The WHO, WHAT, WHERE, WHEN, and WHY of the Lack of Health Equity
By Burgess A. Harrison, Executive Director National Minority Health Association
Health equity is a term that has recently been bandied around and used as a talking point in almost every forum and corporate discussion. But what does health equity mean? And how are American companies and American people dealing with health equity issues? Let’s start by defining the terms.
The World Health Organization describes health equity as “the absence of avoidable or remediable differences among the groups of people, which are defined socially, economically, demographically or geographically.” In simple terms, this means your zip code should not define your health! But as we see far too often, this is still the case. The reality is that minorities have never had the same opportunities for jobs, housing, promotions, and general life advancement as their non-minority counterparts. And whether this disparity is the remnant of slavery, prejudice, bigotry, or backlash from the majority-minority shift is a subject for another day. The fact is we still don’t have health equity.
Health equity is different than health equality. Think about an apple tree that feeds two groups of people – those on the left are six feet away, and on the right, they’re 12 feet away. Giving everyone a ladder that reaches six feet is equality. Giving the right group a ladder that can reach twelve feet is equity. Health equity is not about giving everyone the same things but what they need. The gap between what different groups need is defined as disparity.
Health equity and health disparity are intertwined. Health equity is a social justice issue. Health disparity is the metric used to measure the progress of health equity (or lack thereof). When health disparity decreases, health equity for all increases. Let’s be clear: you can’t have health equality until there is health equity.
The disparity in health equity mainly impacts minorities and underserved communities. They tend to live in intergenerational settings with multiple family members living under one roof. Much of this disparity is a function of cost and affordability: minorities tend to earn less than non-minorities. Minorities also tend to work in service-related jobs that don’t allow for work-from-home opportunities. They use public transportation more than non-minorities, exposing them to more people. For these reasons and many more, minorities are subject to more significant health risks than non-minorities.
It’s been more than two years since COVID-19 was declared a pandemic. During this time, the concept of health equity and the need to achieve it quickly has become even more critical. Health disparities have resulted in about 40 percent of the population living shorter lives and being subjected to implicit bias in basic healthcare interactions. This needs to change – and soon.
So, the WHO is everyone. We need to accept that health equity does not yet exist, and we all need to make it a priority.
During the pandemic, health inequity rose due to a high prevalence of chronic conditions and limited access to quality medical care, especially in densely populated areas. The pandemic exposed the fault lines in our society and healthcare systems. At the same time, the response to it exacerbated the health inequalities, highlighting the need for a health equity lens in corporate decision-making.
What do we need to do to ensure health equity? Everyone is entitled to achieve the best health outcome, regardless of social determinants of health. Your zip code should not determine your health or life expectancy, and achieving health equity will require fundamental changes in providing and managing care.
First, providers need to be available to minority populations. Traveling from the inner city to the suburbs is not practical for many minorities and is a primary cause of under-service. Providers need to promote medical transport services, family participation, and public transportation options to make sure patients can get in to see them. When in-person interactions are not possible, telehealth services can open the door for minorities to access quality care. We can significantly lower the access gap when healthcare providers offer these types of support.
Second, providers need to understand the social distinctions unique to minorities and underserved populations. These distinctions range from communication techniques to treatment programs and advice. Providers should educate themselves and their staff on how to work most effectively with minority and underserved patients.
Third, there needs to be a post-appointment follow-up. Research shows that meaningful, long-term patient-clinician relationships result in improved health outcomes. “One and done” doesn’t work for most Americans and is particularly bad for minorities who have never had access to proper health care. Providers need to ensure their minority patients have adequate follow-up support, including pre-scheduling non-emergency transport, communicating with the patient’s family members or social worker, and identifying how to best communicate directly with the patient.
Finally, trust must be established between the provider and the patient. Providers should have sensitivity to the history of minorities and the U.S. healthcare system. This history has been unacceptable and appalling, particularly when minorities have been subject to vile experiments under the guise of clinical trials. It is incumbent upon healthcare providers to establish trust with their patients if there is any hope of instigating systemic and behavioral changes.
The WHERE refers to where we need to meet the patient. To ingrain health equity into every aspect of healthcare means improving access to standardized services (healthcare equality) and understanding the individual’s needs. The current model of care averaging, where all patients receive the same treatment and therapies regardless of their unique situations, increases inequities and leads to poor health outcomes.
Meeting the patient where they are involves more of an approach than a location. We must meet the patient at their level of understanding, communicate in ways they understand and be sensitive to each patient’s specific needs. Tools such as Patient Activation Measures (PAM), telehealth visits, and coordinating patient travel to and from appointments help providers meet people where they are. Telephone follow-ups are also particularly effective in ensuring patient compliance.
When do we need to start making these changes? The answer is: “A long time ago!” Change needs to happen, and it needs to happen now. It’s nice when large corporations talk about diversity, equity, and inclusion, but rarely do we see any real actions that begin to move the needle.
Companies need to be held responsible for turning their words into actions. It does no good for a company to donate to a nonprofit focused on health equity but fail to address health equity in their organization. Health equity needs to be incorporated into all company policies. According to a recent report, employers can improve health equity by ensuring that employees’ basic needs are met, that benefits are easy to understand and access and that the workplace culture embraces receiving care. In addition, company policies should be reviewed regularly to ensure they address health equity in a transparent and welcoming way.
The bigger question is WHY health inequity, the bias that comes with it, and the health disparity it causes continues? And WHAT can be done to address it?
April is National Minority Health Month. The National Minority Health Association (NMHA) is joining The Good ClinicTM, a wholly owned subsidiary of Mitesco Inc., to raise awareness about the health disparities encountered by minorities and other underserved populations during April and beyond.
Sadly, this is the 21st anniversary of National Minority Health Month. That we only focus on the lack of health equity in the world’s most prosperous and developed country one month a year is mind-boggling. Maintaining our health is a 24-hour-per-day, 7-day-a-week, 365-days-per-year undertaking.
The National Minority Health Association’s mission is to close the disparity gap in minority health care. Accomplishing this will take a combined public/private approach—not tomorrow, but today. Give Your Community a Boost is a nice slogan to help promote National Minority Health Month, but tangible actions and ongoing initiatives are needed to bring about the necessary change.
To this end, the NMHA has partnered with The Good Clinic to kickstart the onset of change. Primed to redefine healthcare, The Good Clinic’s whole-person primary care clinics are conveniently located in high-density neighborhoods and led by experienced, empathetic nurse practitioners. All Good Clinic clients receive a complimentary NMHA membership.
The Good Clinic’s approach is to meet people where they are, understand their unique health and lifestyle issues and goals, and shift the focus from treatment to partnership. Ultimately, The Good Clinic aims to empower its clients with the tools and support they need to successfully manage their health and well-being.
Increasing awareness of the issue, staffing clinics with nurse practitioners to address the physician shortage, and offering a personalized approach to healthcare are some ways to make health equity a reality. Although we don’t like to use the word celebrate when speaking of National Minority Health Month, we do acknowledge that National Minority Health Month is an essential recognition of the need to work toward improving health equity. Now, let’s replace National Minority Health Month with World Health Equity Now. Not tomorrow, but NOW. Every day your zip code defines your life expectancy is one day too long.
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