AHRQ Views: Blog posts from AHRQ leaders
A Call for Action to Achieve Health Equity
Editor’s Note: This AHRQ Views blog post was written by members of the Agency’s National Advisory Council. The Council provides advice and recommendations to AHRQ's director on Agency activities and priorities, including ways that AHRQ can advance 21st century care that is high-quality, safe, equitable, and high-value.
As vaccines for COVID-19 are being deployed across the country, there is much hope that, Delta variant notwithstanding, we will eventually overcome a once-in-a-lifetime pandemic. However, while we marvel at the development of vaccines and the tireless efforts of healthcare workers under extremely difficult circumstances, the pandemic’s impacts across communities have starkly illustrated the existing racial and ethnic disparities in healthcare.
According to data collected by the Centers for Disease Control & Prevention, Blacks and Hispanics were four times more likely to be hospitalized and three times more likely to die from COVID-19 than Whites. Because people of color were more likely to have underlying health issues such as hypertension, obesity, and diabetes, they were significantly more vulnerable to the risks of contracting COVID-19.
Many low-income and immigrant families, who live in multigenerational and often crowded housing, also experience a greater burden posed by similar underlying conditions. These communities are most likely to experience interruptions of work and income.
Immigrants and people in communities of color often work in jobs deemed essential, such as the food services and the delivery sectors, which may require travel by crowded public transportation and work in conditions that were not optimized for safety in the midst of this pandemic. A Health Affairs article authored by AHRQ researchers in 2020 broke important ground by exploring how differences in job characteristics and household composition impacted risks of contracting COVID-19.
In contrast, workers in office-based jobs who are able to work remotely have a significantly lower risk of exposure and infection. Their living conditions allow them to practice social distancing, a luxury that people living in low-income communities often cannot afford.
The above examples of disparities were displayed in plain sight during the COVID-19 pandemic. They serve as a painful reminder of systemic racism; it permeates our society, including our healthcare and public health systems, and has significant impacts on people’s health.
There is no doubt that the pandemic has had substantial and likely long-lasting impacts on the way we will deliver healthcare in the U.S., such as the rapid evolution of telehealth and other process innovations and adaptations. However, true change will not occur until we address health inequalities by structural changes in the healthcare delivery systems.
During the COVID-19 pandemic, telemedicine increased access to care for many, but also exacerbated a digital divide for those without access to high-speed internet or appropriate devices, and/or lacked high levels of digital health literacy. We need to consider access to telehealth and the digital divide as another component of the social determinants of health (SDOH). But as we have learned, it was not just patients lacking access, but also providers working in community health clinics that serve poor communities, where appropriate technology and resources were inadequate.
There are two important strategies to make meaningful changes. First, we must understand and agree that there is no healthcare quality without healthcare equity. This means that future quality measures should be considered through the contexts of systemic racism and equity.
To promote healthcare equity, we need to level the playing field by pursuing economic and social justice. To do so, we must fully understand the role played by SDOH. Research has conclusively shown that only 20 percent of health outcomes depend on clinical medicine, and that 80 percent are due to SDOH. When we examine this crisis and apply lessons to improve the health of vulnerable communities, we must care about the non-clinical drivers of health in their lives, such as SDOH.
AHRQ research could give us the keys and tools to understand individuals more holistically, keeping patients at the center of care. To do so, we must understand fully what it means to treat individuals holistically and what metrics should be used to evaluate and address their needs and how to achieve equity.
Examples from the COVID-19 pandemic have shown how our human service programs often fail to address the social factors that impact health. As policy makers design social programs, they must better integrate the social programs with health to improve public health and increase equity. To achieve this goal, we must seize the opportunity to integrate our public health strategies with our healthcare delivery strategies.
Given the history and strength of AHRQ in healthcare data collection and research, the Agency is in a perfect position to lead this effort, which requires collaboration throughout the Department of Human and Health Services. Data collected by AHRQ and its researchers have shown that healthcare disparities have existed in the U.S. for a long time. Clearly, the COVID-19 pandemic has further illuminated the scale and adverse impacts of this problem, even as it presents an unprecedented opportunity to build on and expand the Agency’s efforts and research capacity to advance healthcare equity.
For all of these reasons, we feel the time is now for a call to action to enhance collaborations among government agencies and key stakeholders that are essential to fulfilling our moral obligation to address the impacts of systemic racism and societal inequities in health and healthcare. Only through such actions, improved integrations, and coordinated efforts across health and human services will we create a holistic and equitable healthcare system for all.
Edmondo Robinson is Senior Vice President and Chief Digital Officer for Moffitt Cancer Center; Peter Embi is President and CEO of the Regenstrief Institute, and holds leadership roles at Indiana University and the Indiana University Health System; Ramanathan Raju is Past President and CEO of New York City Health and Hospitals Corporation; Yanling Yu is President of Washington Advocates for Patient Safety.