Achieving Equity in Neurological Practice

The recent high-profile murders of George Floyd, and other African American individuals, along with the prevailing coronavirus disease (COVID-19) pandemic have reinforced the notion that certain marginalized populations have worse health outcomes than other populations, likely due to unequal and unjust policies and practices. Neurological processes and prognoses frequently vary by sex/gender, race/ethnicity, socioeconomic status, and geographic location. In particular, individuals of lower socioeconomic status and from minority racial and ethnic backgrounds have worse neurological health and often receive a lower standard of neurological care. These inequities in neurological outcomes are attributed to wider societal social influences, which impact how people live and how neurology is practiced. Published evidence suggests that healthcare providers and the healthcare system contribute to inequities in neurological care for vulnerable and underserved populations. However, educating neurology care providers about these issues and training them to provide equitable care for these patients can potentially improve neurology care access, delivery, and outcomes. In this book we provide the theoretical background, scientific evidence, and experiential knowledge warranted to properly care for vulnerable, underserved patients with neurological diseases at the levels of the provider and system. This book examines the root causes of neurological health inequities across a broad range of topics and offers possible solutions for achieving neurological health equity. Initial chapters help to frame the overall issue of neurological health equity. Subsequent chapters evaluate neurological health equity from the clinical practice standpoint, with a focus on select populations and subspecialty care delivery settings. Lastly, we discuss the bigger picture with regard to the pipeline of practitioners and purview of policy makers. This text is relevant for neurology residents and fellows, multidisciplinary neurological care practitioners (neurologists, neurosurgeons, advanced practice providers, hospitalists, emergency physicians, critical care physicians, pharmacists, and allied health personnel), and public health researchers and health policy makers. The book is divided into three sections: Principles, Neurological Conditions, and Priorities. The first section establishes the framework and explains various key terminologies and concepts, which undergird the care of vulnerable and undeserved patient populations. The second section, Neurological Conditions, covers key neurological diseases by sub-specialty describing published evidence of care and outcome disparities, gaps in knowledge, practical techniques for bridging these disparities on provider and system levels. The third section, Priorities, identifies important areas of focus and improvement targeting trainees, researchers, community partners, stakeholder organizations and policy makers, which would be crucial for implementing sustained societal-level enhancements in the neurological health of these vulnerable populations.