Heath Equity: What You Can Do
Infant mortality rates for Native Americans and Alaskan Natives are 60 percent higher than rates for white babies. Hispanic children are more likely to be obese and African-American mothers experience the highest rates of preterm births. Children living in rural areas are more likely to have complex diseases and live further from hospitals; while children in urban areas experience the highest rates of morbidity from asthma.
Health in the U.S. is not equitable. Not everyone has access to healthcare, especially healthcare that is culturally relevant and free from bias. Not everyone lives in safe neighborhoods, can afford safe housing and healthy food, and benefits from quality education—all social determinants that have a significant effect on health outcomes. Because not everyone has equal opportunity to access the resources needed for health and well-being, disparities are pervasive from the earliest years of life.
“The decisions we make depend on the choices available to us,” says NICHQ Chief Health Officer, Elizabeth Coté, MD, MPA. “And not everyone has a healthy set of choices available to them. People try to do the best they can with the choices before them. As a caring society, we can make healthier choices more available to more people. To do that, we must understand how systems and structural barriers limit people’s choices, creating much of these troubling disparities.”
Addressing health disparities and the structures that underlie them will take the concerted efforts of many individuals and organizations. But where does an individual start? How does one person make a dent in a systemic and structural problem?
“Health equity is big, overwhelming and deeply personal,” Coté acknowledges. “Tackling it takes time and trust; it requires deep, internal inquiry from every one of us, so we can take discreet steps as individuals and then as organizations to pursue change. To achieve health equity, we must begin with ourselves—start right where we are.”
First, recognize your own implicit bias
Implicit bias is the unconscious stereotypes that influence our actions and decisions. Everyone experiences implicit bias because everyone develops subconscious stereotypes based on what they see and experience. Identifying your implicit bias, and your conditioning to react to it, can help you double-check that bias is not influencing your actions and choices.
Identify your bias by taking the different Implicit Association Tests (IATs), recommends Coté. IATs measure the attitudes or stereotypes we subconsciously associate with different concepts like age or race. There are 14 different IATs, each focused on different potential biases, including age, skin tone, disabilities, religions, gender, race, and sexuality. Taken together, the tests can help you gain an understanding of your implicit biases. For those striving to improve systems, acknowledging our own implicit bias, and then taking steps to address it, will make each of us more successful in pursuing health equity.
Nationally and internationally recognized expert in healthcare disparities, cross-cultural health and cross-cultural communication, Joseph R. Betancourt, MD, MPH, shares more advice on addressing implicit bias in this article.
Second, develop your own health equity definition
Spend time developing your own definition, Coté recommends. Having a personal definition, one that connects with your life and your experiences, will support your equity efforts in two ways.
First, “because health equity is such a big goal, it can feel messy and unmanageable,” says Coté. “Having a personal definition grounded in our experiences makes it relatable and very real.”
Similarly, she explains, as big as health equity is, it is also deeply personal—it implicates each of us individually—and that can make conversations about it uncomfortable. Here again, a personal definition helps. It gives individuals somewhere to start, a foundation for entering and launching the conversations needed for change.
While personal definitions will vary, Coté recommends always checking your definition against the criteria set forth in the Robert Wood Johnson Foundation’s report on health equity. The report is not meant to define one way to describe health equity; rather it helps “to identify crucial elements to guide effective action.” By checking your definition against these criteria, you can help ensure you’re starting from a similar foundation as other stakeholders, which can spark collective action.
Criteria from the Robert Wood Johnson Foundation:i
- Does it reflect a commitment to fair and just practices across all sectors of society?
- Is it sufficiently unambiguous and concrete that it can guide policy priorities?
- Is it actionable?
- Is it conceptually and technically sound, and consistent with current scientific knowledge?
- Is it possible to operationalize for the purpose of measurement, which is essential for accountability?
- Is it respectful of the groups of particular concern, not only defining the challenges they face but also affirming their strengths?
- Does it resonate with widely held values in order to garner and sustain broad support?
- Is it clear, simple, intuitive, and compelling without sacrificing the other criteria, in order to create and sustain political will?
Rare Diseases Deserve Our Attention
Between 25 and 30 million Americans, many of them children, are living with a rare disease. The complex challenges facing these children and families deserve attention and demand innovative responses. Here, NICHQ President and CEO Scott D. Berns, MD, MPH, shares his experiences, elaborates on successful strategies, and describes his goals for the future.
North Carolina’s Strategy to Address Social Determinants of Health
North Carolina is developing a system that connects individuals with resources to address social, economic and environmental barriers to their health—such as housing, food insecurity, and transportation. By putting funding and policy efforts into addressing social determinants of health, North Carolina is building a system that can improve health outcomes for children and families across the state.
Breastfeeding in 2019: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave
In honor of National Breastfeeding Month, we’ve taken time with NICHQ Faculty Expert, Lori Feldman-Winter, MD, MPH, an internationally and nationally recognized expert on breastfeeding nutrition, education and policy, to recognize successes and learn about opportunities for improvement. Her frank description of bias and her passion for promoting gender-equitable social norms have inspired us to continue pursuing sustainable improvements.
Successful Strategies Hospitals Can Use to Support Safe Sleep
Hospitals on a national initiative to improve safe sleep came together to share successes and lessons-learned. Here, find their highest-rated strategies and change ideas, all of which reflect early successes in their work. Hospitals seeking to improve safe sleep education can refer to this list as a place to start and guide for gaining quick wins.
Improving Transitions in Care Saves Lives
Advancements in care have helped more children with rare diseases reach adulthood, but health systems and providers have struggled to help children transition to adult care, resulting in high rates of complications and mortality for young adults. These strategies for helping young adults with sickle cell disease transition to adult care can save lives.
“The Act of Making a Referral is Not Enough”
Universal developmental screenings can help identify children at risk for developmental delays and connect them with needed supports. An effective screening process relies on successful referrals though—if there is no follow-up with the referred child, families can never access the supports the child may need, and that child may ultimately fall through the cracks. Here, Dipesh Navsaria, MPH, MSLIS, MD, Associate Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health provides five steps to build a referral process that works.