This blog post was initially published in Ellen’s Interprofessional Insights and appeared by explicit permission
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The title of this blog article reflects one jam-packed week in our health equity space! There’s much to follow on the health equity radar, from advancement of the Federal Equity Action Plan to concerning data validating the high incidence of discrimination by the health workforce toward patients. The onset of stress and vicarious trauma for staff witnessing these events was also identified. Each of these actions will provide pause to even the most seasoned health equity warrior.
An Equity Action Plan Amplified
The U.S. Department of Health and Human Services (HHS) released a 2023 update to its Federal Equity Action Plan! The plan amplified the commitment of the Biden-Harris Administration to employ its whole-of-government equity agenda that empowers inclusive access to care for all. Many of this blog’s readership are aware of my affinity for wholistic health approaches that encompass physical, behavioral and psychosocial health. Research affirms the validity of these models to ensure successful outcomes for those populations living amid the wholistic health determinants encompassing social determinants of health and mental health, political determinants health, and the systemic racism that perpetuates them.
The HHS Plan outlines five key areas to advance health equity at the macro, meso, and micro practice levels:
- Prevent neglect and improve care to help children thrive in their families and communities.
- Promote accessible and welcoming health care for all.
- Improve maternal health outcomes for rural, racial, and ethnic minority communities.
- Prioritize the behavioral health of underserved populations.
- Increase clinical research and trial diversity to support innovation.
Each of these actions has been the focus of legislation and funding targeting minoritized and marginalized communities. At the Federal level Aligning for Health is a membership association that uses a team of federal and state administration experts to address the mandate for efficient, integrated and coordinated programs that enhance health outcomes for Americans. Their website has an in-time and interactive tracking tool for legislation on health equity and the SDoH. The current 118th Congress is reviewing the following legislation in this space. The current bill count tally is:
- SDoH Bills; 118
- Health Equity/Disparity Bills: 36
- Maternal and Infant Bills: 0
Since the Equity Action Plan was released in 2022, some progress to address health equity and racial justice has advanced:
- Proposed rules on language access in all health programs and activities funded by HHS and guidance to states on how to comply with language access and effective communication obligations during and after public health emergencies.
- Approved 42 states, DC, and the Virgin Islands to provide 12 months of continuous postpartum coverage through the Centers for Medicare and Medicaid Services (CMS) so that women with low-incomes have stability in coverage.
- Proposed rules that prohibit discrimination on the basis of disability by updating critical provisions that help persons with disabilities access health and human services under section 504 of the Rehabilitation Act of 1973.
- Provided practical guidance to HHS offices on identifying actions to ensure opportunity for all.
In addition, The Kaiser Family Foundation (KFF) Medicaid Waiver Tracker shows 63 approved and 37 pending 1115 Waivers in process across the states. For those who haven’t accessed this informative tool, it is a must read. You can also access a current view of the 1115 Waiver landscape by state through the KFF Tracker.
Discrimination by the Workforce: More Norm Than Exception
This action by HHS is especially timely in light of this week’s compelling and concerning research by the Commonwealth Fund on Health Care Workers Observations of Discrimination Against Patients. The report details the perspectives of >3000 members of the interprofessional care team. Discrimination against patients due to race, ethnicity, language and other cultural areas remains widespread, as does the traumatic impact for the workforce itself. Among the most concerning findings include:
- Close to 50% of the health care workforce has witnessed patients face racism or discrimination.
- Rates were as high 70% in settings with mostly Black or Latino patients, especially in community-based health care centers and school clinics.
- Acknowledgment by almost half of the medical providers surveyed (48%) that they can be more accepting of White patients advocating for themselves than Black patients; “(For) the non-person of color it is seen as advocating for themselves…..and wanting the care they deserve, whereas a person of color doing that is seen as aggressive or belligerent”
- The stress and moral distress faced by the workforce over this level of discrimination is an equally high priority. Some level of stress was reported by > half (69%) of the workforce from being forced to deal this invasive dynamic.
Recommendations
Much more work is required to attain the pinnacle of health equity excellence that society deserves. The Commonwealth report lists a series of recommendations to advance actions to mitigate discrimination and ensure psychological and physical safety for patients and the workforce itself:
- Provide an easy way for patients and health care staff to anonymously report situations involving racism or discrimination.
- Examine policies to make sure they result in equitable outcomes
- Require classes on discrimination at professional schools
- Create opportunities to listen to patients of color and health care professionals of color
- Examine treatment of non-English-speaking patients
- Train health care staff to spot discrimination
I would also add the importance of an ongoing and consistent organizational total quality management approach. This action ensures continuous improvement efforts that are ongoing and sustainable. Addressing health equity, systemic racism, and trauma are NOT one and done.
Professional associations also need to continue their important work to develop advance, and activate strategic health equity deliverables such as implementing revised standards of practice, ethical codes, formal position papers, dedicated tool kits to name a few.
As I’ve quoted through my health equity and DEIB work on many occasions, “Every patient, their family member, and member of the healthcare workforce should feel safe, seen, heard, and valued.”. The healthcare industry cannot possibly begin to address the health equity equation’s abysmal outcomes without first addressing these levels of oppression, racism, and manifesting trauma faced by for all involved.
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