By Alex Drury – Principal,SVP, Business Development
Much progress has been made in recent decades to make healthcare safe, effective, patient-centered, timely, and efficient. But another goal – health equity – has lagged far behind.
Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.
Healthcare has a significant role to play in achieving health equity. While healthcare organizations alone do not have the power to improve all of the multiple determinants of health for all of society, they do have the power to address disparities directly at the point of care, and to impact many of the determinants that create these disparities.
The proverbial gauntlet has been laid down to healthcare organizations: any organization that wants to improve equity must be prepared to fundamentally change the current system that is producing disparities in health outcomes. Thus, any healthcare organization that prioritizes decreasing health disparities must be prepared to make health equity a system property — that is, a system-level priority at all levels of the organization — and to profoundly alter the current system that is producing inequitable results. This is not an issue that can be delegated; addressing health equity requires a major commitment from top-level leadership.
The Institute of Health Improvement has outlined five key building blocks in creating a framework for health care organizations to improve health equity in the communities they serve.
Make health equity a strategic priority: Healthcare leaders must be explicit that improving health equity is an organizational priority, both to support resource allocation for this work and to demonstrate that the organization is serious about reducing health disparities.
In an article by Becker’s Hospital Review entitled “Execs Tout Health Equity, but 43% of Healthcare Orgs Have No Plan to Achieve It," it states: "95% of executives surveyed believe addressing health equity is important. 43.5% said their companies have not put a plan in place. This gap in intent verse execution may cause attrition or the companies leading these efforts to become more attractive to employees." Some ways to do make health equity a priority include:
o Demonstrate leadership commitment to improving equity at all levels of the organization
o Build health equity into business planning, strategic goals and performance evaluations, and executive compensation, and strategic organizational pillars
Develop structure and processes to support health equity work: A health equity strategy requires a supporting organizational structure that can manage the work. Because many equity-related elements need to be considered in the strategy (e.g., hiring, procurement of supplies, planning for new buildings, internal staff training, care redesign),organizations will need an oversight committee structure to enable people throughout the organization to work together on shared health equity goals:
o Establish a governance committee to oversee manage equity work across the organization
o Dedicate resources in the budget to support equity work
Deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact, such as health care services, socioeconomic status, physical environment, and healthy behaviors: To support the execution of the strategic priority of health equity, health care organizations need to develop specific activities to address the determinants of health on which they can have a direct impact, including health care services, socioeconomic status, physical environment, and healthy behaviors. While a discussion of key issues in the equitable provision of care such as health literacy, cultural competency and sensitivity, and availability of high-quality interpreter services is beyond the scope of this paper, these issues are essential to improving health and healthcare equity and must be considered in the design of care delivery for disadvantaged populations.
o Healthcare services
o Socioeconomic status
o Physical environment
o Healthy behaviors
Decrease institutional racism within the organization: When addressing DEI initiatives, it is important for companies to differentiate mentorship and sponsorship programs. We have always heard about mentorship, which often is a leader available to guide and support someone in their progression growth but there has been an uptick the last few years in sponsorship opportunities. While a mentor supports down, the sponsor can act as a promoter and show support and intent to grow someone’s career to an audience of influencers.
Healthcare organizations must understand ways in which they contribute to structural or institutional racism. Institutional racism is not the bigotry that many people think of when they hear the term “racism.” Camara Jones, Research Director on Social Determinants of Health and Equity and the CDC, explains: “Institutionalized racism is defined as differential access to the goods, services, and opportunities of society by race. Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage. It is structural, having been codified in our institutions of custom, practice, and law, so there need not be an identifiable perpetrator.”
o Physical space: Buildings and design, accessibility, affordable parking, efficient waiting times
o Health insurance plans accepted by the organization
o Reduce implicit bias in medical staff hiring practices, patient care, patient-provider interactions, tendencies to stereotype, etc. --- all of which contribute to patient health outcomes
Develop partnerships with community organizations to improve health and equity: There is great added benefit inworking with community partners to address determinants of health that are beyond the reach of health care. This includes safety net providers, who often have existing partnerships in the community and are familiar with the needs of marginalized populations. Community-based organizations already know the community and its needs and are often already engaged in related work in the community. Rather than re-inventing the wheel, health care organizations should build partnerships with other organizations and community partners.
Health systems can invest financial and in-kind contributions in multisectoral partnerships in the community to improve health outside of the health care setting, such as reducing childhood obesity by offering healthier lunches in schools and developing programs that provide academic support to at-risk children.
To sum up -- today, healthcare organizations are doing more to improve health equity, but few have made it a strategic priority. A major barrier is the business case. Leaders understand the moral case for working on health equity, but they need funds to sustain the work. As providers assume more financial risk for populations, improving health equity will make more financial sense.
