Three tools to address health equity

In Washington, DC, where I live, the life expectancy for an infant born in 2020 was 75.3 years. Jump across the border between the capital and Bethesda, Maryland, a wealthy suburb just north of the district, and life expectancy jumps to 88.3 years.

The distance from Bethesda to the Capitol is less than 10 miles, but if you're lucky enough to be born in the suburbs, you live an average of 10 years longer. The difference is even greater when comparing the east and west sides of the capital, with a difference in average life expectancy of 30 years.

It's not just Washington, DC. In Chicago. Buffalo, New York. In Baltimore; New York City; New Orleans, and Columbus, Ohio, there are 20 to 30 year differences in life expectancy between neighborhoods in the same city. This story is repeated in other cities in the United States.

This is not just a problem in urban areas. Wide disparities in life expectancy also exist across rural areas, especially in the Deep South and Appalachia.

How is this possible? And why are we allowing things like this to happen?

Sociopolitical determinants contribute to these disparities, but we need to dig deeper. Indeed, if you are born in a metropolitan area or part of a rural area, you are more likely to have to deal with housing instability, food insecurity, transportation disparities, and educational and economic disparities. Additionally, low-income rural and urban areas may have fewer physicians, particularly specialists, who can adequately serve their communities.

Closing the health equity gap requires changing the incentives in our current health financing system, which erodes access, selects winners and losers, and perpetuates bias. Our system is built on disease management, not disease prevention, and often financially rewards those who manage diseases more than those who prevent them.

We must also recognize that this system is built on the remnants of a racist, classist, and sexist past that still influence policy-making today. We must also confront inaccurate and inflammatory political rhetoric, diversify communication channels, and emphasize the importance of private investment. And of course, health care providers, payers, business leaders, and policy makers must play an active role in changing the system at both the population and individual levels.

Is it a daunting task? True, but it's a necessary effort. Here are his three tools to help you on this journey.

data

There's a lot of talk about data-driven decision-making around population health and health equity. At the same time, there are different perspectives on how to measure impact in this area.

Leveraging data to evaluate the outcomes of different interventions, drugs, and devices has become, and will continue to be, increasingly important for reimbursement and investment. In my class at the Kenan-Flagler School of Business at the University of North Carolina, we discuss using outcomes-based pricing and real-world evidence to drive what is produced, used, and reimbursed. Masu. Understanding population-based outcomes – whether a product or service actually works – is critical to economic success and community health.

Of course, we also need to be aware that data can be biased, so we need to “audit” it.

What does this mean in practice? Ernst & Young partners with health data startups to better understand chronic kidney disease (CKD) and finds that Black CKD patients are diagnosed at later stages of the disease. It was found that there is a high possibility that The main reason for this is that regular care is sporadic or delayed. As stated by Ernst & Young, healthcare companies are using this model to “address similar barriers unique to underserved patient populations and preventable chronic diseases. Life Sciences For businesses, this data can enable a more comprehensive healthcare experience and drive commercial excellence.”

communication and respect

Let me tell you, doctors have strong judgment and sometimes are bad at communicating with patients. After all, we are trained to take in information, make assessments (or judgments), and make those decisions quickly. However, people of color, people who did not graduate from high school or college, women, and other marginalized groups are more likely to feel judged by their doctors.

When this happens, they are less likely to seek our care.

According to the Urban Institute's December 2020 Well-Being and Basic Needs Survey, more than three-quarters (75.9%) of adults who felt judged by their health care provider said they would not seek such treatment. reported that it prevented them from receiving medical care. These numbers include 39% of patients who delayed treatment, 34.5% of patients who sought a new provider, 30.7% of patients who never received the treatment they needed, and 11.4% of patients who did not follow their doctor's orders. % (some respondents selected more than one category). .

Tools like the CDC's Health Equity Guiding Principles for Inclusive Communication can help health care providers devise language that treats all people with respect. Additionally, the Rural Health Information Hub advises healthcare providers to:

• Use first person language
• Avoid using gender-specific terms
• use easy-to-understand words
• Avoid using stereotypes and generalizations to describe individuals or groups
• Recognize words and phrases that “rank” and “prioritize” individuals or groups

private sector partnerships

Expanding government programs like Medicaid, as well as an influx of private philanthropy and investment, are clearly essential to addressing health equity.

However, beyond medical corporations, the private sector also has a role to play in promoting health. As the World Economic Forum has stated, “all companies are health care companies” and can invest to improve health outcomes and life expectancy in their communities. As a group of researchers wrote, harvard business review Last year's options included:

• Leverage your human resources team to help employees better understand their health plans and benefits and the best options for their situation.
• Proven to reduce health disparities by allowing employer-sponsored health plans to cover out-of-pocket expenses that are too high for low-income families
• For example, investing in benefits such as nutrition programs that were not traditionally considered part of health insurance.
• Expanding access to primary care and mental health through virtual care and community partnerships

Addressing health equity is a formidable challenge and requires fundamental changes in the way health systems are designed, encouraged, and implemented. But with bold leadership, we can begin to dismantle the deep-seated disparities that can shorten a person's life by years if they are born in the wrong zip code.