Equity in health is achieved by obtaining the “highest level of health for all people“. This would require:
- addressing population-level factors
- developing health-equity programs
- measuring the impact of these programs
- developing policies that will support and improve population health
In recent years, we’ve heard words like “disparity” and “equity”, but what do these mean in the healthcare context?
Glossary of terms:
- Diversity: The practice or quality of including / involving people from different social or ethnic backgrounds, genders, sexual orientations, etc.
- Equity: The quality of being fair and impartial
- Inclusion: The practice or policy of providing equal access to opportunities / resources for people who might otherwise be excluded.
- Disparity: A great difference.
“Healthy People 2030”
Within the 10-year goals of HHS’ Healthy People program—which identifies public health priorities for individuals, organizations, and communities to improve health—is the elimination of health disparity in the U.S. This was also within the broad objectives of Healthy People 2020. The program provides access to tools, resources, and practices, while also promoting collaboration among stakeholders. It also monitors evident changes in disparities among subpopulations and subsequently identifies priority populations
Social determinants of health (SDoH)—societal factors in the place where a person is born, lives, or works—are a big influence on their health, disease risk, and quality of life. Examples of some of these factors include:
- Safe housing, transportation, and neighborhoods
- Education, job opportunities, income
- Access to nutritious food and physical activity
- Language and literacy skills
Lack of access to a grocery store that sells fresh fruit and vegetables or to transportation can directly impact health. Inability to clearly communicate with your doctor or nurse can also impact health and wellbeing.
Integrating Fairness Within Our Health System
Raising staff awareness about how they interact with patients is a practical approach to impact systemic bias and inequity. Here are some examples:
Race/Culture
- Be sensitive to cultural beliefs and practices
- Are language barriers creating communication gaps?
Disability
- Hearing loss: Does the patient need a sign language interpreter?
- Visually challenged: Make sure forms/resources are in large print or there is an audio version accessible
- Mobility: Ensure ease of physical access; provide a wheelchair and a mobility aid
LGBTQ +
- Wearing a rainbow badge may ease communication
- Ask the patient how they’d like to be addressed – pronoun as well as preferred name
- Visibly display policies for LGBTQ
Empowering the Community
Keeping the population front and center and engaging them in decisions about their health is at the core of some health-equity initiatives that are seeing success in the community.
The Rhode Island Department of Health, for example, has developed a Health Equity Zone Initiative that believes in community-led solutions for addressing SDoH. The framework includes:
- Opportunities for diverse community members to collaborate
- Technical assistance for the community collaboratives to assess and prioritize the community’s needs and develop action plans
- Eliminating disparities and supporting improved socioeconomic and environmental conditions in neighborhoods
- Community engagement to reach public health goals for the region
The San Francisco Health Improvement Partnership is another example of a grassroots-level collaborative effort that engages community members and community organizations in improving their own health while paying particular attention to health equity within programs and services.
The Diversity, Equity & Inclusion Council at Patients Rising
Patients Rising initiated the creation of a Diversity, Equity & Inclusion Council (DEIC) during the Black Lives Matter demonstrations in 2020. Being an organization that advocates for all patients to have access to quality healthcare, the importance of DEI was not new to us, but we thought external perspectives could improve our practices.
We convened a committee of five individuals to review some of our content and strategies and provide feedback—similar to a steering committee or monitoring board. The goal of the reviews was to identify areas where the rhetoric of inclusivity and the accessibility of our content could be improved.
The implementation of this review was so helpful that we decided to make the committee permanent. We added a sixth member and have been having quarterly meetings and reviews ever since. We are learning much from each other and our ongoing discussions have resulted in better quality content and communication.
Our DEIC members have diverse backgrounds and there is BIPOC, LGBTQ+, and disabled representation. The council includes patients, certified advocates, and medical professionals.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.