The Health Divide: When outdated care leads to worse outcomes and deepens disparities
Author(s)
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by
James Causey
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Dr. Lia Knox, founder and CEO of Knox Behavioral Health Solutions, speaks about mental wellness on a Black Women’s Health Panel sponsored by NABJ Milwaukee last month.
Photo credit: (Photo via NABJ Milwaukee)
Published on
November 24, 2025
In health care, the quality of that care can vary significantly from one patient to another, and even from one facility to another — even when they’re just 20 miles apart. This harsh reality became clear to Adrienne Bryant after her recent mammogram.
Bryant, who is the president-elect of the National Association of Health Services Executives, had attended a medical clinic nestled in Oconomowoc, Wisconsin. The clinic’s location and flexible hours suited her busy lifestyle.
Each visit had concluded with a clean bill of health, leaving her feeling secure and confident.
However, her routine took a turn when she tried to book her next appointment and couldn't get a spot. Looking for an alternative, she scheduled an appointment at a different clinic in Pewaukee, a 17-minute drive away.
What followed was a startling revelation.
At the Pewaukee clinic, she was met with a devastating diagnosis: They had detected cancer, thanks in large part to the advanced machines they employed.
“If I had continued going to Oconomowoc, they would not have found it as early as they did,” Bryant said.
Much of the national conversation has centered on who can get care, while deeper reporting on the uneven quality of that care — by race, income, disability, immigration status or geography — remains far less common. Those who do undergo medical procedures or scans requiring specialized equipment, such as mammogram machines, are often subjected to outdated machines, which can contribute to even worse outcomes.
The use of older or less effective technology disproportionately affects low-income and racial and ethnic minority communities, worsening existing health disparities.
Bryant recently shared her experience on a panel at the Black Women’s Health Forum, held in October and hosted by the National Association of Black Journalists–Milwaukee. The forum aimed to educate and empower Black women about their health, giving them the knowledge to ask the right questions during checkups and procedures with their doctors.
Access to newer technologies is uneven
Bryant described her experience as a realization that inspired her to take a more proactive approach to her health care. She responded by starting a small group with her friends to discuss health-related topics via text.
This platform helped them challenge stigmas and share their experiences. They asked questions, held each other accountable for check-ups and appointments, and offered support to anyone needing a friend to accompany them.
They would ask each other questions like: What was your appointment like? What happened during the visit? What questions did you ask? Were all your questions answered? What equipment did they use? Was the equipment state-of-the-art?
Cherie Harris, a breast cancer survivor and the director of marketing, media strategy, and community engagement for C. Harris Communications, who was also part of the women’s health panel, pointed to mammogram technology, noting that equipment in lower-income areas and smaller clinics often trails behind the latest technology available in wealthier regions. Since 2000, two significant advancements have occurred: A shift from screen-film mammography to full-field digital mammography, and the adoption of digital breast tomosynthesis, a type of 3D mammogram.
While these advancements improve early detection and increase survival rates for many women, access to these newer technologies remains unequal.
Research has found that Medicare coverage can enhance access to innovative breast cancer screening methods in underserved areas and help diminish racial and regional disparities in breast cancer care. These disparities also tend to lessen as technology spreads from wealthier areas — where private insurance is more common — to underserved communities where public insurance is more prevalent.
However, this process is slowed because Medicare reimburses providers at far lower rates than private insurers, reducing the financial incentive for many health systems to invest early in cutting-edge technology.
Eric W. Christensen, who co-authored a study published in Radiology, said that in today's competitive health care world, providers are less likely to offer newer technology and services in areas with low payment rates.
Women of color less likely to get advanced scans
The study by Christensen exploring the relationship between race and access to newer mammographic technology for women with Medicare insurance revealed that Black women had less access to advanced mammographic technology.
This gap was evident both during the transition from screen-film to digital mammography and during the shift to digital breast tomosynthesis.
This issue is particularly critical, given that Black women are still more likely to die from breast cancer than White women across the U.S., even though Black women have slightly lower rates of breast cancer incidence.
More broadly, health journalists might start by looking at how the quality of medical equipment at local facilities compares to that in nearby wealthier areas. Who uses this equipment and what barriers do communities of color and low-income individuals face in accessing the latest, most advanced technology? I would love to see more original investigations on these themes.
There are also opportunities for explanatory journalism here: There’s clearly a need for more education about the different types of mammography scans, leaving patients better informed to ask the right questions. This vital question might not have occurred to women during routine mammograms.
For example, Bryant had never thought about this question until she visited another facility and discovered she had cancer, which the clinic she usually went to had missed. Not only did the new facility have state-of-the-art equipment, but it also had mental health counselors on staff to help her cope with the news.
“The day I walked into the mental health professional's office, I sat there, and I cried for two hours straight. Not a word came out of my mouth except for just ugly crying,” she said. “But I needed a space to cry.”
She’s doing better today. Simply switching to a facility only 20 miles away potentially saved her life.