It was some years before I learned the language that explained the difference. Studying law gave me a framework to consider racial inequality by exposing me to structural barriers such as redlining, and Black exclusion from wealth-building opportunities such as the GI Bill. I carried this framing into my later work advocating for health equity in public policy and health services research. My early experiences clarified for me what was already intuited. Race-based inequities aren’t the result of personal choices. They reflect societal decisions that give blackness second-class status and normalize their unmet needs.
This knowledge has been empowering for me because it informs the pathway to change.
Understanding Systems
A strong evidence base confirms what many of us recognize intuitively—multiple systems influence health and must be aligned to improve lives. For example, one significant study found that when systems collaborate, there are fewer premature deaths from cardiovascular disease, diabetes, and the flu.
Conversely, fragmented systems prevent us from treating the whole person. Urging a diabetic to eat nutritious food doesn’t mean much if she lives in a food desert. Providing someone else with job training but taking away his subsidized medical care once he is employed is self-defeating. Policies that keep people who have been involved with the criminal justice system out of public housing break the link between a secure home and positive health outcomes.
There are many tools to align systems—including integrated financing streams, joint governance bodies, interorganizational agreements, pooled data, and shared workforce models. But we need to learn more about what works best and get that into wider practice.
At Systems for Action, we are supporting projects that test novel ways to repair pervasive fragmentation, including these:
- In Chicago, the Comprehensive Care, Community, and Culture Program (C4P) pairs high-need patients with a single outpatient and inpatient medical provider. It provides systematic screening for unmet social service needs, access to a community health worker, and community-based arts and culture programming.
- In Atlanta, Georgia State University researchers plan to test whether improving transportation for low-income patients with diabetes improves access to care while reducing healthcare costs. These improvements could include vouchers for public transit and ride-share apps, so they can more readily reach medical care and sources of fresh food. The research question: does enhanced mobility improve access to care, diabetes progression, and the use and costs of services?
- In Florida and Texas, hospitals and clinics are increasing screenings for social determinants of health so systems can work together to improve health outcomes more equitably. The screenings result in more referrals to nonprofits and other community-based organizations. It’s sometimes unclear the organizations’ capacity to absorb these increased referrals for services. Research sheds light on how to strengthen cross-system integration and expand effective partnerships.
I’m not naïve enough to believe that if we could just align our systems, we would vanquish racial disparities, but I am convinced the pressure we are seeing on communities of color foregrounds the power of better alignment.
Data stemming from that same study I mentioned earlier about diabetes, heart disease, and the flu suggest that communities with strong multi-sector networks have fewer COVID-related deaths and lower infection rates. That information should certainly inspire action. Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations. And the racist practices that have been so vividly documented in numerous locales have also sent a stark message about the need for system-wide change.
Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations. And the racist practices that have been so vividly documented in numerous locales have also sent a stark message about the need for system-wide change.
My personal and professional journeys have led me to much the same awareness—systems need to work together to advance health equity. Let’s all join forces to push that alignment forward.
Systems for Action has a new funding opportunity to award studies rigorously testing innovative approaches to helping medical, social, and public health systems work together to dismantle systemic racism and address the health and social needs of people experiencing health inequities. Applicants may apply for one of two available funding categories: Developmental Award (a pilot study) or Impact Award (should have preliminary research results).
Full proposals are due by the end of March 2024. Learn more here.
