Ending Unequal Treatment Strategies to Achieve Equitable Health Care and Optimal Health for All (2024) / Chapter Skim
Currently Skimming:
9 Overarching Conclusions and Recommendations
9 Overarching Conclusions and Recommendations
Pages 307-322
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From page 307... ...
. Twenty years after Unequal Treatment, this report reviews the status of health care inequities for racially and ethnically minoritized populations, identifies the major drivers of those inequities, identifies gaps in the evidence base, provides insight into successful and unsuccessful interventions, and proposes strategies to close these gaps.
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Some progress has occurred in developing systems to monitor health and health care equity and increasing research to document inequities and metrics to measure and understand them. But, despite better understanding these inequities, the nation has failed to translate this knowledge into sustainable actions that close longstanding gaps in the delivery of equitable health care to minoritized populations to achieve equitable health care and optimal health for all.
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2. Racial and ethnic health care inequities are driven by a complex interaction between health care and key external societal forces that serve as enablers or barriers to achieving equitable health care and optimal health.
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GOALS AND RECOMMENDED IMPLEMENTATION ACTIONS The study statement of task specifies that "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" and "apply its expert judgment in order to develop recommendations with a focus on advancing health equity." As the report has emphasized throughout the chapters, "health equity" and "health care equity" are different but inextricably linked. Eliminating inequities in health care delivery can positively affect health equity; however, changes to health care systems and clinical care alone are insufficient to advance racial and ethnic health equity.
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Without data, it will be impossible to know if health care inequities have been eliminated or health equity has been advanced. An intensive effort should be made to continue the collection, evaluation, and dissemination of health and health care equity data to ensure systemwide accountability for eliminating inequities in health care and advancing health equity.
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The variation in performance measures for health care equity impedes efforts to hold health care systems, organizations, and clinicians accountable for their performance in promoting equitable health care outcomes. In addition, health equity should become an expectation of the entire health care delivery system and expectations of high-quality care should include equity as a core value at the organizational level.
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2-3. The Centers for Medicare & Medicaid Services should expand the number of Section 1115 demonstrations designed to address adverse social determinants of health by combining clinical care with invest ments in health-related social needs as an element of care delivery. Health equity should be incorporated explicitly as a goal of program design, payment structure, and evaluation.
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New research approaches, including communitybased participatory research and studies conducted in primary care settings, show promise to advance interventions to improve health and health care equity, but few implementation studies or comparative effectiveness studies have occurred to facilitate adoption of the most effective interventions. To achieve this goal, the committee recommends the following actions: Implementation Actions: 3-1. National Institutes of Health and other federal and non-federal research funders should expand funding for research aimed at addressing health care inequities, structural racism, and health-related social needs, and exploring the various approaches, strategies, and policies needed to eliminate health care inequities.
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Goal 4: Ensure Adequate Resources to Enforce Existing Laws and Build Systems of Accountability That Explicitly Focus on Eliminating Health Care Inequities and Advancing Health Equity Many current laws and regulations have been underused. The Office of Civil Rights, as one example, is under resourced limiting its efforts to enforce civil rights statutes and address the complaints it receives from individuals.
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These structural inequities disproportionately impact minoritized populations but addressing these inequities benefits everyone. As discussed in Chapter 4, the ACA expanded health care coverage to millions of low-income individuals and set in motion long-term changes in how health care is organized and delivered, spurring greater emphasis on
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From page 317... ...
Moreover, social and economic policies that have implications for health care equity vary across states, which means that racially and ethnically minoritized populations in different states do not equitably benefit from such reforms. In particular, the Indian Health Service continues to be underfunded despite evidence of extensive unmet need and service capacity shortages and the long-standing treaty-based obligations on which Indian Health Service financing rests.
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From page 318... ...
This report emphasizes how inequities in HRSNs and the health care system's inability to address these needs hinders its ability to deliver equitable care to achieve optimal health outcomes for all people. The committee recognizes that addressing inequities in health care requires substantive changes in the larger societal forces that influence health and health care, and emerging health care delivery models that integrate social needs care into health care settings show promise to advance equity.
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Recommendation 7: The Centers for Disease Control and Prevention should coordinate the creation and facilitate the use of common measures on multilevel social determinants of racial and ethnic health inequities, including scientific measures of racism and other forms of discrimination, for use in analyses of national health surveys and by other federal agen cies, academic researchers, and community groups in analyses examining health, social, and economic inequities among racial and ethnic groups. Recommendation 8: Congress should increase funding for federal agencies responsible for data collection on social determinants of health measures to provide information that leads to a better understanding of the correlation between the social environment and individual health outcomes.
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Curricula should include evidence on the social determinants of health, protocols for working in interprofessional teams to address social needs in health care settings, interpersonal and organizational approaches to advanc ing health equity and decreasing health disparities, and competencies relating to collecting, securing, and using data and technology to facilitate Efforts to achieve optimal health care for all and eliminating racial and ethnic inequities in health care is not a zero-sum game. Addressing the factors that contribute to health and health care inequities benefits everyone.
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State agencies and academic institutions, includ ing community colleges, should develop standards for training and ad vancement (e.g., career ladder programs) for community health workers and other emerging social care workers.
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2019. Integrating social care into the delivery of health care: Moving upstream to improve the nation's health.
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