Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Headache. 2020 Nov;60(10):2473-2485. doi: 10.1111/head.14004. Epub 2020 Nov 3.
Migraine and severe headache affect approximately 1 in 6 U.S. adults and migraine is one of the most disabling disorders worldwide. Approximately 903,000 to 1.5 million African American (AA) men are affected by migraine in the United States. Racial disparities in headache medicine exist. In addition, there are limited headache studies that attest to the inclusion of or have robust data on AA men in headache medicine in the United States. Racial concordance between provider and patient may ameliorate some aspects of care disparities. Moreover, it has been demonstrated that diversity and inclusion particularly in leadership of organizations has consistently produced positive change, increased innovation, and long-term success. Most national headache organizations strive to improve the care and lives of people living with headache disorders yet only ~0.5% of their physician members are AA men. Herein, we provide an observation of equity issues from the perspective of AA men in the headache medicine subspecialty. Part 1 of this manuscript explores inherent and potential challenges of the equity of AA men in headache medicine including headache disparities, mistrust, understudied/lack of representation in research, cultural differences, implicit/explicit bias, and the diversity tax. Part 2 of this work offers possible solutions to achieve equity for AA men in headache including: (1) addressing head and facial pain disparities and mistrust in AA men; (2) professionalism and inclusion; (3) organizational/departmental leadership buy-in for racial diversity; (4) implicit/explicit and other bias training; (5) diversity panels with open discussion; (6) addressing diversity tax; (7) senior mentorship; (8) increased opportunities for noteworthy and important roles; (9) forming and building alliances and partnerships; (10) diversity leadership training programs; (11) headache awareness, education, and literacy with focus to underrepresented in medicine trainees and institutions; and (12) focused and supported the recruitment of AA men into headache medicine. More work is needed for equity of AA men in headache medicine.
偏头痛和严重头痛影响了大约 1/6 的美国成年人，偏头痛是全球最致残的疾病之一。在美国，大约有 903,000 到 150 万非裔美国男性（AA）受到偏头痛的影响。头痛医学领域存在种族差异。此外，关于非裔美国男性在头痛医学中的纳入情况或有可靠数据的头痛研究有限。提供者和患者之间的种族一致性可能会改善一些护理差异。此外，已经证明多样性和包容性，特别是在组织的领导层中，一直产生积极的变化、增加创新和长期成功。大多数国家头痛组织都致力于改善头痛障碍患者的护理和生活，但只有约 0.5%的医生成员是非裔美国男性。在此，我们从头痛医学亚专业的非裔美国男性的角度观察公平问题。本文的第 1 部分探讨了非裔美国男性在头痛医学中公平性所面临的固有和潜在挑战，包括头痛差异、不信任、研究中代表性不足/缺乏、文化差异、内隐/外显偏见以及多样性税。本文的第 2 部分提供了实现非裔美国男性在头痛方面公平的可能解决方案，包括：（1）解决非裔美国男性头部和面部疼痛差异和不信任问题；（2）专业性和包容性；（3）组织/部门领导层对种族多样性的认同；（4）内隐/外显和其他偏见培训；（5）多样性小组进行公开讨论；（6）解决多样性税；（7）高级指导；（8）增加重要角色的机会；（9）建立和建立联盟和伙伴关系；（10）多样性领导培训计划；（11）以医学受训者和机构中代表性不足的群体为重点，开展头痛意识、教育和扫盲工作；（12）专注并支持招募非裔美国男性加入头痛医学。在非裔美国男性在头痛医学中的公平性方面还需要做更多的工作。
