Amid the ongoing impact of the COVID-19 pandemic, prominent thought leaders and stakeholders in health care say it’s time to rethink how health inequities are addressed, stressing the need to build better relationships with patients and to mitigate the causes of health disparities that have plagued racial and ethnic minorities for years.
“Traditionally, the focus has been more on health care costs and utilization, quality and health outcomes,” Dr. Regina Benjamin, former U.S. surgeon general under President Barack Obama, told onlookers Wednesday during a U.S. News & World Report forum on the state of financial and health equity. “However, now quality and improved health outcomes depend on having knowledge and the right tools … but it also depends on us being able to communicate with our patients, and it depends on our patients being able to understand us – but more importantly, us understanding our patients.”
Underscoring the issue of health inequity are recent survey findings from CVS Health and The Harris Poll that showed patients of color were more likely to report receiving poor-quality health care in the last year, while one-third of Black and Hispanic Americans reported experiencing or witnessing discrimination based on race or ethnicity when visiting a medical facility.
People of color were also more likely to view structural racism as a factor that negatively impacted the quality of their health care, with 75% of Black Americans reporting that belief compared with 35% of whites.
“I’m still in awe that we see numbers like this in our health care institutions,” Pamela Sutton-Wallace, chief operating officer for the Yale-New Haven Health system, said during the forum, which was held in New York and broadcast online. “It really is about, ‘How do we move from the conversation, move from the data collection, to the actual implementation of solutions that we know can change fundamentally some of those really important statistics?’”
During a panel discussion among health care executives on the state of equity in hospitals, Dr. Steven Corwin, president and CEO of the New York-Presbyterian health system, said issues of inequity are rooted in a multitude of longstanding causes, including a lack of diversity in academic medicine and the implicit biases present in clinicians, as well as in some of the clinical tools they use to make diagnostic decisions.
“You’re dealing with historical vestiges that promote and create bias,” Corwin said.
Dr. Philip Ozuah, president and CEO of the Montefiore Medicine health system in New York, said social determinants such as a lack of having reliable transportation to get to medical appointments are a big contributing factor to disparities experienced by Black patients.
Using technology, he said, can help address such factors.
“By understanding that and putting processes in place – using technology and flagging our teams for patients who are at risk for having that barrier, and providing mechanisms for patients to access transportation – you begin to eliminate one of those barriers,” Ozuah said.
Corwin also said a key component to curbing health disparities is to collect patients’ demographic and socioeconomic information, in order to understand what specific factors are hindering their health. To do that, he acknowledged, requires developing trust that health care providers have struggled to establish with underserved patients.
“You have to explain to people why their information is going to be used positively and not be used to stigmatize them,” Corwin said. “These are the types of things you have to work on in order to ultimately provide equitable care.”
Ali Shirvani-Mahdavi, vice president of health equity analytics for pharmacy benefit management company Optum, said the benefits of addressing health equity go beyond providing a public good and hold potential for massive cost savings.
Mahdavi outlined Optum’s strategy, which he said involves the use of clinical, social and demographic data to create a more holistic view of patients, with the goal of better understanding the relationship between the socioeconomic and clinical factors that affect a person’s health. Mahdavi said the information gathered is used to create pilot programs aimed at addressing various social determinants of health.
“Data analytics technology helps us to start the process, helps us identify where to focus, helps us measure the outcomes, and helps us redesign the programs if they are not meeting the need,” Mahdavi said. “But really, that is just the starting and ending point. The middle part is all about collaboration, it’s all about bringing the right resources at the right time to the right partners for the right solution into the mix.”
“Whether it’s in the health care space, jobs and economics space, or whether it is in how we think about the justice system or policing, equity has to be a guiding principle, a guiding pillar, a guiding sense of how we do business,” said Marc Morial, president and CEO of civil rights and advocacy organization the National Urban League.
Benjamin, the forum’s closing speaker, called for the country “to take a more holistic and integrative approach to community health” – one encompassing “everything from safe highways and worksite wellness programs to clean air and healthy food.”
“We have to get to a place where everybody understands that almost everything that we do, even though it’s not labeled health or prevention, really does affect the health and quality (of) life of all Americans,” she said.
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