Health inequities in the United States have seemingly been exacerbated during the recent coronavirus outbreak. Unfortunately, prior to this pandemic, certain groups like low-income families, patients who do not speak English as a primary language, as known as Limited English Proficient (LEP) patients, and people of color were among the most susceptible to be treated unfairly and lack appropriate access to care and resources. This was highlighted as early as 2002 in a Institute of Medicine report.
Nature of the Threat: So What Are Health Inequities?
The World Health Organization defines health inequities as differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. These inequities often contribute to health disparities – preventable differences among population groups in health outcomes and risk for injury or mortality. For example, a number of inequities and disparities are prevalent among LEP patients. LEP patients often experience longer length of inpatient stays when interpreters were not used during admission and discharge, greater risk for hospital acquired infections and pressure ulcers and higher risk of readmission for chronic conditions.
More Money, More Problems: The Costs of Inequities and Disparities
According to a 2018 report by the W.K. Kellogg Foundation, health disparities total an estimated $93 billion in excess medical care costs and $42 billion in lost productivity.
The Only Real Change Comes From Inside
Systemic changes to eliminate these costs and improve care quality can seem insurmountable. It takes time, commitment and resources for organizations to create necessary improvements. Entities like the American Hospital Association’s Institute for Diversity and Health Equity, along with the Department of Health and Human Services’ Office of Minority Health (OMH) offer several resources health organizations can use. One of these resources, developed by OMH, is the National Standards for CLAS (Culturally and Linguistically Appropriate Services) in Healthcare. These standards offer 15 action steps for health organizations to advance equity, improve quality of care and eliminate disparities.
But individuals can take action too. I propose four practical steps we can each take as individuals to advance equity in our behaviors and thinking.
- “Sit down. Be humble.” These words famously quoted by Grammy-award winning artist Kendrick Lamar couldn’t be truer for healthcare professionals. All healthcare employees must exude cultural humility when interacting with other professionals and patients whose life experiences are different from their own. Cultural humility is a lifelong journey towards 1) self-awareness and reflection related to one’s own culture(s) and 2) understanding and respecting the differences of someone else’s culture(s). The term cultural competency is frequently used in the equity space. I believe before one can be competent, an individual must be humble enough to admit incompetence and knowledge gaps. When this occurs, we can swallow our pride to learn and build the right attitudes and behaviors to effectively interact and communicate with someone who is different.
- “ Re:Definition” — Reframe how you think about equity. Throughout my career, I have encountered several health professionals who assume that seeking health equity equates to being a social justice warrior. I challenge providers and administrators to reconsider this notion. Health equity isn’t about being a social justice advocate, but rather, being a better informed healthcare professional. When we all strive to create equitable processes and policies that promote fairness among patients and staff in our fragmented healthcare system, we more adequately fulfill the Hippocratic Oath to “first, do no harm.” Ultimately, we are positioned to meet the Institute for Healthcare Improvement’s Triple Aim to improve the patient experience of care, improve the health of populations and reduce the per capita cost of care.
- “This is America” — Reframe your relationship to diversity and inclusion to achieve the Triple Aim. Most of the Diversity & Inclusion practitioners I have had the pleasure to work with in the healthcare sector are people of color. I don’t think this is a coincidence. It could be assumed that those in subordinated groups would get it. What about those who are in positions of power and privilege, though? I think everyone has a role towards operationalizing diversity and inclusion, not just people who are underrepresented. Why? Beyond the moral and ethical imperative to ‘do the right thing,’ as well as the need to deliver high-quality care, there are two fundamental reasons. The first is America’s changing demographics. By 2050, people of color are projected to account for more than half of the U.S. population. The healthcare workforce should be reflective and culturally attuned to the community it serves (refer back to #1 – Be Humble). To be clear, this is not about quotas or hiring someone because of their race and gender. This is about expanding the talent pool to attract, recruit and retain top talent who can be culturally and emotionally responsive to patients’ needs. The second reason is federal law. Laws like Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act prohibit discrimination on the basis of race, color, national origin, age, sex or disability. Healthcare providers are federally required to provide qualified interpreter services for LEP patients. Therefore, every employee should know how to access an interpreter or translator (and also know the difference between the two). So, embedding diversity and inclusion will be everyone’s responsibility in healthcare.
- “Never Scared” — Be courageous. We all must boldly step out of our comfort zones. This is particularly important for members of dominant groups, where one population is equally or overly represented. This means having difficult conversations about topics like racism, sexism, ageism, ableism, homophobia and transphobia, among many others. More specifically, we must examine how these ‘isms’ and phobias can detrimentally affect our coworkers and patients. We must also not be afraid to assess our conscious biases, fearlessly uncover our unconscious ones and work to mitigate how these biases can hinder us from delivering care to marginalized groups.
One Day It’ll All Make Sense
Amidst the COVID-19 pandemic, healthcare professionals at every level continue to resiliently display the balancing act of appropriately responding to a crisis, while being proactive to prevent future crises. Similarly, by practicing cultural humility, reframing equity, diversity & inclusion and being courageous, every person in the healthcare industry will be poised to help our system address disparities and promote health equity for years to come.
Stephen Graves is a diversity, equity, & inclusion practitioner and consultant, with over seven years of progressive experience. He has worked in and with health systems and academic medical centers.