Health Equity vs. Diversity, Equity, and Inclusion. Where Should We Focus Efforts for Racial Justice?

Dr. Adrienne Mims, MD, MPH, FAAFP, AGSF
Dr. Adrienne Mims, MD, MPH, FAAFP, AGSF

Chief Medical Officer (CMO), Rainmakers Strategic Solutions

The past two years have awakened many people in America to social injustices that are deeply rooted in our society—healthcare, criminal justice, laws, and social structures. For others, the longstanding decades of injustice have now been placed in the spotlight. As we focus our efforts on making this country a better place now and for future generations, we need to look at how the past has impacted healthcare to direct these needed changes.

In the realm of healthcare, we focus on health equity, while outside of healthcare, we focus on diversity, equity, and inclusion. Across the entire society, social justice is the focus, and dedicated and sincere efforts to change are needed across this spectrum.

The COVID-19 pandemic resulted in a great disparity in mortality by age and race.1 In April and May 2020, most COVID-19 deaths in the United States occurred in urban areas with a larger population percentage of non-Hispanic black, non-Hispanic Asian, or Hispanic and a smaller percentage that are non-Hispanic white. Prior differences in levels of comorbidity, access to healthcare services, transportation, internet access, and the racial distribution of front-line workers in service industries have contributed to higher rates of death in specific populations during the COVID-19 pandemic.

Line Chart: Provisional Death Counts for Coronavirus Disease 2019 (COVID-19) By Week of Death
Bar Chart: Age-standardized

Image Sources: CDC

While the focus acutely shows the disparities, it brings opportunity for real change. As a clinician, my focus trends towards achieving health equity.

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.2

This definition of health equity can support a robust evaluation of current healthcare delivery systems to determine if the current distribution of resources for all people being served by a healthcare organization result in comparable outcomes. To achieve health equity, an organization would first need to assess the population being served and the outcomes of interest (for example, control of hypertension, perinatal morbidity, or adherence to end of live wishes). If a variation in outcomes differs by personal characteristics—race, language, culture, income, sexual orientation, physical limitations, etc.—then inequalities exist.

Some assessment tools and transformation programs are designed for healthcare organizations to use quality improvement methods to implement systems changes to achieve health equity. The available tools support various healthcare settings, including hospitals, public health departments, primary care, and multispecialty clinics.3,4,5,6,7 Healthcare leaders should act by making racial equity a central focus for improving the U.S. healthcare system.8

Outside of the provision of direct healthcare services, organizations can still support achieving health equity. Many companies have employees that may be impacted by inequities, their business provides goods and services that impact communities, or their work impacts the social structures of society. Their framework for improvement would be a focus on diversity, equity, and inclusion and can be supported by available resources. 9,10,11

Infographic: What is Diversity, Equity, and Inclusion (DEI)? A brief description of each term is provided.

The ultimate goal for transformation goes beyond healthcare systems and public and private companies; rather it is to achieve racial justice in the American culture. The landscape for change starts at home but extends to schools, workplaces, government, philanthropy, entertainment, sports, and religion.

What is racial justice?

The systematic fair treatment of people of all races, resulting in equitable opportunities and outcomes for all. Racial Justice [is defined] as the proactive reinforcement of policies, practices, attitudes, and actions that produce equitable power, access, opportunities, treatment, impacts and outcomes for all.

Racial justice—or racial equity—goes beyond “anti-racism.” It is not just the absence of discrimination and inequities, but also the presence of deliberate systems and supports to achieve and sustain racial equity through proactive and preventative measures.11

Racial justice means having policies, beliefs, practices, attitudes, and actions that promote equal opportunity and treatment for people of all races.12

Where is your company in this journey and what is your next step? Let us know in the comments below.

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