“You never know who’s swimming naked until the tide goes out.” Warren Buffett might have been speaking of economics when he said that, but the principle applies to healthcare as well. Sometimes it takes a disease, an accident – or a pandemic – to reveal who’s really unprotected when a medical disaster hits.
The determining factor? Health equity.
While equity is often confused with equality, there’s a meaningful difference. Equality means two people are given the same resources, while equity means they’re given the necessary resources to achieve an equal outcome. Consider two people, one using a wheelchair and one walking, who both enroll in a class that’s accessible via a staircase. Technically, they’ve been granted equal access, but one is still excluded. When the school builds a ramp to accommodate the person using a wheelchair – that’s equity.
Healthy equity has two aspects: population health and access to quality, affordable healthcare. Or, as the U.S. Centers for Disease Control and Prevention (CDC) puts it, health equity is “when everyone has the opportunity to be as healthy as possible.”
Health Inequities Create Health Disparities
Imagine a group of residents in a town with a Tier 1 medical center. Some of them come from a demographic marked by historical trauma. Others struggle with healthcare literacy or lack insurance. Still others live in an affluent neighborhood where residents tend to have excellent coverage, high salaries, and advanced education. These people all live close to the same hospital, but they definitely don’t share the same health outlook.
Over time, these inequities breed healthcare disparities.
It’s a well-worn cliché to say that the U.S. health system demands radical transformation. But even incremental changes can make a difference in a patient’s life – such as these 9 practices that can build health equity.
#1. Inclusive Communication
Communication is one of the biggest barriers to health equity. Patients may not speak the dominant language of the hospital staff or clinical literature; the “Digital Divide” may leave some patients without Internet access; public health campaigns may fall short of reaching their intended audience.
And without clear, detailed communication, patients may not get the information they need to steer their own health journey. A few ideas:
- Diversify channels for public health campaigns. Radio spots, invoice flyers, and social marketing on Discord, Facebook, and TikTok can reach a variety of patients no matter what media they typically consume.
- Ensure interpreters are available for patients. 35 million U.S. citizens over 18 (more than 15 percent of the adult population) speak a language other than English at home. Some are bilingual, but many may not be able to understand providers or navigate treatment plans that are only available in English.
- Include caregivers in treatment plans. A family member may share facts about a patient’s medication compliance or remember instructions that a senior with dementia doesn’t. Involving them can give a fuller picture of patient health to the provider, while providing an extra layer of support at home.
#2. Partnership with Community Organizations
Healthcare systems can feel like complete worlds unto themselves – sprawling across campuses and containing clinics, hospitals, chapels, mobile units, and academic programs. But patients who can access healthcare like vaccinations or mammograms at trusted “third places” like a mosque or a workplace or library are more likely to be proactive about their own health. It also provides an opportunity for healthcare leaders to connect patients to resources that address social determinants of health like instable housing or food insecurity. Collaborating with community organizations such as senior centers, food banks, universities, bookshops, or religious institutions can go far in bringing health equity to disadvantaged patients.
#3. Clinician Diversity
When patients see healthcare professionals from their own background, it helps build their faith in healthcare systems. Staff that reflect a range of ages, races, sexual and gender identities, religious practices, and economic backgrounds can also introduce fresh perspectives and help their colleagues serve diverse patient populations. Yet while almost every clinical and hospital website promises diversity and inclusion in healthcare, there’s still plenty of room for improvement. There were more Black male medical students in 1978 than in 2014 – and one study of LGBTQ medical students found that 44% feared discrimination in medical school, with more than 30% staying closeted.
#4. Multidisciplinary Care Teams
Interdisciplinary care teams are common these days, keeping a patient’s providers connected across all levels to improve care coordination. Taking this a step further into community-based care can be especially helpful in building health equity for patients from marginalized populations. This might include nurses arranging post-discharge services with local organizations or setting up referral programs that work in the opposite direction. By working together, clinicians, social workers, and community health workers can help educate patients on disease self-management and stage faster clinical interventions when necessary – reducing hospitalizations.
#5. Smarter Data Collection
Data lights the roadmap to healthcare transformation. Tracking pay equity, connecting chronic condition rates by demographic, or measuring patient satisfaction are just a few ways healthcare leaders can spot the need for new policies or identify which patient groups need what kind of resources. By aggregating and analyzing data for a specific Tribal nation, for instance, health strategists might connect environmental toxic exposure to high cancer rates. Or they might spot the need for education on lifestyle changes in a community experiencing high hypertension rates.
#6. Workplace Culture Changes
Everyone in the healthcare ecosystem plays a role in patient experience, from the admissions desk to getting test results to receiving an invoice. Discriminatory practices can be subtle, yet alienate a patient from returning for follow-up care. To help patients and staff feel valued, DEI groups can conduct surveys to identify culture gaps – and create resources like webinars, ethics hotlines, training, and advocacy groups to foster inclusivity.
#7. Digital Health
Telehealth has lifted many patients out of healthcare deserts and connected them to clinical expertise. From a virtual specialist consult to discreet behavioral therapy, the ability to access treatment from their living room can be a godsend to patients with mobility or transportation issues, or those who simply don’t have clinical resources in town. The catch: telemedicine programs must address the Digital Divide, which can cut people without Internet access off from valuable information. One 2021 study found that telemedicine use was lower in communities with higher rates of poverty, excluding patients who could benefit from virtual care.
#8. Increased Access To Mental Health Services
The shortage of mental health services in the US is rampant in underprivileged communities, resulting in untreated mental conditions for people with the highest level of housing instability and food insecurity. Combined, these factors can become a powderkeg that, once exploded, can aggravate comorbidities or drive higher rates of incarceration for disadvantaged people. Better support systems and wraparound services are critical for connecting people to care at every stage of their mental health journey.
#9. School-Based Health Centers
Health disparities begin early in life, which has put schools in the healthcare spotlight. School-based health centers are becoming primary resources for underprivileged children who might not otherwise receive care. School shootings, bullying, and substance misuse have highlighted the need for mental health screenings and services at a young age; telehealth can connect students to specialty and primary care during school hours. By giving all children access to clinical care, regardless of economic background, school-based health centers can give at-risk students a better chance at a successful and healthy life.
Paving the Path to Health Equity
Health inequities spring from many factors outside the healthcare system. We can’t wait for poverty, historical trauma, and other barriers to be solved before achieving health equity; we need to account for those factors within the healthcare system and build our own scaffolding to elevate patient outcomes. There’s no blueprint for a more equitable world. But the above practices are a solid start for any community.
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