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“We are at a moment when we have to choose: are we on the side of history that moves towards equitable health or are we [going to] stutter step and create worse problems?”
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3 Lessons COVID-19 Teaches about Addressing Health Equity

By IHI Multimedia Team | Monday, May 11, 2020

Equity 3 Lessons COVID

Photo by Wokandapix | Pixabay

IHI President and CEO Derek Feeley pulled no punches when describing the disproportionate data on people of color sickened or killed by COVID-19 in the US and elsewhere: “The numbers are shameful.”

Almost 900 health care professionals registered for the May 8 IHI Virtual Learning Hour — Centering Equity in the Response to COVID-19 — to learn what actions Feeley and other experts recommend to address health inequities during the current crisis and beyond.

The media in recent weeks has reported on how the impact of COVID-19 in the US and the UK is hitting communities of color hardest. The reasons for this are sometimes explained as the consequence of a range of underlying health conditions (including hypertension, diabetes, and asthma). Too often, however, IHI President Emeritus and Senior Fellow Don Berwick noted, the fact that “these issues are driven by structural racism has been hidden far too much.”

Acknowledging that the COVID-19 pandemic is far from the first time a public health emergency has highlighted injustices in health and health care, the panelists — Luella Toni Lewis, MD, Founder and President, Liberation Health Strategies; Ronald L. Copeland, MD, FACS, Chief Equity, Diversity, and Inclusion Officer and Senior Vice President of National Diversity and Inclusion Strategy and Policy, Kaiser Permanente; and David Ansell, MD, MPH, the Michael E. Kelly Presidential Professor of Internal Medicine and Senior Vice President/Associate Provost for Community Health Equity, Rush University Medical Center — agreed on three courses of action that can turn the current crisis into opportunity:

  • Collect, understand, and act on data. African Americans, Latinos, and people in indigenous communities (including American Indians, Alaska Natives, and Native Hawaiians) are overrepresented among COVID-19 deaths and infections in the US. Lewis noted that numbers like these are now reported in some states because advocates — including African American physicians — demanded stratified data from local authorities to document the illness and deaths that were beginning to soar in their communities.

    Copeland shared his belief that data should be used to: 1) raise awareness; 2) define opportunities for improvement; and 3) create transparency to allow evaluation of actions. “You can’t evaluate and act on what you can’t see,” he said, “and it’s hard to see what you can’t measure.” Copeland cautioned, however, that data on its own changes nothing, noting that evidence of structural racism has been documented in many comprehensive studies over the years without necessarily prompting change. “Data is important,” he explained, “but moral and political will [to take action] are more important.”
  • Develop long-term relationships with communities. Ansell described the role of Rush University Medical Center (RUMC) as part of West Side United, a collaboration between health care institutions, residents, civic leaders, community-based organizations, businesses, and faith-based institutions. Their mission is to reduce the life expectancy gap between downtown and the West Side of Chicago by improving health and health care, the physical environment, economic vitality, and education. Ansell said that “building long-term relationships in communities we serve” has been the key to making progress. When the disparate impact of COVID-19 on the African American community became clear, West Side United’s established infrastructure allowed them to quickly organize a Racial Equity Rapid Response team with support from Chicago Mayor Lori Lightfoot. Instead of wasting precious time determining where to begin, the team soon learned from residents that increasing testing availability was the community’s most urgent need.

    Lewis underscored the importance of “understanding the expertise of people in the community” during the current crisis, but also as plans develop around the country to emerge from lockdown. “Whose voices, bodies, and experiences [will] we value?” she asked as state and local governments consult with health care organizations and public health authorities in the coming weeks and months. Lewis asked, for example, who has more relevant experience to offer regarding how to maintain physical distancing on public transportation than “someone who has to take two buses and a train to get to work.”
  • Build equity into quality accountability. Calls to make health care more equitable are hardly new. After all, the Institute of Medicine included equity as one of the essential six aims for improvement of the US health care system almost 20 years ago. Yet, many organizations still do not undertake even basic equity improvement efforts, such as stratifying their quality data by race, ethnicity, or language preference. Copeland called on health care accrediting bodies and health systems boards to hold institutions and their leaders accountable for providing inequitable care. Falling short, he asserted, should “impact their compensation or their accreditation status.” As Copeland remarked, “This is what health [means] in the 21st century, and to do less is not acceptable.” Lewis agreed and added, “We are at a moment when we have to choose: are we on the side of history that moves towards equitable health or are we [going to] stutter step and create worse problems?”

To learn about other ways to embed and center equity in the response to the pandemic, watch and listen to the full Virtual Learning Hour. Learn more about IHI’s special series of weekly COVID-19 Virtual Learning Hours.


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