Ending Unequal Treatment Strategies to Achieve Equitable Health Care and Optimal Health for All (2024) / Chapter Skim
Currently Skimming:
1 Unequal Treatment: 20 Years After
1 Unequal Treatment: 20 Years After
Pages 17-48
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 17... ...
This consensus committee was charged with highlighting current drivers of racial and ethnic health care disparities, providing insight into successful and unsuccessful interventions, identifying gaps in the evidence base, proposing strategies to close those gaps, considering ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care, and making recommendations to advance health equity. Unequal Treatment was mandated by Congress as a follow-up to the 1985 Report on Black and Minority Health, requested by the Secretary of Health and Human Services (HHS)
|
From page 18... ...
racial and ethnic minorities among health professionals. • Recommendation 5-4: Apply the same managed care protections to publicly funded health maintenance organization (HMO)
|
From page 19... ...
Cross-Cultural Education in the Health Professions • Recommendation 6-1: Integrate cross-cultural education into the training of all current and future health professionals. Data Collection and Monitoring • R ecommendation 7-1: Collect and report data on health care ac cess and utilization by patients' race, ethnicity, socioeconomic status, and where possible, primary language.
|
From page 20... ...
. Prominent among these themes is the importance of the following: • Increasing awareness and understanding of health care inequities among actors in the health care ecosystem; • Standardizing and providing guidance on the collection of data on race, ethnicity, socioeconomic status, acculturation, and language use in all health and health care data systems; • Increasing diversity in and strengthening the health care workforce through accessible professional education and incorporating cultur ally competent education and training; • Adopting alternative payment models to aid payment reform; • Implementing approaches to address factors that influence health; • Using data and data systems to their full potential to advance health equity research;
|
From page 21... ...
population it serves. 5-4 Different payment policies have shown mixed results in 4 reducing racial and ethnic health care inequities.
|
From page 22... ...
Data Collection and Monitoring 7-1 Health data granularization and access to the data are still 7 lacking for some minoritized populations. 7-2 Metrics that measure and track progress to advance racial and 8 ethnic inequities have been created and adopted by health care systems, health insurance payers, professional organizations and accrediting bodies, and researchers, but wide variation exists in many of the equity performance measures.
|
From page 23... ...
However, its inadequacy disproportionately affects minoritized populations. Looking at one metric, the percentage of the population that lacks health insurance, rates have remained high across all populations but are highest for minoritized populations.
|
From page 24... ...
White life expectancy increased from 77.2 years in 2003 to 78.8 years in 2019 before declining to 77.0 years in 2020 and increasing to 77.5 years in 2022. By contrast, Black life expectancy was 72.4 years in 2003 before rising to 74.8 years in 2019, declining to 71.5 years in 2020, and increasing to 72.8 years by 2022.
|
From page 25... ...
The significant drops in life expectancy for all people in 2020 sounded the alarm of a failing health care system, unable to respond to a public health crisis, but were most drastic for minoritized populations. One recent analysis over a 22-year period also reported that Black populations had over 80 million potential years of life lost compared to their White counterparts (Caraballo et al., 2023)
|
From page 26... ...
. The economic burden of racial and ethnic health inequities was $421.1 billion for minoritized population (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander populations)
|
From page 27... ...
health care equity. Thus, NIH charged the National Academies with conducting a study to highlight the major drivers of health care disparities, provide insight into successful and unsuccessful interventions, identify gaps in the evidence base, propose strategies to close those gaps, consider ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care, and make recommendations to advance health equity (see Box 1-2)
|
From page 28... ...
The update will highlight the major drivers of health care disparities, provide insight into successful and unsuccessful interventions to reduce disparities, identify gaps in the evidence base, and propose strategies to close those gaps. The committee will consider ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care and make recommendations to advance health equity.
|
From page 29... ...
Drawing on this detailed literature review, and supplemented by public input, the committee will apply its expert judgement in order to develop recommendation with a focus on advancing health equity.
|
From page 30... ...
, social justice, health inequities, minoritized populations, public health, primary care, health economics, health technology, health care services research, health care financing, community-engaged research, health professions education, health law, and ethics (see Appendix E for the biographies of the committee members)
|
From page 31... ...
. For this study and its specific task, the committee did not extensively examine the evidence base related to achieving health equity broadly but focused on racial and ethnic inequities in the health care system, especially in terms of care access, use, and quality.
|
From page 32... ...
Furthermore, the committee acknowledges that reductions in health inequities will require simultaneous improvements to health care as well as the many factors beyond health care that influence health, as shown in the committee's conceptual framework. In this report, the committee frequently uses the terms health care and health together, because interventions to reduce racial and ethnic health care inequities also commonly advance health equity.
|
From page 33... ...
Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable in equalities, historical and contemporary injustices, and the elimi nation of health and health care disparities. Health inequity refers to a state of being in which someone is denied the possibility of being healthy by belonging to a group that historically has been economically and socially disadvantaged.
|
From page 34... ...
Unequal Treatment identified numerous social factors, including race and ethnicity, that lead to "unequal treatment." Using "unequal treat ment" implied that health care inequities could be eliminated by providing the same treatment to all patients regardless of their race or ethnicity. However, with the availability of electronic health record systems and the ability to analyze observational population data, it is clear that equal treatment is not necessarily equitable.
|
From page 35... ...
Health equity programs should focus on achieving optimal outcomes for individuals, including careful attention to implicit biases associated with race and ethnicity and other SDOH. By recognizing and promoting ef fective strategies to address these harmful biases, the nation can work toward a health care system that prioritizes individual needs and reduces inequities, moving closer to health care equity for all.
|
From page 36... ...
Although these individuals are also often described along with other racial and ethnic groups, the phrase "American Indian and/or Alaska Native" is distinct be cause it is used in the context of legally enforceable obligations and responsibilities of the federal government to provide certain services and benefits to members or citizens (and, in some cases, descendants) of federally recognized Tribal Nations.
|
From page 37... ...
• Multiracial: people who identify with more than one race. • Tribal: describes Tribal Nations in the United States but is also used as an adjective to describe circumstances related to them, such as tribal communities or tribal policies.
|
From page 38... ...
Structural determinants of health, also referred to as the "determinants of the determinants of health," include structural racism and other structural inequities and thus influence not only population health but also health equity. • Structural or systemic racism: the totality of ways in which a society fosters racial and ethnic inequity and subjugation through mutually reinforcing systems, including housing, education, employment, earnings, benefits, credit, media, health care, and the criminal legal system.
|
From page 39... ...
. These actions, bolstered by 7 This term was also used in the 2023 National Academies report Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity.
|
From page 40... ...
Setbacks have also occurred, chiefly resulting from judicial developments that weakened some ACA provisions designed to address health care inequities, ended the constitutional right to accessing reproductive health care services, and disrupted efforts to achieve greater educational diversity. The ACA was informed by evidence documenting where and how discrimination appears in the health care system and the urgent need for far-reaching policy solutions.
|
From page 41... ...
Furthermore, some civil rights reforms have not been implemented, with no accountability or penalty when measures are not obtained. • Continuing racism in health care and society, at large: Unequal Treatment documented pervasive racism in health care, deeply embedded in the very structure of the system.
|
From page 42... ...
; non–health care sector partnerships; and societal commitment to equity. These key external societal forces act individually, intersect with one another, and constantly interact with the domains in the health care system to pose significant influence on equitable health care.
|
From page 43... ...
disproportionately impact minoritized populations and manifest as unmet HRSNs, which many health care systems are unable to address, further exacerbating inequities in care access, quality, and outcomes. • The interest of partners outside the health care sector, such as social service agencies, can shape priorities and programs of health care systems, either negatively, by exacerbating inequities and widening inequity gaps, or positively, by unlocking long-term opportunities to advance health care equity.
|
From page 44... ...
• Discovery and Evidence Generation. Data and research are critical resources needed to implement, evaluate, and enforce strategies to eliminate racial and ethnic health care inequities and advance health equity.
|
From page 45... ...
These laws have and could have had far-reaching positive effects toward the goals of eliminating health care inequities and achieving health equity. However, these reforms have significant structural limitations.
|
From page 46... ...
Chapter 4 explores the evolution of U.S. health care and civil rights laws as they affect the complexities of health care inequities and discusses developments and shortcomings of some of the most significant policy and law interventions aimed at addressing inequities and advancing health equity.
|
From page 47... ...
2014. What are health disparities and health equity?
|
From page 48... ...
2023. Federal policy to advance racial, ethnic, and tribal health equity.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.