A New Approach to Eliminating Health Disparities

Feb 10, 2015, 2:13 PM, Posted by Dwayne Proctor

Children smiling at a school playground. Last year, Spokane County received the Foundation's Culture of Health Prize for improving community health by addressing the critical link between poverty, education, and poor health. Here, children play at St. Anne's Center in Spokane, where teachers are trained to catch and address early warning signs that may indicate future problems in school.

I, like many others, have made a commitment to living healthier this year. I am resolved to find and eat a new fruit and vegetable each month, decrease my consumption of meat to a few times a week, and drink at least a half-gallon of water each day. I also plan to laugh more and spend more time outdoors. My personal goals aside, I also find myself more hopeful than at the start of many past years about the state of health in our nation as a whole.

  • More Americans than ever before have access to the health care they need because of the Affordable Care Act;
  • States throughout the nation are making significant progress in helping kids achieve a healthy weight;
  • The disparities gap between black and white Americans’ life expectancies is narrowing.

These bright spots indicate that America is heading down the road to better health—but they only begin to address the challenges many Americans continue to face in accessing good health. As highlighted in a recent article in the New England Journal of Medicine, significant gaps and unmet needs remain.

Authored by Marshall Chin, director of RWJF’s $8 million national program Finding Answers: Disparities Research for Change, which seeks and evaluates projects aimed at reducing racial and ethnic health care disparities, the piece points out that while differences in processes of care—such as administering shots and prescribing medicine—are becoming more equitable between racial and ethnic groups, the health outcomes are far from even. Black enrollees in Medicare plans still fare worse on control of blood pressure, cholesterol, and glucose than white enrollees, even though the care they receive has improved, writes Chin.

Unfortunately, this is a reality we at the Robert Wood Johnson Foundation understand all too well. We know that if you are black, you are 21 percent more likely to die from heart disease than if you are white. If you live in the “Deep South,” your life is an average of three years shorter than if you live in other parts of the U.S. And if you live below the poverty line, you are 25 percent more likely than higher-income Americans to develop hypertension.

Health disparities like these not only affect the day-to-day experiences of individuals, but also threaten the prosperity and well-being of entire communities. They can be experienced between ethnic groups, income groups, and regions of our nation. And while the greatest impact of health disparities unquestionably falls on those directly affected, no one is immune: these inequities hurt all of us.

It is through this lens that RWJF will approach its work this year. We are specifically targeting the elimination of these pervasive gaps in health to give everyone in our country an equal opportunity to live a healthier life.

Fortunately, we are not starting from scratch. Since 2010, RWJF has invested more than $600 million to address disparities across the health landscape. And last year, we introduced a new goal for RWJF and the nation: to build a strong, vibrant Culture of Health, enabling all in our diverse society to lead healthier lives, now and for generations to come.

Going forward, RWJF plans to take a broader approach, and focus on the systems that drive health outcomes. Eliminating health disparities is a bold and ambitious goal, but we believe it is both achievable and necessary to ensure the health and prosperity of our nation. Our new efforts will embed the disparities lens in all that we do, and connect the dots between investments so that our work—and the work of our allies—go further to strengthen the programs, institutions, and resources that improve the well-being of all people.

As Chin discusses in his piece, our country has made significant progress in improving health, but addressing long-term health disparities is more complicated than “standardizing the care provided to patients.” Instead, we must make connections between a person’s health problems and other life circumstances to yield truly transformative change.

“Eliminating disparities requires truly patient-centered care—that is, individualized care by caregivers who acknowledge that patients’ beliefs, behaviors, social and economic challenges, and environments dictate their health outcomes,” he writes. Then, by either providing incentives and/or assistance, we can help those key institutions and other stakeholders work together to eliminate them.

Through our new approach, RWJF will do just that. We will go beyond quality and access to health care to dig deeper into the factors and social determinants that research proves impact a person’s health—the neighborhoods we live in, the schools our children attend, the jobs we work, and the resources inside our communities.

We will then reach out to youth leaders, parents, and community advocates who have long supported health equity to identify new opportunities to tackle the systemic issues that impact a person’s well-being. We will also seek out business leaders, government officials, and organizations who can help us leverage these existing systems and institutions so we can help improve overall health for all.

An example of where we have seen great success is with Spokane County, Wash., where nearly 1 in 5 children lives below the federal poverty level. Spokane County received our Culture of Health Prize in 2014 for realizing, and addressing, the critical link between lack of education, poor health, and poverty. Within seven years, the local school system, government officials, and business leaders worked together to help raise high school graduation rates by 20 percentage points and build career pathways for students to support economic sustainability in Spokane. With greater academic and workplace success, also comes more positive health outcomes.

Most of all, our efforts will help build awareness among all the systems that impact health to provide people the tools and resources they need to be healthy. This work will be an integral part of our mission to build a Culture of Health that enables everyone to make healthy choices where they live, work, and play, no matter their demographic or social status.

In the next five years, we hope to take significant steps toward achieving our vision by helping make the movement for health equity broader than it is today. With greater participation from private industry, policymakers, and individuals whose life experiences reflect the disparities we aim to eliminate, we expect the nation to achieve even greater accomplishments in the next decade.

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