In the last of a three-part series on health equity, Ron Wyatt, MD, Medical Director and Patient Safety Officer for The Joint Commission, responds to concerns that health equity is too daunting to achieve.
How can anyone say health equity is too big to tackle?
If black men get more limbs cut off, needlessly, or don’t get kidney transplants, or get fewer cardiac procedures. If black women, who have a lower incidence of breast cancer, die more often than white women from the disease.
How can anyone sit idle and say this is too big to tackle?
To say it’s too big is just an excuse.
You have to decide to start. You can start small, with one thing. It’s no different than any change movement.
First, you have to have the will to start. Then, you develop a strategy for your patients and your community. Then, you align that strategy with your resources and then you execute on your strategy.
So, if you want to do small tests of change, do that. If you want to work in one community, do that. If you look at your patient demographics, where do they live? You should know where they live. Start on one street. When they come to the hospital, start in one unit.
The Data Is Clear
At the Joint Commission, we’re looking at all the data because people are always saying, “Show me the data.”
Well, there’s plenty of data, and anyone who says “Show me the data” has had their head in the sand for the last 30 years. Then, we’re going to do the analysis and say, “Here are areas where you need to start.”
Health care organizations, across the continuum, must begin to analyze existing data sets, stratify the data by race, ethnicity, geography, socioeconomic status, insurance, status, income, and employment to better understand where to begin the work to improve outcomes and become adaptive learning organizations. Health and health care organizations must make the elimination of the social determinants of health and equity a top strategic priority.
But you have to start.
Upending the Legacy of Racism
You’ve got to look at the history behind this. It’s not new.
In the 1800s, one of the fathers of gynecology experimented on black women; he got his gynecological surgeries correct on young black women. He wouldn’t even try it on white women until he was getting the right outcomes — and he didn’t even use anesthesia that was available. Or look at the physician who created what we now call birth control, back in the 20s and 30s. She experimented on black women, too. High-dose birth control gave these women strokes, heart attacks — all sorts of complications from hormonal therapy. Until they got the dose right, white women didn’t get it.
It is known that blacks and Hispanics receive less pain medication for long bone fractures and other injuries, people with sickle cell crisis are labeled drug seekers, the obese patient is treated with less respect and dignity, and LGBTQ people have challenges with access to quality care.
The same kinds of decisions get made today. When you look at the numbers, it’s glaring. We don’t need more research, we need action. So, in my mind, where do we start to do something? So, if you tell me you can’t, then what you’re saying to me, is you won’t.
Inaction is a violent act that harms. When you say to me you won’t, then in my mind you’re perpetuating systemic racialization and the other so called “-isms” that are all too real.
Time for Action
You may wonder why I’m so passionate about this. I have an 18-year-old daughter. I have two grandkids. I want to know that when they need health care, it’ll be there. That may be selfish on my part, but it keeps me going.
My hope is that the system starts to change. I believe that some of it is starting to happen. Health equity is at least more in the conversation now, I think, than it has been in the last 20 years. Now is the time that we all need to come together to start to push against the inequality we know exists.
You may also be interested in:
The first two installments of the series - Is It Time for a National Goal to Improve Health Equity? and What’s the Relationship Between Health Equity and the Triple Aim?
Video: What Is Health Equity, and Why Does It Matter?
Health Affairs: Moving From Documenting Disparities To Reducing Them