Eliminating Disparities: from Intent to Action

Posted March 25, 2015 by Charles Homer, MD, MPH

In recent months, our nation has experienced an escalation of difficult “conversations” about the persistence of racism, the injustices of income inequality, and the harm that discrimination inflicts on us all. Perhaps more than anywhere else, these issues are inescapable in our healthcare system and manifest themselves in the health outcomes of our children.

NICHQ’s intent has always been to address disparities in health outcomes. Our initial mission statement—eliminate the gap between what is and what can be in healthcare for ALL children—emphasized “ALL” so that the benefit of our efforts didn’t accrue to a select and privileged few.

We have sought to translate the “ALL” intention into action by addressing disparities in our work. Here are a few examples:

  • Responding to Bob Ross, CEO of the California Endowment’s challenge at our first national forum in 2002, we produced a groundbreaking report on using improvement and the chronic care model to promote cultural competency and address disparities.
  • We emphasized equity in the agenda for child health improvement we announced in 2007.
  • When selecting communities to participate in our groundbreaking Collaborate for Healthy Weight project in 2010, we prioritized those that served disadvantaged and minority populations.
  • For the national Best Fed Beginnings program in 2011, we selected hospitals based on those with historically lower rates of breastfeeding, and specifically serving African American women.
  • For the past five years, NICHQ has served as the national coordinating center for the Health Resources Service Administration sickle cell program to make sure that people with this disease, who are predominantly African American, benefit from improvement science. (One need only spend a few minutes listening to the experience of patients with sickle cell disease to know that racism remains rampant in our healthcare system.)
While we have achieved meaningful improvement results in these projects, I strongly believe a more explicit and focused set of activities are needed to not only reduce disparities but eliminate them. Under the leadership of NICHQ’s Chief Health Officer Shikha Anand, MD, MPH, we have specifically made addressing the needs of vulnerable children NICHQ’s core strategic priority for 2015. One aspect of this renewed focus is to consistently measure the impact on vulnerable populations, including by race.

Our current signature program, the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) seeks not only to reduce infant mortality but also to specifically eliminate racial disparities. This program is explicitly addressing disparities in each of five content oriented tracks (safe sleep, smoking cessation, pre-term birth, perinatal regionalization and pre- and inter-conceptual care) and also has one track specifically addressing the social determinants of health.

In other areas, we must develop more and deeper true partnerships with families and communities that experience economic disadvantage and racism. We are building this approach in a new program we have launched addressing the emotional development of young children and is core to our shared leadership of the Child Health Hub in the 100 Million Lives initiative being coordinated through the Institute for Healthcare Improvement. We also must revise our messaging about quality to elevate the critical dimension of equity and expect to see this in our communications. Equity is the central issue driving health outcomes for children and their well-being and must be at the center of our work.

As I transition to a new platform to promote justice in our society, I leave with confidence. The explicit and elevated focus on equity is precisely right for NICHQ and for our nation’s children.


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