Racial Disparities in Primary Care for Children and The Implications on Child Health During COVID-19

Racial disparities in healthcare primary care have been largely studied in American adult populations; however, studying racial disparities between primary care in children has remained largely unexplored. The lack of studies on children in primary care may be due to the assumption that adult racial disparities are representative of adolescent disparities. On the contrary, children have unique primary care experiences due to school-based care, a focus on preventative care, and the strong influence adolescent care has on future health. 

Using questions from the Pediatric Primary Care Assessment Tool (PCAT) developed by Johns Hopkins, parents of hispanic, white, black, and Native American children in San Bernardino County, California answered questions that indicated that on average non-white families rated their children’s primary care as lower quality than their white counterparts. Interestingly, although Asian parents indicated seeking care at doctors’ offices most often across all racial groups, they rated the quality of care lowest. White families reported the highest quality of care and highest rates of insurance, although they visited doctors’ offices slightly less often than Asian families. Hispanic families reported visiting health maintenance organization clinics most often, rather than doctors’ offices, and had the lowest rates of insurance, yet they reported higher quality of care than Asian families. It is unclear if Asian families have higher expectations of care, which would explain their perceived lack of primary care quality, or if there are other factors changing primary care quality for Asian families. Although both white and Asian families visited doctors’ offices at nearly the same rate, white families reported seeing a consistent pediatrician more often. Furthermore, families who had consistent pediatricians had the highest rates of perceived quality of care, suggesting that a familiar team of doctors may increase quality of care. For children living in low socioeconomic areas like black communities, it is extremely difficult to have a consistent physician from a clinic. This idea is supported by a study by Christakis et al. which found that lower consistency in primary care physicians was correlated with decreased overall health and increased hospitalizations for children. 

Quality of primary care for children has implications beyond their health as they age. In unforeseen circumstances, such as the COVID-19 pandemic, minority children with parents who are more likely to work essential jobs are at increased risk of becoming seriously ill due to parental exposure and poorer health. Childhood is where most development occurs and pediatrics must be expanded to serve underserved communities. Primary care is important in keeping all young children healthy, and in order to insure the highest quality care for children, the system of primary care must not only be available to all families, but primary care must be consistent to learn the needs of each child to maximize patient health. 

 Stevens, G. D., & Shi, L. (2002). Racial and ethnic disparities in the quality of primary care for children. Journal of Family Practice, 51(6), 573-573.