July 7, 2020

What health equity really looks like—and why it's so important

Daily Briefing

    On the Radio Advisory podcast, host Rachel (Rae) Woods spoke with Michael Currie, chief health equity officer for UnitedHealth Group, and Graham McLaughlin, VP of social responsibility for Optum, about what health equity really looks like, and why it should be a priority for every hospital and health system leader.

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    (The Daily Briefing is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group.)

    Read a lightly edited excerpt below, then listen to the podcast to hear the full conversation.

    Rachel Woods: Mike, what do we actually mean when we talk about health equity?

    Michael Currie: Rae, we're talking about being able to respond to and provide based on the unique needs of the individuals. So for example, if you think about three individuals: one is a tall man, 6'4", one is a woman who's about 5'8", and one is a child who's four feet tall.

    If the goal is to make sure that everyone has a bicycle, "equality" is making sure that everyone has a bike—not a bike tailored their unique sizes and capabilities, just a bike. "Equity" implies and means that to provide a bike that is specific and unique to the needs of that individual.

    Woods: So we know that health care companies all tell us they're interested in reducing health disparities. But I'm wondering how that compares to their actual actions, the things that they do day-to-day to actually reduce the disparities.

    Graham, can you tell me where most health systems actually are and perhaps where they start when they're talking about improving health equity?

    Graham McLaughlin: Usually the journey's threefold. The first is our direct care. How do we think about closing that empathy gap and addressing unconscious bias? So really training on cultural competency, unconscious bias education, etc.

    Second, how do we then move to broaden our community benefit efforts? Not just charity care, but really thinking about expansion to community programs. And then third, how do we fully integrate strategy? Both switching from fee-for-service to a broader payment model, but also thinking about how do we drive community impact?

    Woods: Let's just do some more level-setting. Mike, where do you see the impact of structural racism?

    Currie: Health conditions, health status, access and utilization patterns, where access is based on quality providers to various communities, especially when we talk about communities of color—so where you live is important. The safety of where you live is important. Access to quality of care is important. Every single one of those and 15 other different aspects all relate back to a history of racism that structurally still exists today, whether it's unconscious or conscious.

    Woods: And it's everything from failing schools and food deserts and unaffordable housing to actual inadequate health services that ultimately result in a much shorter lifespan for Black people when we compare that to their white counterparts. And I think that's just important to recognize. I think there's an unfortunate and false stereotype among white people that the difference in life expectancy when we look at black communities comes from things like gangs and gun violence, but what you're saying is that that's not the case.

    Currie: It's twofold. So, there's accountability within the black community as well. Are there things that we can, should, and will do to improve the safety of our communities and do better amongst ourselves? Absolutely, you could say that about every single race or ethnicity or age group or gender group, that's pretty universal.

    But what we're talking about here is the playing field being level and that's where racism and structural racism, historical racism, and even current racism has a stake in what you see based on where people live. You touched on many of them—what education looks like in some communities, what the safety is like in some communities, what access to care is in some communities, what nutritious food is available in some communities, all of that is rooted in a history and past. We need to learn from the past so we can be better in the future, but we also want to be able to have a candid enough discussion so that people can not be paralyzed by inaction and move towards a common solution and no solutions are going to be there.

    Woods: Have either of you come across a health care leader who just pushes back on this concept? Perhaps they understand that the social determinants impact health, but maybe they push back on the role of the hospital or the role of medical care, especially when it comes to things like schools and food deserts and safety out in the streets.

    Do you actually hear that pushback? And what do you say when it comes up?

    McLaughlin: I think there's two pieces of pushback you sometimes hear. One is, how broad does our mission have to be? What we're talking about are not necessarily just the problem of a health system. And then secondly, how do we align to ROI?

    So on the first one, a good example is Rush Health. Rush actually changed its mission from being the best in patient care to improving health. There was a 16-year gap in life expectancy between folks who were a couple miles away in their jurisdiction, so they said, we're going to be an anchor institution and we're going to think about how we hire differently, how we spend differently, how we really support the ecosystem of health in our community. So it's not about just when people come through our doors, but it's us thinking more broadly about the way that we are an anchor in the community.

    Woods: Mike do you hear the pushback of "this isn't my job?" And how do you react to it?

    Currie: I don't know that I would necessarily call it pushback. What I would categorize it as is a sense of awkwardness and discomfort. And that discomfort is associated with really three main things. Graham touched on one: money and return on investment.

    Two: I don't want to be the only one doing this. So, is there a groundswell of other leaders like me trying to do something or am I on an island all by myself? There's a discomfort to be out there and perceived as by yourself.

    And then authenticity. Do I really believe that this is the best thing to do or am I just kind of going along to get along? You really have to be aware of all of those when working with whomever the leaders are to figure out where you think they are and where they might even say they are, and then try to figure out solutions based on what the reality is.

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