In April of this year, IHI began facilitating an initiative called Pursuing Equity, a two-year learning and action network.
Eight participating teams—with additional support from the Rx Foundation and the Bristol-Myers Squibb Foundation—are testing a framework to articulate the way health systems can directly reduce inequities in health care.
The framework the teams are testing is described in IHI’s White Paper, Achieving Health Equity: A Guide for Health Care Organizations
. It is based on IHI’s research and experience working with leaders in the field and emphasizes a systems view of health equity, as well as the role health systems have in moving toward equitable health care.
Health equity may be a new term for some. It refers to a state where everyone has the opportunity to attain their full health potential and no one is disadvantaged from that opportunity by their social circumstances. While there will always be variation in health outcomes, Pursuing Equity aims to address a subset of those differences—inequities. Inequities are the differences that are systematic, avoidable, unjust, and often tied to social disadvantage. They are predictable and based on demographics such as race, gender identity, sexual orientation, language spoken, and religion.
The initial theory for the role of health care in advancing equity has five pillars:
- Equity has to be a strategic priority and core to the mission of the health system, with clear and visible leadership support.
- Structures and processes must be in place to support equity as a priority.
- Systems must deploy specific strategies to address the multiple determinants of health on which health care can impact, including inequities in clinical areas, physical environments, and socioeconomic status of employees.
- Health systems must strive to eliminate institutional racism, a system of advantage based on race, where the policies and practices of institutions contribute to differential access to goods, opportunities, and resources.
Health systems need to partner deliberately and authentically with other community organizations.
The eight teams in Pursuing Equity have outlined charters that span the five pillars and answer the three model for improvement questions: What are we trying to accomplish? How will we know a change is an improvement? What changes can we make that will result in improvement? The goal is to capture promising strategies in each pillar to lay the groundwork for a national initiative that identifies ways organizations can impact equity at the system level.