Across the past two years, the health care industry has faced a series of headline-grabbing actions from both courts and legislatures that threaten access to care. While leaders remain committed to creating a more equitable health care system, they now have the added challenge of contending with the intensifying politicization and polarization of health care.
Faced with these oppressive obstacles, how do leaders navigate this charged environment, guide their organizations, and work to depoliticize health care? And how do leaders maintain forward progress against critical health equity goals despite these headwinds?
At 2023 Health Evolution Connect, executives from across the health care industry came together to discuss this challenge and identify solutions. In a conversation entitled “Advancing Health Equity: How to Continue Forward Progress Despite Increasing Polarization and Politicization of Health Care,” moderator Jonathan Perlin, MD, PhD, President & CEO, The Joint Commission Enterprise, and discussion leaders Georges Benjamin, MD, Executive Director, American Public Health Association; James Hildreth, PhD, MD, President & CEO, Meharry Medical College; and Airica Steed, EdD, President and CEO, The MetroHealth System, shared how they and their organizations are working to combat disparities across the health care system despite these obstacles, as well as advice for leading through contentious times.
Advancing Health Equity Must Be a Relentless Pursuit
Although “health equity is at the top of health care executives’ agendas,” Perlin said, the industry continues to struggle with “significant issues” when it comes to health disparities. He noted that, “according to CDC statistics, black and African American individuals have more than twice as high an age-adjusted mortality rate when compared with white Americans, and American Indian and Alaskan Native death rates are even higher.”
And growing polarization and politicization in health care has further illuminated critical issues affecting health equity, leaders said, making the need for executives across the industry to work together to implement actionable solutions increasingly urgent.
However, the discussion leaders noted that health equity work needs to go beyond the current headlines and instead address the systemic problems that create disparities in U.S. health care. “I see the headlines as just attention that has been given to a topic that quite honestly has not progressed as quickly as it should be, and we absolutely need to be fueled and shaped in a different way,” Steed said.
To do so, leaders need to focus on addressing the structural racism and other systemically oppressive constructs that underpin health care in the United States, leaders said. “Every system gets the results that it’s designed to get, and we’ve designed a system that is inequitable and discriminates against people, whether it’s on race or ethnicity or social orientation or rural or urban,” Benjamin said.
Hildreth agreed. “Racism is real and it actually causes a lot of harm in populations, results in high blood pressure, premature death, the list is quite long and quite objective as to what racism does. That’s the main problem here, and until and unless all lives are valued the same, we’re going to be having these conversations.”
The path forward can at times feel insurmountable, the discussion leaders acknowledged, but they urged executives to be relentless in their pursuit to create a more equitable health care system.
“Stay focused on your mission,” Hildreth said. “It’s getting quite challenging to do the work that we do when at every turn it seems people are looking for ways to demonstrate hate against one group or another. It’s a very disconcerting feeling that you have,” he said. However, at Meharry Medical College, the organization’s “north star is to make sure that African Americans can become healers and get the care that they need. And through all the rhetoric and politicization of science and health care, that’s what keeps us focused,” he noted.
Although leaders stressed the gravity of the situation, they also illuminated a path forward. Health care executives must embrace the responsibility to drive change and advocate for health equity—and do so through leading by example.
“You stay focused on your mission. You try to stay above the fray. You don’t succumb to false arguments. You follow the evidence as long as it leads you. And as long as you stay true to that, people will follow you,” Benjamin said. He continued, “People want leadership. They want someone to tell them the truth. So at some point, there will be a tipping point and things will change,” as long as people have honest, accountable leaders.
How To Lead and Make Progress Amid the Challenges
Leaders were optimistic that executives across the industry can come together to make progress, even amid the increasing threats to health equity. “America as a whole and the world as a whole can come together when we have a real call to action and a real sense of urgency,” Steed said. She cited the global response to the COVID-19 pandemic as evidence, underscoring that humanity can unite in the face of a common threat. “Just imagine what we can make possible if we all had that same sense of urgency, if we all had that fire in our belly” that leaders had during the Covid-19 pandemic, she implored.
The discussion leaders highlighted how executives can continue to make progress on health equity, despite the current headwinds:
1. Advocate for Change: Executives can use their positions and voices to advocate for policy and industry changes that promote health equity. They should work with policymakers and organizations across the health care ecosystem to create an environment that supports equitable health care delivery. For example, Steed said she is advocating for greater support “for public health systems, like The MetroHealth System, that really care for everyone.” She explained, “We open our doors wide, we extend our hearts very wide into the communities at large, regardless of where people come from, what their zip code is, whom they choose to love, any demographic that makes people feel less than. We are considered a super safety net academic medical center and an academic health system, and I don’t think there are adequate protections for health systems like The MetroHealth System that don’t turn anyone away.”
2. Bridge the Technology Gap: Leaders must be mindful of how new innovations and technologies could exacerbate or mitigate inequities, Hildreth said. As an example, he highlighted how telehealth and virtual care can improve health care access, but also how these technologies are being deployed and used unevenly, particularly in already underserved communities. “The technology gap has prevented some communities from benefiting from telemedicine and telehealth because the technology, the bandwidth isn’t there,” he explained. Hildreth called on organizations and executives to ensure new innovations, such as digital solutions and those involving big data and artificial intelligence, benefit all segments of the population equally and be used to uplift, not further isolate, underserved communities. Executives should invest in technology infrastructure that ensures all communities have equal access to telehealth and other innovations.
3. Collaborate and Innovate: Leaders emphasized the need for collaborative and innovative solutions. Executives should explore partnerships and collaborations with technology companies, public health agencies, and community organizations to address health care disparities. “I think that the true silver lining in the COVID-19 pandemic is that it demonstrated that the health care industry can build the rocket ship and fly it at the same time. We can come together and collaborate among a set of ideals and circumstances. We can change the narrative and we can drive health outcomes if we truly want to,” Steed said.
4. Embrace Accountability: Regardless of political affiliations, accountability is paramount. Executives should prioritize transparency and data-driven decision-making to ensure equitable health care outcomes, leaders said.
5. Encourage Citizen Engagement: Leaders highlighted the significance of citizen engagement in addressing growing polarization and politicization in health care. “Citizen engagement is empowering, and accountability is what it’s all about,” Benjamin said. Executives should actively engage their communities and patients to foster a sense of shared responsibility for health equity and encourage open dialogue and participation to drive meaningful change.
6. Foster Inclusivity: “Ensuring an inclusive work environment is important because it enhances not only the product you’re providing, but also the team’s ability to be effective. A team operates much better in a diverse environment where people bring a variety of life experiences to the table for health care. It improves patient outcomes. The evidence is unequivocal in that area,” Benjamin said. In the pursuit of health equity, executives must ensure that inclusivity is a central tenet of their organizations. Executives should prioritize diversity in leadership and decision-making to ensure organizations are addressing disparities effectively.
7. Prioritize Efforts to Address Social Drivers of Health: Executives must continue to expand their organizations’ focus beyond clinical care and address the social drivers of health—such as housing, education, food insecurity, and others—that can perpetuate health inequities. “If you really want to do something that transforms the health of United States, work on innovations that merge primary care and public health,” Hildreth said. “We’re the only country in the world where they’re thought about separately, but they should be in lockstep to benefit the population maximally.”
By embracing these opportunities and leading by example, executives can play a pivotal role in advancing health equity and reshaping the future of health care—even amid a divisive political climate, leaders contended. “Martin Luther King famously said that ‘the arc of the moral universe is long, but it bends toward justice’—but it’s clear it doesn’t do that without help and engagement,” Perlin said. “This is a galvanizing moment to move forward.”
