Dr. Shereef Elnahal, president and CEO of University Hospital in Newark, New Jersey, discusses the role hospitals and health systems can play in advancing equity through internal programs, community collaboration and advocacy for policy changes.
What’s your philosophy on DEI at University Hospital?
Our history is very much embedded in health equity. Our hospital, as did many major institutional structures throughout the history of this country, displaced one of the most prosperous Black communities in the country about a century ago. And then during the civil rights movement in the 1960s, in Newark there was a rebellion from the community precisely because the government did not meet everyone’s needs equitably. So our hospital was a major subject of the agreements that actually ended the uprisings in Newark. And those agreements were codified in the Newark Accords, which I keep on my desk so that I can be reminded why I am here.
What do you see as your duty to the community in regards to equity?
It’s important to really break down these concepts because you can’t really address them or operationalize how you address them until you understand them. So the first is the baseline state, which is simply inequity and unfortunately, for healthcare outcomes, opportunities have not been made equal to folks based on their ZIP code.
One approach has been one around equality, which is to provide universal benefits to everybody. Of course, if you have groups of folks who start at a much lower baseline, those benefits don’t end up being enough. A classic example is Medicare, which is a universal benefit for everybody over age 65, but it does not necessarily solve for the inequities that people of color have faced in this country for so long. And often it isn’t enough, especially for our dual-eligible patients and patients who were born into and continue to live in poverty.
So the next level up to that is equity, which is to essentially, in a patchwork way, solve for the fact that marginalized groups of people don’t have equal access to opportunity.
Explain how hospital programs help with these concepts.
Our violence intervention program treats vulnerable folks who’ve been victims of, or even perpetrated, violence in the community, but then we provide wraparound services to help prevent violence from happening in the future and convince folks that there’s an opportunity to thrive. But ultimately the real goal is justice. And justice involves correcting the systemic inequities at their root, at the core. And the key to that, bar none, is economic development—to allow for everybody to have an opportunity to participate in the economy, to have a career path, a career trajectory. And you can do as much as you want with targeted benefits and programs, but unless you are fixing the system to better allow for economic thriving of everybody in the community, you’re not going to do that.
How are you addressing economic development?
We’re among the biggest contributors to the mayor’s Hire Newark Initiative. And we are also making strides in procuring more from local, small businesses and minority- and women-owned businesses. We are building a new hospital and we need to have locally formed small businesses and contractors supporting that work so more people are employed, wages go up and more people have the opportunity to thrive.
How are you making sure those efforts have impact?
I’ll talk about two of our programs as an example. For the violence intervention program, the number of social service referrals and housing referrals for folks who are homeless and were victims of violence has skyrocketed since the beginning of the program. We’ve seen a reduction in overall emergency room utilization with the combination of our hospital-based violence intervention program and our trauma survivorship program.
Another program addresses readmissions. Again, this is largely because of a lack of social supports at home and the lack of a home in the first place. We’ve been able to escalate community health worker intervention and engagement with patients in the community. We’ve seen improvement in some of the preventive health measures like cancer screening and screening for hypertension and other chronic conditions. But to really achieve health justice in this country, we need the gears of policy behind us. We need the inequities, for example, on reimbursement of things like mental and behavioral healthcare and addiction care to be rightsized. Because these are conditions that really reduce quality-adjusted life years and cause death far more than is appreciated. That’s just one example of many things the federal, state and local governments can be doing to achieve health justice.
How do you work with policymakers to address these issues that benefit the community and you as a provider?
I think every organization, especially in vulnerable communities, needs to be thinking about not only how we recruit talented people of color from outside the community and outside the organization. There are Ivy league institutions offering graduates of color opportunities to fill any job extremely well across the country, but policy can help make investments to develop careers locally.
We want our entry-level folks at University Hospital getting apprenticeships, getting training so they are the most qualified candidates for promotions and they’re entering the supervisor, managerial and eventually executive levels from the ground up. Because unless we are offering economic mobility, we are not developing folks and we are not contributing to the economic thriving of the community.
I think every organization can do that. It requires investment. It requires making it a clear priority because it’s not cheap. It costs money. But it’s well worth it because the trust that you get and the talented people that you can foster in a system like that is really amazing.