The COVID-19 pandemic has placed a spotlight on health inequities across the country. Job losses associated with the sharp reduction in economic activity have increased food insecurity for families and endangered individuals’ ability to pay their rent or mortgage. For those individuals living in overcrowded homes or homeless shelters, social distancing or self-quarantine is nearly impossible, leaving them at risk of exposure and more likely to become ill from COVID-19.
COVID-19 is also disproportionately affecting minority communities. Systemic racism has led to inadequate investments in education, safe and affordable housing and food access — which is exacerbating the spread of the virus. In many cases, these communities face increased risk of exposure because their work and living situations do not allow for social distancing. In addition, they may have higher rates of certain chronic conditions that intensify symptoms of COVID-19.
This public health crisis has made it clear that addressing health equity is necessary to improve health outcomes and save lives. Trustees have an important role to play in improving health equity in their communities.
Understand What Health Equity Is
The best place to start is understanding what health equity is, and what it is not. Health equity has been defined as the attainment of the highest level of health for all people. It also has been described as a situation in which everyone has a fair and just opportunity to be as healthy as possible. Health equity is not the same as health equality, where everyone gets the same opportunities for health. Health equity requires a concerted effort to increase opportunities to be healthier for everyone, including those for whom obstacles are the greatest. This means that efforts must encompass individuals facing poverty, discrimination or its consequences, and lack of access to good jobs with fair pay, quality education, food, housing and health care. The difference between health equity and health equality is illustrated in the graphic below, created by the Robert Wood Johnson Foundation.
Health equity is also not the same as health disparities. Health disparities reflect differences in health status between populations, for example, a higher burden of illness or mortality experienced by one group relative to another. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to accessing quality health care based on their race, ethnicity, religion, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity — or other characteristics historically linked to discrimination or exclusion. As a result, we can make progress towards health equity by identifying and addressing health disparities.
Know Your Patients and Community
To improve health equity, trustees must learn about the patients and community served by their hospital or health system. In many cases, hospital leaders present a large amount of data at board meetings that discusses the patient population or community, including patient safety and quality metrics or data from the hospital’s Community Health Needs Assessment.
To really understand health inequities, however, trustees must request and review data that highlights health differences between population groups, not just data on the patient population or community. This includes data that is stratified by race, ethnicity and language preference, sexual orientation and gender identity and other socioeconomic data. Understanding patients and the community at this level allows trustees to identify which health care disparities exist — and then target interventions to address those disparities.
Include Health Equity in Every Conversation
It is important to have conversations about health equity in the boardroom. It may also be helpful to have a board committee dedicated to health equity where meaningful dialogue around solutions for the future can take place. However, to really make progress on health equity, it will be necessary to ask questions about health equity at every table and in every conversation.
In a recent conversation hosted by the American Hospital Association, Maria Hernandez, president and chief operating officer of Impact4Health and Karma Bass, senior principal at Via Healthcare Consulting shared that this includes talking about health equity in discussions about quality outcomes, strategic direction, board composition and e xecutive leadership and who comprises it.
Advancing Health Equity Will Take Time and Collaboration
Addressing health equity will take time and is not something that can be accomplished in one meeting or by implementing one program. The steps laid out above are a starting point for trustees and can be followed by cultural competency training and an examination of efforts to increase diversity in leadership and governance, among other things.
This work also cannot be done by trustees and hospitals alone. It will require collaboration from other stakeholders, including education, transportation, housing, planning, public health, faith-based organizations, community organizations and other industries and businesses. Trustees can influence discussions in their own industries; and, as prominent and well-connected representatives of the community, they can play a significant leadership role in fostering the collaborations necessary to improve health equity.
Health Equity in Action
Hospitals employ several approaches to improve health equity. This includes developing strategic plans to reduce disparities; standardized collection of race, ethnicity, and language, sexual orientation and gender identity and other socioeconomic data; stratification of quality measures by race and ethnicity; improving diversity in leadership and governance and collaborating with community organizations to address disparities. In addition, hospitals have implemented interventions to address disparities when they are found.
The following are examples of how hospitals are addressing disparities during the COVID-19 pandemic.
The University of Arkansas for Medical Sciences developed and implemented a screening tool to determine whether patients who tested positive for COVID-19 were able to self-quarantine. Individuals who cannot self-quarantine due to homelessness or other reasons are referred to an appropriate and safe housing facility.
Henry Ford Health System is addressing the social determinants of health in their community through a partnership with the United Way of Southeastern Michigan and the BET COVID-19 Relief Fund. At Your Door: Food & More is a rapid-response community outreach program to address Black health disparities exacerbated by COVID-19. AYD is providing contact-free deliveries of food boxes, personal protective equipment, diapers, culturally-informed education and equipment for virtual support — allowing vulnerable populations to reduce risk of exposure.
Hospitals are also joining efforts to address the systemic causes leading to health inequities, including addressing racism in their communities. In Chicago, 36 hospitals and health care providers released a statement outlining their shared commitment to addressing racism as a public health crisis. These organizations are investing in their communities, developing hiring programs for BIPOC and are committed to re-examining their institutional policies through an equity lens.
Trustee Takeaways
Boards can ask the following questions to enhance their discussions about health equity:
1. What are the demographics our hospital serves?
2. What health disparities exist in our patient population and community?
3. What steps can our organization take to address these disparities?
4. What organizations can we collaborate with to improve health equity?
5. How can health equity be incorporated into our strategic plan?
6. How will we assess progress on health equity?
Priya Bathija is vice president of strategic initiatives at the American Hospital Association. To access more trustee resources related to health equity visit trustees.aha.org.