Achieving Health Equity by Design

Abstract

Achieving Health Equity by DesignDisparities in health outcomes by race and ethnicity and by income status are persistent and difficult to reduce. For more than a decade, infant mortality rates have been 2 to 3 times higher among African American populations, rates of potentially preventable hospitalization have been substantially higher among African American and Latino populations, and the complications of diabetes have disproportionately afflicted African American and Latino populations. 1 These and other disparities have persisted despite recognition that inequity costs the economy an estimated $300 billion per year. 2 In addition, health disparities threaten the ability of health care organizations to compete fiscally as insurers increasingly base payments on quality and outcomes, such as reducing preventable admissions and readmissions.A common explanation for long-standing disparities is the challenge of addressing social determinants of health, including income inequality, poor access to transportation, inadequate educational quality, and substandard housing.

Mapping Neighborhood Health Geomarkers To Clinical Care Decisions To Promote Equity In Child Health

“…The current health care climate increasingly emphasizes and incentivizes equity and prevention, “value over volume.” 14–18 The National Academy of Medicine recently articulated a vision for “healthy communities,” using fifteen core social determinants of health (such as education, housing, and air and water quality). 19 This vision aligns with the Accountable Health Communities program under way through the Centers for Medicare and Medicaid Services, which seeks sustainable funding models that promote “data systems that bridge health and community services.” 20 …”

Product or Process: Cultural Competence or Cultural Humility?

“…Cultural competence has long been viewed as the cornerstone of fostering cross-cultural communication, reducing health disparities, improving access to better care, 23 increasing health literacy and, in general, promoting health equity. 24 The problem is that much of the recent work done to address health inequities has focused on increasing cultural competence among providers as if this could somehow empower at-risk groups to overcome decade's worth of social disadvantages that are at least partially responsible for poor health outcomes. 24 Additionally, despite decades of theorizing about and researching cultural competence certification, there is a lack of consensus about its key components.…”

“…24 The problem is that much of the recent work done to address health inequities has focused on increasing cultural competence among providers as if this could somehow empower at-risk groups to overcome decade's worth of social disadvantages that are at least partially responsible for poor health outcomes. 24 Additionally, despite decades of theorizing about and researching cultural competence certification, there is a lack of consensus about its key components. 25 Adding cultural humility, a process of openness, collaboration, and self-reflection rather than a presumption of competency, 26 to cultural competence could be uniquely beneficial.…”

Swimming ‘upstream’ to tackle the social determinants of health

“…We can use principles of Experience-Based Design23 to involve patients in co-designing services that meet not just their health needs but their social needs as well. We can go one step further and engage and listen to communities at risk to understand their needs and priorities 24. Healthcare organisations can develop mutually beneficial partnerships with community agencies to address identified needs, engaging patients directly in their health where they live and work.…”