Ascension, CommonSpirit Health, Trinity Health and 20 other Catholic health systems have pledged to confront systemic racism in part through top-down examinations of their operations to ensure they're promoting diversity and inclusion.
The systems, which together treat more than 4 million patients annually and employ almost half a million people in the U.S., unveiled the initiative Thursday alongside leaders from the Catholic Health Association. A big part of the undertaking will be addressing the disparities that led to COVID-19's disproportionately devastating impact on communities of color. They'll also ensure COVID tests are accessible in minority communities and vaccinations are prioritized for those at higher risk.
"I submit shame on us if we do not seize this moment as a nation and as a society to make measurable, demonstrable and systemic changes," Lloyd Dean, CEO of CommonSpirit, said at a news conference Thursday.
CHA has been working on the issue behind the scenes for years, but it came to a head over the summer as Blacks were dying at higher rates from the coronavirus and after the police killing of George Floyd, said Kathy Curran, the association's senior director of public policy.
"You had the ongoing work and then these flashpoints," she said. "Our board said, 'No this has to stop. We have to work together on this.'"
CHA's board endorsed a pledge in July which it then rolled out to its members, none of which declined to participate, Curran said.
The pledge begins with a commitment to take immediate action against inequities that have defined the pandemic's impact. It then goes into broader systemic changes designed to ensure health equity. Providers who agree to the pledge will examine all aspects of their organizations, including how they recruit, hire, promote and retain employees as well as how they conduct business operations and hold leaders accountable.
St. Louis-based Ascension has already been doing that under a systemwide program that encourages belongingness, diversity and equity, Dr. Tamarah Duperval-Brownlee, Ascension's chief community impact officer, said at Thursday's news conference.
"It helped us determine where our policies, practices and ways of working may contribute to or even perpetuate disparities, inequities and systemic racism," she said. "It's important work, and it's called us to listen, to pray, to learn even before any action is taken."
Christus Health, another participant, has been focused on the issue for years, said Ernie Sadau, president and CEO, at the news conference. As a result, the health system's board is now 45% made up of ethnic minorities and 40% women, Sadau said.
Providers signing the pledge are also committing to building and strengthening relationships with communities of color with the goals of learning the needs of those communities and determining how best to partner around creating sustainable change.
Finally, the pledge urges providers to use their voices to advocate on a policy level for changes that will help eliminate health disparities and systemic racism.
Much of that work has been happening for years within Catholic health systems, Curran said. The difference now is they'll join together to share ideas and learn how they can do more.
"This is not a one-time do a press release wash your hands and we're over thing," she said. "This is a long-term commitment we're making."
One example is Chicago-based CommonSpirit's $100 million partnership with the Morehouse School of Medicine designed to improve patient access to Black clinicians and help Black medical students gain community experience. Another is SSM Health's sponsorship of a health education center for Black men located inside a barbershop in Madison, Wis. PeaceHealth, headquartered in Vancouver, Wash., is collaborating with churches and community organizations to ensure minority communities have information on COVID.
There's no prescribed way systems should go about their in-depth assessments, Curran said. Each system has appointed a representative who will report back to CHA on their work. CHA is still determining how it will monitor progress, she said.
"All of our systems have tons of measures they have to report on to all kinds of people," Curran said. "We're not trying to come up with some new check the box list of things to do."
The pledge does not include a specific monetary commitment, although some health systems have made specific promises on their own. Providence in Renton, Wash., for example, has said it will invest $50 million over the next five years to reduce health disparities and achieve health equity.
And while Curran said providing free or discounted care is something CHA is constantly paying attention to, expanding that assistance is also not part of this pledge. Across U.S. Catholic hospitals, 2.7% of expenses went to free or discounted care, also known as charity care, in their latest reports to CMS, according to a 2020 report from Community Catalyst. That's slightly higher than the 2.3% at other not-for-profit hospitals, but below the 3.8% spent by for-profit hospitals and even lower than the 4.2% by public hospitals.
Community Catalyst also found Catholic hospitals had a smaller percentage of Medicaid discharges than other types of hospitals: 7.2% in their latest reports to CMS compared with 8.3% at other not-for-profit hospitals and 9% at for-profit hospitals. Sister Mary Haddad, CHA's CEO, said at Thursday's event that the events of 2020 revealed that more must be done to confront racism in the communities its members serve. Going forward, Catholic health systems will use health equity as the prism through which they look at all their work, she said.
"We are called to address the systemic causes of disparities," Hadded said. "Our hope is that by coming together with a shared commitment and purpose, we can do our part to eliminate the racial inequities in our marginalized communities."
