Disparities in healthcare due to social determinants of health should prompt healthcare organizations to incorporate health equity in their care delivery.
This is the first post of a three-part series covering Modern Healthcare’s Social Determinants of Health Symposium, which was held virtually on August 11, 2022.
While delivering her opening remarks to symposium attendees, Fawn Lopez, publisher and vice president at Modern Healthcare, called on all healthcare organizations to increase their efforts in addressing social determinants of health (SDOH). “The highest quality of care is not enough to help those who cannot access or afford it,” she shared. “It is a sobering fact that in this country some communities face a greater risk of adverse health effects than others, largely due to social disparities.”
According to a 2021 report by CancerCare, the breast cancer mortality rate in the United States is disproportionately higher among Black women compared to White women. Black Americans also have the highest incidence and mortality rates for lung, colorectal, and prostate cancers. Hispanic men and women experience a higher incidence of stomach and liver cancers than their White counterparts, while American Samoan men are eight times more likely to develop liver cancer compared to non-Hispanic White people. Additionally, lung, colorectal, liver, kidney, and stomach cancer incidence are higher among American Indian and Alaska Native peoples compared to the rest of the U.S. population. “Disparities in healthcare have been thoroughly studied and researched for decades,” said Bobby Mukkamala, MD, immediate past chair, American Medical Association (AMA). “Despite this information being available for long periods of time, most have gone unaddressed.”
Ana McKee, MD, FACP, chief medical officer, executive vice president, and chief diversity, equity, and inclusion officer at The Joint Commission, believes healthcare leaders bear some culpability to unaddressed SDOH. “They have not been held accountable for what turns out to be a very costly disengagement with these communities,” McKee explained. “The costs are huge to the society … [and] the organizations who participate in risk contracting and bundle payments.”
Building Community Partnerships
Following the identification and analysis of SDOH in healthcare, speakers noted that strategies for mitigating health disparities are key to improving patient outcomes. “Moral imperative needs to be in line with a strategic imperative,” said Rebecca Winokur, MD, MPH, lead physician executive and medical director of Health Equity at Oracle Cerner. And community partnerships are an effective strategy for healthcare organizations that are looking to advance health equity. “Engaging communities has to be a part of how we move forward in healthcare,” confirmed Garth Graham, MD, MPH, director and global head of Healthcare and Public Health at Google.
Recognizing this, Andrea Ducas, MPH, senior program officer at the Robert Wood Johnson Foundation, shared with attendees what her organization is doing with its Raising the Bar initiative, outlining the principles that embody their ethos. “We aim to be fair, just, treat all people with dignity and respect, and to rectify past harms while preventing future ones,” she said. Rectifying past transgressions is a strategy Dr. McKee also shared with symposium attendees. “It is important to acknowledge all the mistakes of the past, prior to embarking on the journey of health equity,” she said. “If the goal is to increase awareness and sensitivity within a community, it is important to build that bridge.”
In 2020, West Side United launched a six-million-dollar initiative aimed at closing health gaps in West Chicago over the next five years. The program is in collaboration with the AMA, Rush University Medical Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, AMITA Health, Cook County Health, Sinai Health System, and University of Illinois Hospital & Health Sciences System and Illinois Medical District, with Northern Trust serving as a financial partner. “Those dollars went to support affordable housing across the west side. They [those dollars] provided start-up capital for businesses who exist in corridors that, in some cases, have not been rebuilt since the riots in 1968 when Dr. King was assassinated,” said Ayesha Jaco, executive director at West Side United. “It is about going back to retool and to support communities that have been historically disinvested due to structural racism and other factors.”
Therefore, with the unique history of the U.S., it is irresponsible for healthcare organizations to ignore the impact SDOH have had on populations across the nation. And, as speakers confirmed throughout the day’s sessions, care must be analyzed within the context of a patient’s environment. “For all our quality methods, we are really pushing to make sure we can stratify everything, using race, ethnicity, language, gender, and age, among many others,” said Karen Fiumara, vice president of Patient Safety at Brigham and Women’s Hospital. “I struggle with the fact that we were not using a health equity lens before 2019.”
Looking to the Future
Healthcare can be a catalyst for achieving equity on a societal level, and the current lack of accountability that exists within the space is something that healthcare organizations cannot afford to continue. Cancer is currently the second leading cause of death in the U.S., as 1 in every 2 men and 1 in every 3 women are estimated to be diagnosed with cancer at some point during their lifetime. To optimize patient satisfaction and care, developing effective practices that advance health equity is important to ensuring moral and strategic imperatives remain in lockstep.
