address them.
Veterans are a multifaceted group with health issues that are both common and unique to their service experiences. Veterans have various unique issues, including those stemming from return to civilian life or living with traumatic injury. They experience mental health and substance-use disorders, post-traumatic stress and traumatic brain injury at disproportionate rates compared to their civilian counterparts (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671760/).
Health disparities also exist within the veteran population itself. According to a chartbook compiled by the U.S. Department of Veterans Affairs (VA), veterans who are lesbian, gay or bisexual (LGB)*—compared with veterans who do not identify as LGB—report worse health and more chronic conditions; report higher rates of smoking, drinking excessively and having poor sleep quality; and female veterans who are LGB report depressive and anxiety symptoms at double the rate of female veterans who are not LGB.
As investigator and codirector of the Equity Capacity Building Core of the VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Leslie Hausmann, PhD, is working to eliminate health disparities in the veteran population. Her research and activities focus on building tools to engage the health care workforce and identifying and making systemic changes to address disparities happening at the local level.
“When I would present research about veterans’ health disparities, leaders of various VAs thought that these disparities weren’t happening in their population,” she says. “There was a disconnect between data at the national level and action on the ground. I’ve been working with the national VA Office of Health Equity Research and a team here in Pittsburgh to design tools specifically to bridge that gap.”
One of the tools Dr. Hausmann and colleagues are developing is the VA Primary Care Equity Dashboard. VAs across the country can use this tool to look at data with regard to disparities in their own patient population. The intent is to support quality improvement and to get VA health care providers to think about equity in every step of their quality improvement process. With the dashboard, users can see how their facility is performing overall in several quality measures—like chronic disease management.
“Then there’s an equity deep-dive area of the dashboard where there’s information about how specific subgroups are performing in terms of health equity,” says Dr. Hausmann, who is also associate professor of medicine (Division of General Internal Medicine) and of clinical and translational science at the University of Pittsburgh. “Because they comprise the majority of the data, white, male veterans’ health measures are often right in line with the national average. This doesn’t provide a complete picture. If you look at the breakdown of data, smaller populations like veterans who are women or racial/ethnic minorities may be performing at lower rates than the national average. We’re trying to shift the culture to move past the idea that if the overall data on veterans’ health measures are fine, that everyone must be fine. We want people to think intentionally about how groups that we know are at risk for health disparities are performing.”
In using the dashboard’s data, if a quality improvement team notices a disparity in its VA, Dr. Hausmann and her team then do coaching and facilitation with them to figure out how to eliminate the disparity. The dashboard also includes toolkits to help VA health care providers tailor different treatments to different populations and make systemic changes by looking at exactly how marginalized populations are being underserved.
Dr. Hausmann says that, overall, the VA is doing well in providing high-quality health care to veterans. Disparities are not even as stark within the veteran population as they are in the general population. But, she points out that the goal is to eliminate any disparities that exist, which is her ongoing research focus and that of the Pittsburgh VA’s Center for Health Equity and Promotion.
To learn more about participating in research about veterans’ health, please visit https://veteranshealthfoundation.org/get-involved/.
*Data are taken from the 2013-18 National Center for Health Statistics National Health Interview Survey, which only has data available for the LGB subset of the LGBTQ+ population.
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