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Q and A on Health Equity Course: Wildly Different Results for Predictable Reasons

By IHI Open School | Monday, April 27, 2015

DI Council

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 Council?

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 system.

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 mission.

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 course TA 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!

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