The US has a long history of healthcare inequity, driven by disparities in wellness, access, and outcomes. The COVID-19 pandemic and attendant crises have shed new light on the challenges Black Americans and other communities of color face in seeking high-quality care. As we’ve followed the numerous ways our healthcare system has been upended and challenged this year, we’re also seeing both provider and payer organizations approach the challenge of health equity with new creativity and innovation. 

To work toward a healthcare system that takes care of everyone, it is critical to understand some of the limitations and discrimination that currently exist. In this post, we’ll examine some of the main focuses and programs designed to improve the social determinants of health and how they can contribute to healthcare equity for all Americans. 

Social Determinants of Health

What are the Social Determinants of Health?

The US Center for Disease Control (CDC) defines social determinants of health as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” These factors have a massive impact on patients’ health and are strong indicators of healthcare access and quality.

Healthcare providers and payers continually work to interpret and develop programs to understand, support, and influence positive change for a wide range of communities and health categories. But, as we’ve seen, much more must be done in an effort to provide comprehensive care and coverage for all health factors and according to the individual. 

As Vice Admiral Jerome M. Adams, Surgeon General, MD, MPH, explains, “Minorities have long experienced disparities related to the medical and social determinants of health – all of the things that contribute to your health and wellbeing. The COVID-19 pandemic has magnified those disparities, but it has also given us the opportunity to acknowledge their existence and impact and deepen our resolve to address them.”

Health can be influenced by many different factors, but generally organized into five broad categories. 

  1. Genetics 
  2. Behavior 
  3. Environmental and Physical Influences 
  4. Medical Care
  5. Social Factors

Resources that enhance the quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education and job opportunities, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins. Think of some of the social determinants of health in the following categories that help explain some of the differences in everyday life. 

Access 

  • Healthcare services, quality education, job opportunities, and training
  • Internet, media, mobile communication

Availability

  • Safe housing, healthy food, community resources, transportation, public safety

Social and Community  

  • Social support, norms, and attitudes (discrimination, racism, etc.)
  • Exposure to crime, violence, social disorder, incarceration (lack of community support)
  • Socioeconomic conditions (concentrated poverty, stress, fatigue, etc.)
  • Language and literacy barriers 

What is Health Equity? 

Health equity is the opportunity to attain one’s full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance. The CDC states that “achieving health equity, eliminating disparities, and improving the health of all groups is an overarching goal for Healthy People 2020 and a top priority. 

“Health equity is the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.” – US Department of Health and Human Services

Discrimination in Healthcare 

Building a better future and a more just and equitable healthcare environment is contingent on eliminating discrimination and bias. Discrimination can be present in many factors of care delivery, access to healthcare services, and systematic disadvantages for certain communities or individuals. 

HealthyPeople.gov describes discrimination as “socially structured action that is unfair or unjustified and harms individuals and groups. Discrimination can be attributed to social interactions that occur to protect more powerful and privileged groups at the detriment of other groups. While not all stressful experiences negatively affect health or occur because of discrimination, many do impact health and can be related to discrimination. Racial discrimination is one of the biggest issues in American society and our healthcare system. 

Racial Disparities and Inequities in Healthcare 

According to the Office of Disease Prevention and Health Promotion, discrimination on the basis of race has been linked to disparities in health outcomes for racial/ethnic minorities. Racism has been linked to low birth weight, high blood pressure, and poor health status. The 2015 National Healthcare Disparities Report indicated that white patients receive better quality of care than 36.7% of Hispanic patients, 41.1% of black patients, 32.4% of American Indian/Alaska Native patients, and 20.3% of Asian and Pacific Islander patients.


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The CMS Equity Plan for Improving Quality in Medicare

Ultimately, provider and payer organizations can only do so much without CMS making equity a priority and accountability. In 2015, the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health’s (OMH) mission was to eliminate health disparities among all Medicare minority populations, especially those who experience high disease burdens, worse quality of care, and barriers to accessing care. 

With this in mind, OMH developed the CMS Equity Plan for Improving Quality in Medicare, which is an action-oriented, results-driven approach for advancing health equity. In all, the plan focuses on increasing understanding and awareness of disparities, creating and disseminating promising solutions, and implementing sustainable actions.  

The CMS Equity Plan includes Six Primary Objectives: 

  1. To expand data collection and reporting.
  2. To evaluate disparities and integrate appropriate solutions.
  3. To develop and implement approaches to reduce health disparities.
  4. To help healthcare workers meet the needs of vulnerable populations.
  5. To improve communications and language access for non-English speakers and people with disabilities.
  6. To increase the physical accessibility of healthcare facilities.

Improving Healthcare for Everyone 

While discrimination in healthcare has been a longstanding issue, COVID-19 has shed a bright light on US racial disparity and health outcomes. With racial and ethnic groups listed as the most susceptible to COVID-19, extra precautions should be taken. Instead, social determinants and discrimination exist, and the need for more conversations and the willingness to bring about change is necessary to improve standards of care for every patient, no matter their differences.

With an ongoing need for current education, training, new approaches to identifying discrimination, etc., plans such as the 2015 CMS Equity Plan should be re-evaluated and updated accordingly. Updated plans and coordination between multiple federal agencies will provide additional efforts to help address discrimination and other social determinants as keys issues in efforts to build a more equitable healthcare system. 


Take a look at our healthcare equity resources to learn more.

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