Many health care organizations are now engaged in a wide range of efforts to advance health equity by creating more opportunities for health and removing obstacles to good health within health care institutions and communities. Produced in partnership with the University of California, San Francisco, this report describes many of these innovative efforts. The full report and an executive summary discuss research on how inequitable social conditions impact the health care system; the full report discusses in more detail how inequities in education, employment, housing, and structural racism result not only in poorer health outcomes but also in higher health care costs.
What Can the Health Care Sector Do to Advance Health Equity?
A study says eliminating racial/ ethnic health disparities would reduce health care costs by $230 billion and indirect costs of excess disease and mortality by more than $1 trillion over four years.
Despite the strong links between health and social conditions, inequities in the social determinants of health have traditionally been viewed as beyond the purview of health care. That sentiment is rapidly changing amid growing recognition among payers and providers that inequities in employment, housing, environment, transportation, and education limit the benefits of health care, drain resources, and make it challenging for health care organizations to operate efficiently. Making sure everyone has a fair and just opportunity to live the healthiest life possible would benefit society and the health care sector.
Studies find that low-income people and racial and ethnic minorities experience worse health because of inequitable social conditions. One study estimates that eliminating racial/ethnic health disparities would reduce health care costs by $230 billion and indirect costs of excess disease and mortality by more than $1 trillion over four years. Inequities in health care—such as lack of health insurance, unaffordable medical expenses, and structural racism in health care—create disparities in care and make the system more costly and less effective. Health care providers and health care systems must play a major role in advancing health equity to prevent needless suffering, premature deaths, and avoidable costs.
Initiatives described in the report include making health care institutions more equitable, improving the social conditions of individual patients, and improving social conditions in communities, for example:
Community Health Centers have been the foundation of efforts to advance equity in health care access and quality for over 50 years. They operate at more than 8,000 sites in every state and U.S. territory, and have been demonstrated to provide care for chronic diseases comparable in quality to care provided in settings with significantly more advantaged populations.
In a partnership between the New York City-based Mount Sinai School of Medicine and Healthfirst (a non-profit provider-sponsored insurance company), Mount Sinai receives enhanced payments for postpartum follow-up. The enhanced payment aims to defray expenses for employing social workers and care coordinators. The program also incorporates clinician education and performance feedback. It focuses on reducing disparities in postpartum care for high-risk low-income women; the program achieved a 27 percent increase in postpartum visit rates among the target population from 2015–2017.
After pledging to the American Hospital Association’s #123forEquity Campaign to Eliminate Health Care Disparities (see Section 4), Navicent Health in Central Georgia used three strategies to ensure that every person in every community they serve receives high quality, equitable, and safe care, including:
1. Increasing the collection and use of data on race, ethnicity, language preference and other socio-demographic characteristics;
2. Increasing cultural competency training; and
3. Increasing diversity in leadership and governance.
Following these efforts, diversity in leadership and governance increased over 15 percent from 2012–2016,and readmission disparities between blacks and whites with diabetes, heart failure, and chronic obstructive pulmonary disease were eliminated.
Based on focus group input from the community, the Greensboro, North Carolina Health Disparities Collaborative designed an intervention for black patients undergoing breast or lung cancer treatment using trained nurse navigators. Navigators assisted patients from diagnosis through treatment and recovery (typically three years). The collaborative observed a 10 percent increase in treatment completion among black patients who received this customized support.
The Henry Ford Health System in Detroit promoted qualified minority employees to leadership positions—an effort that has been associated with increases of 57 percent and 44 percent in the number of the organization’s top leadership positions held by nonwhite persons and women, respectively.