Health equity: Making the journey from buzzword to reality

The reality of COVID-19’s disproportionate impact on Black and Brown communities has made health disparities in the U.S. impossible to ignore. This isn’t the first time. These communities faced an undue burden during the H1N1 flu pandemic and even the 1918 flu pandemic.

What’s more, researchers at Harvard’s School of Public Health and the Johns Hopkins Center for Health Equity have grappled with these issues for years—and yet seemingly intractable problems remain.

Social determinants of health—factors such as socio-economic status, living environment, education and employment—are responsible for up to 90% of health outcomes. We know that systemic racism has resulted in less educational achievement, higher rates of poverty and inadequate housing among African Americans. These inequalities, often spanning generations, directly cause higher rates of preventable disease and shorter life expectancies.

These problems extend to members of the LGBTQ community. Research suggests that LGBTQ individuals experience health disparities linked to social stigma and discrimination, including high rates of psychiatric disorders and substance abuse. Lesbian and bisexual women face higher rates of breast cancer.

So how can healthcare leaders vanquish these disparities? The answer relies on the establishment of clear governance structure and responsibilities. As chair of the board of directors of Advocate Aurora Health, I can say that hospital systems expect more accountability from their boards than ever before.

Hospital boards must first ensure they reflect the communities they serve.

This is where the Black Directors Health Equity Agenda, a national coalition of African Americans who serve on the boards of healthcare organizations, seeks to make a difference. The group, which I co-founded, is dedicated to supporting more focused strategies and accelerating the goal of eliminating health inequities.

Next, is it best to ensure focus by creating a standing board committee dedicated to health equity? Or is progress better made when the tenets of health equity are embedded throughout the enterprise and all governance structures?

Once an organization establishes its governance model to address health equity, it must then determine how to measure performance and give incentives for success. As our country grapples with the complexities of health disparities, will we determine that health equity is a human right? If so, should the government define goals and metrics for achieving equity?

Finally, boards and health systems must also commit to promoting equity, diversity and inclusiveness within their own workforce. At Advocate Aurora, we’ve made significant strides by tying executive compensation to specific goals for diverse hires in leadership positions, lower turnover rates among employees of color and investment in minority- and women-owned businesses.

Advocate Aurora and other systems have committed to reaching beyond traditional healthcare boundaries to address social determinants of health.

We have invested in care managers who help patients receive the proper follow-up care to manage chronic diseases. These managers screen patients for food, housing and transportation security. When necessary, they “prescribe” nonmedical resources, such as our own Healthy Living Food Farmacy which offers free fruits and vegetables. NowPow, a mobile messaging and referral platform, helps us connect patients with its database of thousands of such services.

Recognizing that disparities are also tied to sexual orientation and identity, we’ve updated our EHR system to document a patient’s gender identity, sexual orientation, sex assigned at birth and inventory of organs, which helps clinicians make informed decisions.

These are difficult subjects with no easy answers. As our country confronts and responds to the health problems imparted by its history of racism, we understand that a robust response is critical to creating a more just society where all people have the opportunity to live well.