A Prescription For Health Equity

Health goes far beyond the scope of just genetics and biology of a patient. As discussed in “Racism in Healthcare and the COVID-19 Pandemic”, social determinants have noticeably more of an impact when it comes to the overall health of an individual. Even before the pandemic, basic healthcare needs of marginalized groups were not being met and the recent events of COVID-19 further exposed the magnitude of health inequities in The United States. By achieving health equity, “the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically, or geographically”, health disparities can be eliminated, and vulnerable communities can reach optimal health.  National, state, and local government as well as health professionals and organizations, must act in unison in order to achieve health equity in the United States.

5 Interventions to reduce health disparities to promote health equity

It is crucial to recognize that to accurately tackle health inequities, our actions must focus on equity rather than just equality. The distinction between equality and equity is crucial.  Equality can be thought of as everyone receiving the same resources or opportunities. While this can be useful, equality does not consider that different circumstances require different measures; equity takes these differences into account. When equity is achieved, each person is given the resources and opportunities based on their individual needs.  The challenging goal of bringing health equity to populations that experience health disparities will require drastic changes from the individual level to society as a whole. The following list represents 5 core interventions and strategies that can be implemented to advance health equity for underrepresented groups.

1. Develop laws, policies, and programs that account for health disparities

            The government is ultimately the ringleader when it comes to making decisions about public health and often minorities are left out of their agenda. It should go without saying that brushing off health disparities regarding policy making is dehumanizing and is indirectly killing people in minority groups. To secure long lasting health equity, Civil Rights laws should be used as an instrument to eliminate disparities in health care. Washington D.C. is actively combating racism in medicine by incorporating “genetic information” into their Civil Rights provision which will prevent institutionalized barriers. The Title VI of the 1964 Civil Rights Act, prohibits racial or national origin discrimination by organizations that receive federal financial assistance. While this law is progressive, it is old and does not fully serve the needs of minority groups therefore it needs reform. Instead of cutting funding from an institution that violated this law, a government position should be made to send out officials to improve inequities in the establishment as well as conduct required anti-discrimination trainings for all physicians and staff. In addition, this civil rights act should be altered in a way that holds the physician accountable for any actions he/she does with respect to the quality and quantity of medical care received by minority patients.

2. Confront institutional racism within healthcare

To be successful in promoting health equity, health professionals and systems must identify, challenge, and eliminate any policies, programs, and/or administrations that endorse racial advantages. At a small scope, there needs to be mandated anti-racism training for hospitals and medical schools. According to the Institute of Healthcare improvement (IHI), “Health professionals can and should play a major role in seeking to improve health outcomes for disadvantaged populations”. Stating the problem is not enough– a person must be actively participating in antiracist behavior.  In a top-down approach, medical education needs to touch on racism. The New England Journal of Medicine published a piece identifying 5 key categories in which race was misrepresented in textbooks, lectures, presentations, and assessments. A pivotal finding was that curriculum tends to pathologize race. Educators link poor health outcomes for minority groups but how racism plays a role in. Further, diseases are often linked to race which can lead to bias in diagnoses. For example, cystic fibrosis is associated with White people which can cause a doctor to overlook that as an option for a patient of another race.

3. Promote collaboration and meaningful community partnerships

            Attaining health equity is not a job that can be done by one person, it needs a group-wide effort. In this regard, community engagement is an effective approach to bring about change because it enables a better understanding of communities’ needs and goals.  Since every community is different, some strategies or interventions may work for some but not for others; so, it is of interest to understand a community’s history, demographics, values, cultures, etc. before rectifying any problem. To increase the likelihood that initiatives will be widely accepted, citizens need to be included in every step of planning/research, informed about changes, and be able to collaborate on projects. Effective partnerships are vital for community-based solutions for increasing equity and reducing disparities. In the case of COVID-19, Telehealth which essentially is a virtual visit with a medical professional, was utilized to decrease exposure to the virus but it did not take inequities into consideration. According to research conducted by The University of Pittsburgh and Harvard Medical School, more than 41% of Medicare patients lack access to a desktop or laptop computer with a high-speed internet connection at home…” (AMA) which puts them at a disadvantage in terms of receiving healthcare. A community-based solution could be partnering up with local libraries or schools to provide access to their computers or planning a donation drive to collect computers to distribute.

4. Take specific actions to address the physical environment

Health and the environment have been put into two separate boxes for far too long. Health is governed by the environment either directly through instances of air pollution or indirectly by living in a zip code with no nearby grocery store.  By identifying and spreading awareness about top environmental public health concerns within specific communities that affect overall health, it will help in environmental policy making and social change. Data from the American Lung Association revealed that compared to white individuals, people of color are over 3 times more likely to be breathing the most polluted air. Before launching any efforts to address any environmental health issues, those affected by environmental impacts the most need to be educated on how the environment plays a role in someone’s overall health and what risks they may face if nothing is done. Since most prescribed solutions for improving environmental burdens are costly, it is ideal to start small – at the community level for long term success to be seen. This can be done by creating community cleanup programs, promoting sustainable practice, and forming partnerships with organizations in order to get funding for tree planting to improve air quality.

5. Focus on prevention

An unfortunate reality is that social determinants act as barriers in preventing individuals from taking preventative measures to avoid health risks. As healthcare providers, leaders, and officials there needs to be a consensus acknowledging the fact that marginalized populations have social determinants set in stone right from birth so by putting preventative measures into effect it will alleviate the weight they carry. Having said that, there needs to be a shift to primary prevention which are measures that aim to prevent diseases from occurring. Primary prevention services that can be useful for adversely affected populations are health education programs, increased screening for health risks, and subsidized farmer’s markets or grocery stores.

Endnotes

Racism is the cancer of our society, and it has been spreading into health care for quite some time. To cure this disease that is obstructing health equity, it will require massive changes from the federal level all the way down to local. Individuals in a position of privilege should routinely ask themselves “What can I do to be a part of the solution?” The crimes are hiding in plain sight and if current trends continue, humanity as we know it will become another victim of racism. In the end, racism is a multifactorial problem that is not a one day, one person job, together we can work together to end racism.

Written By Kaitlyn Bernard

Edited By Ann-Christine Noll

Last Updated: 10/06/2021