Despite a wide range of efforts to address health equity, disparities in both healthcare and overall health continue to persist. As health inequities continue to affect vulnerable populations, healthcare organizations, institutions and providers must shift towards a health equity centered, population health approach, according to a recent discussion paper published by the National Academy of Medicine.
“If we’re trying to achieve the quadruple aim — better culture, better care, better health and lower costs — these places really need to shift their focus to have health equity be front and center,” said Melissa Simon, MD, MPH, GME ’06, the George H. Gardner, MD, Professor of Clinical Gynecology, founding director of the Center for Health Equity Transformation and first author of the paper.
In the paper, Simon and her colleagues emphasize that health equity is an integral component of a “patient and family engaged care” culture. Further, the authors explored examples of recent efforts that have created significant change on both policy and cultural levels.
Read a Q&A with Simon below.
What was the motivation behind this paper?
We wanted to emphasize and explore health equity as an integral component in the culture of patient and family engaged care, rather than a peripheral outcome. We believe that you must ensure that health equity is engrained into the fabric of an institution and by centering health equity as a priority instead of an outcome, then you have a better chance of achieving it. This requires a transformational culture shift in the way institutions are structured at every level from the way they delivery patient care, to their teaching, scholarship, policies and practices.
What is “patient and family engaged care”?
Patient and family engaged care is care that genuinely centers patients and their families, and also applies to a community context. Oftentimes we say we’re patient-centered, but what does that really mean? Are we just giving lip-service to patients and their families by letting them serve on advisory councils or tell their stories to leadership, but never have them give true feedback? Have we really centered the patient, family and community in everything? Have you aligned all the leavers of an institution, the mission, the values, the leadership, governance and the policies, and if it’s at an academic health center, the scholarship, the teaching the education, the communication and the quality of care? And when you’re looking at a racial justice or through a health equity lens, does that include all communities?
How can health equity be engrained into the fabric of an academic institution, organization or healthcare delivery system?
It involves a lot of intentionality, a lot of transparency and a lot of iterations. This is a call for a transformation with a marathon mindset that nothing is going to happen overnight. It starts with the leadership, the highest levels of leaders in all aspects of an institution. They all have to lead with health equity as a priority, with centering patients and family and communities with a health equity lens, and it’s really apparent when it’s not. You can see just by counting the number, or lack thereof, of leaders in, for example, the C-suite, a dean’s executive committee, the board of directors or the board of trustees, how many Black people, indigenous people or people or color are actually true high-level leaders and how many are actually in power and given power including budgets to operationalize the work. You can see what the values of an institution are by who it appoints as its high-level leaders and by where the true investments in an institution lie.
There are many people already working in healthcare delivery institutions and at academic health centers that have the talent and ability to be appointed to high level leadership positions and who are Black, indigenous or people of color, but aren’t given a chance for a variety of reasons, including long-standing systemic racism.
What challenges can come with wanting to prioritize health equity in these spaces?
There is a real reluctance to change and until we can really be introspective about our biases, preferences and privileges, we will not be able to see why we aren’t incorporating or valuing leaders, families and patients who are Black, indigenous or people of color.
We need to take an introspective and critical deep dive into what our policies and practices are at all levels, whether it’s around examining quality data, examining policies with respect to healthcare access, where clinics are located, and ultimately determining where our footprint is and where it isn’t.
We must ask ourselves what our investments are, where they are and why they are in some places and not in others? Where is there missed opportunity? How do we show up in the community and in all communities? Who do we serve and who should we be serving? These kinds of questions are really essential to becoming more aware, more empathic and move us towards centering health equity and racial justice in everything we do.
How has the push for health equity been amplified since the start of the COVID-19 pandemic and in regard to recent events with the Black Lives Matter movement and racial justice?
COVID-19 has revealed what many experts in health equity and advocates of health equity have known for decades: that there are structures and systems in place that clearly advantage and privilege some and clearly disadvantage others. This is rooted in structural and institutional racism, or what some also call systemic racism. It’s clear and consistent in pretty much everything we do; in every agency, institution and organization there are elements of this. Institutions have also participated in creating this disadvantage, so we do have an onus on us to really change the course of how we do business in every aspect.
The opportunity is on the table right now, the iron’s hot. Right now, we have this opportunity to not only call out systemic racism but figure out how we can dismantle this system that has excluded people in so many ways, including access to healthcare, consistently over decades and centuries.