IHI Open School Short

Video Transcript: How Can Health Care Promote Health Equity?: A Conversation Between Donald Berwick, MD, and David R. Williams, PhD, MPH

Donald Berwick, MD, Senior Fellow and President Emeritus of IHI
David R. Williams, PhD, MPH, Professor of Public Health, Harvard T.H. Chan School of Public Health

INTERVIEWER: So let’s go back to the four-year gap between the racial gap and life expectancy that remains, and is unconscionable. Can we close that with health care? Or not?

WILLIAMS: That’s a good question. So health care clearly has a part to play. And you know, ensuring that every patient gets high-quality care would be a step in that direction. Because there are racial/ethnic disparities not only in the onset of disease and the prevalence of disease, but in the course of the disease, the severity and course is worse, and part of the poorer prognosis and the more difficult severity of disease for many monitories reflects the fact that they don’t get as high quality care. So quality care is important.

Most estimates suggest, though, that medical care alone will not solve the problem. We have to look at all of the factors that drive health. The fact that medical care is important in terms of restoring us to good health once we get sick, but what drives health? What makes us healthy in the first place has a lot to do with the opportunities to be healthy in the places where most Americans spend time, in our homes, in our workplaces, in our schools, in our neighborhoods. And so where we live, learn, work, play, and worship, and opportunities to be healthy in those places, have a lot to do with health.

So health strategies would include things like ensuring that every child has a life where they can grow up and thrive and be not only ready for school, but a life free of early childhood adversity and stress, which could include things like chronic poverty, for example, stressors that have long-term negative health consequences. There is a very strong relationship in the United States and elsewhere in the world between education and health. So ensuring good-quality academic success ensures better socioeconomic success, which is powerfully linked to health. Looking at the opportunities to be healthy in neighborhoods, in some neighborhoods, it’s not easy to find a safe place to exercise. There isn’t access to fresh fruits and vegetables.

So again, creating a culture of good health, where the healthy choice becomes the easy choice, where people work and where people live, are all factors that can play a role in improving the quality of health. And racism has played a role in creating neighborhoods that aren’t equal in access to resources and so on. So that’s another distil mechanism in which racism affects health.