This year, the IHI Open School launched our very first course on health equity — a small step toward the Institute of Medicine’s aim
to make care equitable for all people. The course was the result of work by the
IHI Diversity and Inclusion Council, co-chaired by Alex Anderson, a researcher
on the Institute for Healthcare Improvement’s Innovation Team. We asked Alex
five questions to learn more about how the course came about, how he became an
advocate for diversity and equity as a white man, and what efforts IHI is
making toward inclusive, equitable systems.
OS: How did you get
interested in health disparities?
AA: I grew up in a predominately white and comfortable
middle class neighborhood in Las Vegas. I really believed in the American dream
— if you tried harder, you could improve and get ahead. I now recognize this is
inconsistent with most people’s experience.
My world view drastically changed when I moved to
Philadelphia for college. I participated in a program called Penn for Youth
Debate which connected college students with public junior high and high
schools in order to establish after-school debate programs. I worked with smart,
engaged, and hard-working students. However, these students, like most students
in Philly’s public schools, were living in communities with high rates of
poverty while constantly facing extreme funding cuts from the city and state. After
more than a decade in the Philadelphia public school system, nearly all of the
students were functionally illiterate — copying notes from the chalk board to a
notebook was nearly impossible. I couldn’t understand that juxtaposition. It
was clearly not the students’ fault. A larger problem was responsible.
It wasn’t until I was lucky enough to start working at IHI
that I had the language to articulate what I observed — that every system is
designed to get the results that it gets. Looking back on my experience in
Philadelphia schools, I understood that the educational outcomes were a product
of a failing system, not failing people.
OS: How do you view
your role in addressing diversity, as a white man helping to lead the D&I
AA: There are several reasons I’m involved in the D&I
Council, and why I believe all people, including white men, have a role in the
struggle for an equitable society.
First, I believe it’s important to acknowledge that the inequitable
system we live in unfairly benefits me. I do not hold racist beliefs, but I am a
beneficiary of racist systems. I grew up as a white man in a comfortable,
middle class family. I lived in a mostly white and comfortable middle class neighborhood
and was educated in a well-funded, mostly white public schools. I excelled
there because the system around me was designed for me to excel. As a
beneficiary of these systems, I feel a responsibility to put that privilege
toward being an ally who works alongside others to create a more equitable
Another reason is practical. If you’re trying to advance
equity in an organization or community, you need to include anyone and everyone
willing to help. The problem is too big and urgent to sit around and wait or to
refuse the help of some people. If you’re asking yourself, “can I be part of
this?” the answer is absolutely yes.
Finally, social inequity is not just a problem for people
from minority backgrounds. First of all, diversity involves more than just race
— it spans differences in ethnicity, gender, ability, socioeconomic status, cultural
and religious background, and many other dimensions. I want to live in an
inclusive world, because I believe that groups will never generate the greatest
ideas or execute them without including as many different perspectives as
possible. In my view, organizations and communities without diversity will never meet their full potential.
OS: What is the
D&I Council, how did it form, and what do you do? What are some of your
results so far?
AA: At the end of the day, IHI’s mission is very clear — we
want to improve health and health care worldwide. That means for all people, in
all places. If we don’t work toward closing disparities, we won’t achieve our
IHI’s Diversity and Inclusion Council is one of my favorite
things about IHI. We are IHI team members — working in various departments and
at various organizational levels — who meet regularly to promote diversity,
inclusion, and equity in everything that IHI does.
The Council formed at the end of 2011 at the urging of our
Board of Directors. IHI needed to develop a staff that is more representative
of the communities where we work. We started by looking back and evaluating our
hiring in the previous few years. The Council recommended specific changes to
our hiring process — namely, slowing down the hiring process to guarantee a
diverse candidate pool at each phase of the hiring process. In the years
leading up to this process improvement, IHI’s rate for new hires of minority
backgrounds was less than 10 percent. In the years of hiring since, our minority
hiring rate has been near 40 percent. These results are not a product of the Council
— they are the product of an organization focused on improving.
Aside from work force diversity, the Council also works on
fostering a sense of inclusion among staff. We host potlucks and “Lunch and
Learn” sessions, we create safe spaces for conversations that may be difficult
to have in a traditional work environment, and we organize volunteer
opportunities in the community.
More recently, the Council has worked closely with the rest
of IHI to elevate our focus on health equity, including the IHI Open School
102: Improving Health Equity.
OS: What would you say
to health students who look at the issue of health disparities and feel
deflated because it represents another problem to solve? Why should people care
about this, and why are you hopeful about it?
AA: Students pursuing a career in health are likely aiming
to make people’s lives better. Our systems in the US and globally get wildly
different results for predictable reasons — race, gender, income, and geography
clearly determine whether you will have a long, healthy life or a short,
unhealthy life. Our current system does not provide all people with the same
opportunities for life and health. As people who value equal opportunity, we
should care because it’s the right thing to do. As improvers, we should care because
this avoidable variation is the basis of low quality care.
I am hopeful about the future because the work is advancing
— we are slowly getting better at solving these issues. Data is the foundation,
and we are getting more rigorous in collecting it — for example, at a health
equity conference hosted by the Disparities Solutions
Center at Massachusetts General Hospital, I learned that nearly 90 percent
of all US hospital systems are stratifying their patient data by race,
ethnicity, gender, and socio-economic status. Yet, less than 15 percent of
those systems are doing anything with that information. That’s a huge
opportunity for improvement. Students and young medical professionals are
heading into careers with innumerable opportunities to improve care equitably.
OS: The course talks
about how health inequalities are a social problem, not resulting from one
individual, nor solved by one individual. What do you suggest individuals do to
get started on this issue?
AA: That’s completely true — the state of disparities is not
the result of one person’s efforts, or one system’s poor design. It’s an
outcome of a huge combination of factors from the design of neighborhoods and
communities, to resources for education, to access to healthy foods, to the way
we treat wealth and income. Dr. Joan Reede, dean of diversity and community
partnerships at Harvard Medical School, says in the course that disparities are
all around us. Doing something is as easy as seeing one of those disparities, and
taking action — in your family, school, workplace, or community.
A really easy way to get started is to think about what’s
already happening in your community. If you’re a student, does your school have
an organization focused on diversity or equity? Join it, listen, and share your
ideas. If you’re a professional, does your organization have a team focused on
diversity, inclusion, and equity? If yes, join it! If not, send out an email to
your co-workers and invite everyone to join an informal lunch conversation — you
would be amazed about how much you can learn about your co-workers just by
asking questions such as: What can we be doing better around diversity,
inclusion, and equity? How much of your full self do you bring to your work,
and how much do you want to? Get an understanding of your peers, generate some
ideas to improve, and get started!