Gabriel Perna | June 9, 2021
In the days and weeks after George Floyd was murdered, civil rights activists and supporters protested the injustice, inequities and systemic racism that Black people and other communities of color face in everyday life.
Health care was no different. Across hospitals and health care organizations in the U.S., statements were made, knees were taken in solidarity, moments of silence were practiced, and some vague and specific initiatives were announced promising to address racism as a critical public health issue. For health care leaders who have been addressing health equity challenges their entire careers, like Maulik Joshi, DrPH, CEO of Meritus Health, it hasn’t been nearly enough.
“A year later, I think you still see a lot of statements and not as much action,” says Joshi. “People have the energy to do something but instead of taking the time to write out statements, they should be taking action.”
Joshi, who wrote an op-ed on the subject, says that while health care has increased its activity around these issues over the past year—and even in the years before Floyd was killed—the industry still struggles with earning results. He uses the example of COVID.
“We look at disparities in COVID around ethnicities with hospitalizations and mortality, and we talk about how terrible it is. Then literally three months later, we’re having the same problem with disparities around the vaccine. If there was ever a time where we’d try and do something to ensure this wouldn’t happen, it would be during COVID…and yet we still have these problems,” Joshi says. “We need to be focused on meaningful results.”
Zing Health CEO and co-founder Eric Whitaker, MD, is another health care leader that has spent a lot of time in his career trying to improve health inequities. Not only has he started Zing, which offers Medicare Advantage plans for vulnerable communities in both urban and rural areas, but he ran the first Black men’s clinic in the country on the South Side of Chicago in the late 1990s. He has mixed feelings about the progress that’s been made post George Floyd.
“There have been lots of performative announcements and a year later, not a whole lot has changed. But we are still in the early days and I’m an optimist. My hope is that more Americans have had their eyes open, but the jury is still out on whether systemic change is going to follow,” Whitaker says.
Some leaders in health care do believe there is increased excitement and willingness to tackle the challenges of health equity. Leon Clark, Sutter Health’s Chief Research and Health Equity Officer, says he sees a sense of urgency and recognition that these problems need to be addressed with alacrity. Kristen Azar, RN, Sutter’s Institute for Advancing Health Equity Scientific Medical Director, adds that the recent movement around health equity feels different since the George Floyd murder.
“There are increasing calls for accountability for health systems to really be part of the solution. Questions on how we can measure health equity, measure progress and hold systems accountable will be part of the conversation moving forward. There’s also been a real push to make equity a part of quality and integrate the concepts together, so we think about equity whenever we think about quality and safety,” says Azar.
Clark notes that even with the increased excitement, the work to address these problems is complex and many organizations may not know where to start. Along with Azar’s concept of integrating equity and quality, he suggests organizations measure where they are internally with respect to disparities, continue to gauge any progress they’ve made, and make a long-term commitment to these initiatives.
Eric Whitaker, MD, CEO of Zing Health
Where does action begin?
Sutter formally launched the Institute for Advancing Health Equity in December. It was the culmination of years of equity work at the organization and operationalized its approach for the years to come.
Health care leaders looking to make a dent in health inequity can take actionable steps, says Joshi. It won’t solve all the problems in their community, but it’s a good place to start on the journey. For example, he says every hospital and health care organization tracks demographic data by race and ethnicity.
“I would do an audit of how well that data is being collected. I used to joke, ten years ago if you looked at my medical record, it would say I’m a Caucasian and I’d have to change it every time,” says Joshi. He also says organizations should stratify clinical results and measures by ethnicity and race data to see where the biggest disparities exist.
Beyond data, Joshi says health care organizations should undergo unconscious bias training and review their processes for advancing people of color into leadership roles. “I believe interviewing a person of color as a finalist for all leadership positions is a step towards achieving more equity. I’ve seen it work,” Joshi adds. These plans should be transparently laid out to all employees and patients and he says the organization needs to measure progress (or lack thereof).
Those who have seen success in addressing health equity challenges also emphasize the importance of community engagement. In a recent report for NEJM Catalyst, Joshi and two co-authors highlighted the work of the Maryland Vaccine Equity Task Force (VETF) in improving vaccine uptake in the state. To his earlier point about using data, the group leveraged a Vaccine Equity Index to track vaccination rates among racial and ethnic groups. Moreover, Joshi said the task force has seen success in reaching out to vulnerable communities through churches, community, and non-profit organizations. The task force has also utilized mobile vaccination clinics.
Elsewhere in Maryland, Bon Secours has a thriving low-income housing program in West Baltimore with 802 units in service and nearly 300 more in development. George Kleb, executive director for Housing and Community Development at Bon Secours Baltimore Health System, says that the long path to success in this area is through collaboration with local community organizations.
“The way we look at community engagement is that it’s practice, it’s something you do over and over again. You learn the skills and you hone the skills. Just like a lot of doctors practice medicine,” says Kleb. “It’s about showing up, listening, walking with the community, and not making decisions without involving the community we’re serving.”
Whitaker is another advocate of using community engagement to move the needle on health equity. He harkens back to his time running a Black men’s health clinic in Chicago. He says what made that project work was trust between the provider and the community. He says Black men knew they could come to the clinic and receive help with any challenges they might be having, regardless of whether it had to do with their health.
“This little community center on the South Side of Chicago became a place where people knew they’d be safe and they could get the help they needed and deserved,” Whitaker says. “I’ve seen what happens when you have trust. I’ve seen how transformative it can be.”
All those who work on health equity agree that these problems will not be solved overnight. It’s going to take a lot of long, steady work. That’s where the people who are truly committed to health equity will separate from the people making a statement.
“Do what you say you’re going to do. It’s incremental and slow, but if you make a commitment, fulfill that commitment, make another commitment, fulfill that commitment…over time, people will believe you are really there to help them,” says Whitaker. “It’s a long-term process. There is no quick, easy fix.”