Health Disparities Health Equity Systemic Racism

A Social Justice Contract for Healthcare Professionals and Organizations?

Our industry’s efforts to address racial, cultural, and ethnic inequities in healthcare has been incredibly slow. Just look at the timeline. In 2002, The Institute of Medicine published the report “Unequal Treatment,” which found “racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.” (Fierce Healthcare, Industry Voices) That was nearly 20 years ago.

In 2008, the World Health Organization Commission on Social Determinants of Health published its seminal report Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. In its report, the Commission stated: “inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces.” The Commission then went on to outline three recommendations and related principles of action:

  • Improving daily living conditions of these people and communities;
  • Tackling the inequitable distribution of power, money, and resources—the structural drivers of the conditions of daily life;
  • and measuring the extent of health inequities and assessing the health equity impact of policy and other actions.

Those reports were from 2002 and 2008; yet, health and economic inequities persist. We’ve made little progress in dismantling the infrastructure (laws, regulations, policies, business practices) that underpins the current status quo – covert systemic racism which enables rampant health inequities in our country.

Although I would love to see institutions within our industry commit to a social justice contract of some sort, I think that time has passed. The time for talk is over. We need leaders of health systems, hospitals, medical centers, and payor organizations to develop and implement plans of action to break down the barriers to health equity. The question is, what will motivate these leaders to take action? What is different today that might lead them to do the right thing? Do we need something like a health inequities scorecard that looks at communities and health systems and evaluates them using pre-defined KPIs? The scorecard would then be published and successes would be celebrated and turned into case studies for others to emulate. I’m just thinking out loud, but unless there is public accountability, positive change will likely creep along at a snail’s pace.

So where do we go from here? If your organization is doing great work in the areas of health equity and racial justice, please share them with me! I’d love to e able to provide concrete examples of leading practices.

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