Critical Conversations: How Can We Advance Health Equity?

To ensure racial/ethnic disparities are not being amplified, the foundation is prioritizing being more intentional about the research we fund. We have taken the time to delve into understanding health equity research and how to identify research with a health equity lens. Currently, we ask our applicants and reviewers specific questions to ascertain and encourage engagement in critical thought about how each research proposal considers and centers health equity and health disparities. Our commitment is to continuously learn from experts on this topic, particularly the significance, impact, and best practices of facilitating health equity research.

Racial disparities in the field of health are attributed mainly to how accessible healthcare is, who is delivering care, as well as the quality, efficacy, and value of the care administered. Although eliminating these inequities is quintessential, challenges caused by the interlocking oppressions characterized by the social gradient of health pose a critical public health issue. Assuring more significant equity and accountability of the healthcare system to those it disenfranchises is vital to improving disparities in health outcomes relative to social, political, and economic determinants of health. Regardless of a stakeholder’s positionality, health equity is not the sole responsibility of any entity or individual. Health equity requires a series of consistent simultaneous macro, mezzo, and micro-level intersectoral changes.

Health equity is a state in which all individuals can reach and maintain optimal levels of health. Although health is considered an issue primarily in the healthcare enterprise, health is indeed an issue of the entire public health system. Many unfavorable health outcomes are created or exacerbated by social and political factors, such as where individuals live, eat, & play and the conditions within those environments—in that regard, we cannot ignore socio-economic, socio-political, and socio-environmental factors. Health affects us all; therefore, health equity is significant solely because everyone deserves the chance to be healthy. Unfortunately, the current healthcare enterprise is structured to treat healthcare as a privilege instead of a fundamental human right. Attaining quality healthcare typically requires financial security and extensive knowledge of how to navigate the system— which individuals negatively impacted by social determinants of health often do not possess.

How do we move from critical discourse on health equity to actionable solutions to put knowledge into practice?

• Currently, very little research stratifies data by race, sex, and specific comorbidities to address sex inequities within broader health disparities among marginalized populations. A more granular approach to clinical, social, and behavioral research could provide more precise and meaningful data to identify how inequities and disparities manifest at different points within the public health system. For example, in minority populations, quality of life, sudden illness, chronic illness, and preventable death have been under-analyzed. Requiring all publicly and privately funded public health research to report results stratified by race, gender, SES, age, ethnicity, occupation, sexual identity, ability status, and residential location would: 1) provide insight into what multidimensional interventions are needed using a systems-level approach, and 2) hold public and private agencies accountable to conduct diverse and inclusive studies.
• Allocating more funding to eradicating health disparities is imperative. While new research is a simple tool for understanding the association between two factors, the interstitial layers of issues addressing causation can only be assessed through tangible action, i.e., providing resources to extend agency and access to marginalized communities. An individual would not benefit from putting a band-aid on a broken bone. Systemic issues operate the same way; one cannot treat a problem without addressing the mechanism of injury.
• Chiefs of diversity and inclusion cannot become proxies for accountability within our healthcare system, government, and workforce. Positioning a figurehead to tackle issues of how implicit biases and racism permeate every corner of American culture is not a viable solution. While more Black and brown clinical and social practitioners are needed in the field, increasing their presence in other health promotion aspects is also integral. Studies show that people of color are more likely to learn more efficiently when information is presented by people who look like them. While this information has primarily been tested on school-aged children, there is the belief that these attitudes continue well into adulthood.

Although there have been significant advances in addressing how social determinants affect health, race remains an important factor in determining whether an individual receives care, how an individual receives care, and in determining health outcomes. According to the renowned 2008 Institute of Medicine landmark report: “Unequal Treatment provides compelling evidence that racial/ethnic disparities persist in medical care for a number of health conditions and services. Numerous efforts are underway to reduce or eliminate racial and ethnic healthcare disparities and address some social factors that affect healthcare outcomes. Despite these many efforts, disparities in access to quality care remain, and for some measures being tracked, gaps in care are getting larger rather than smaller.” In 2022, the American Cancer Society released a report outlining current cancer statistics and highlighting disparities. This report revealed that white adults in the U.S. with melanoma have a 5-year survival rate over 20% higher than Black adults (ACS, 2022). This disparity is primarily due to insufficient representation of the clinical manifestations and signs of skin disorders in darker skin.

Health disparities are also prevalent in behavioral health outcomes. A meta-analysis including nearly 400,000 participants showed the most prominent association between lack of equity and adverse mental health. Daily experiences with inequity were causal in people of color being 1.72 times more likely to develop depression and 2.24 times more likely to develop anxiety (Williams, 2018). In 2019, the CDC reported a national decrease in suicide rates. A follow-up cross-sectional study further investigated suicide trends among more stratified subgroups. When adjusted for age, the results of this study indicated that while there was a national decrease in suicide rates, there was an increase of 30% for Black individuals and a 16% increase for Asian and Pacific Islander (API) individuals (Ramchand, 2021). Many barriers that impede the utilization of behavioral healthcare services are the stigma associated with mental illness, financial burden, lack of trust in the healthcare system, lack of culturally competent doctors and allied health professionals, and underrepresentation of people of color in the healthcare field.

Health equity is currently centered in many ways, and pragmatic solutions are becoming a mainstream priority. The question health equity poses to the public health system is: Who deserves the ability to experience a life of optimal health? The answer should be a resounding “everyone.”