Plotting the Points to Success: The Path to Health Equity, Part 4
The following is part 4 of 5 in a series of articles titled, "The Path to Health Equity" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth, as well as other contributors to Ask Your Pharmacist.
True health equity is the goal of a number of health organizations and initiatives across the country. This concept, comprised of the absence of unfair and avoidable or remediable differences in health among groups of people, is often seen as a distant aspiration rather than a tangible reality. But is that a fair assessment?
While significant progress has been made in addressing health inequities, the path to achieving true health equity remains challenging and multifaceted. Health equity is not merely the absence of health disparities; it is a fundamental right that should be enjoyed by all individuals, regardless of their social or economic standing, race, ethnicity, gender, or any other factor. It is about ensuring that everyone has the opportunity to reach their full potential for health and well-being.
The path to health equity is not a linear one, but rather a complex journey that requires addressing systemic inequities and empowering individuals with the knowledge and tools to make informed decisions about their health.
Is Health Equity Achievable?
The goal of health equity is to create a society where everyone has a fair and just opportunity to be as healthy as possible, regardless of their social or economic standing. This means addressing the root causes of health inequities, such as poverty, discrimination, and lack of access to quality education and healthcare.
The question of whether health equity is achievable is a complex one. There is no doubt that we have made progress in recent decades in reducing health inequities. For example, the life expectancy of Black Americans has increased significantly, and the gap in infant mortality rates between Black and white babies has narrowed. However, there is still much work to be done. Health inequities continue to exist, and they are often deeply entrenched in our society.
It is difficult to say definitively whether we will ever know when we have achieved health equity. This is because health equity is not a fixed goalpost. As we learn more about the causes of health inequities, we will need to continually adjust our definition of what it means to be healthy and equitable.
However, there are some things we can do to measure progress towards health equity. We can track changes in health outcomes, such as life expectancy, infant mortality rates, and rates of chronic diseases. We can also measure access to healthcare, education, and employment. And we can measure the social determinants of health (SDOH), including poverty, discrimination, and lack of access to healthy food, housing, and transportation, among others.
By tracking these indicators, we can get a better sense of whether we are making progress towards health equity. However, it is important to remember that these indicators are not perfect. They do not capture all of the factors that contribute to health equity, and they may be influenced by other factors, such as economic trends or changes in healthcare delivery systems.
In addition to tracking indicators, we also need to listen to the voices of people who have been affected by health inequities. They can tell us about their experiences and help us to identify the most effective ways to address health inequities. That said, no two stories are exactly the same, and a personalized approach is needed.
The 5 Key Priorities for Reducing Disparities in Health
To address health inequities and improve health outcomes for all Americans, the Centers for Medicare & Medicaid Services (CMS) developed the CMS Framework for Health Equity. This framework outlines five key priorities for reducing disparities in health:
Expand the Collection, Reporting, and Analysis of Standardized Data on Demographics and Social Determinants of Health — By collecting and analyzing data on demographics and social determinants of health, CMS can identify disparities in health outcomes and target interventions to address them. This data can also be used to measure progress over time and possibly incentivize providers to reduce disparities among their patients and the community.
Assess Causes of Disparities Within CMS Programs and Address Inequities in Policies and Operations — CMS will assess the causes of disparities within its programs and identify policies and operations that may be contributing to these disparities. CMS will then work to address these inequities by implementing new policies, changing existing policies, or providing additional resources to providers.
Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities — CMS will provide training and resources to help health care organizations and the workforce improve their ability to identify and address health disparities. This training will focus on culturally sensitive care, implicit bias, and social determinants of health.
Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services — CMS will promote language access, health literacy, and the provision of culturally tailored services to ensure that all beneficiaries have access to the care they need. This includes providing interpretation services, translating materials into multiple languages, and training providers on how to provide culturally sensitive care.
Increase All Forms of Accessibility to Health Care Services and Coverage — CMS will work to increase all forms of accessibility to health care services and coverage, including geographic accessibility, physical accessibility, and financial accessibility. This includes expanding access to broadband internet in underserved communities, providing transportation assistance to beneficiaries, and exploring new payment models that incentivize providers to care for underserved populations.
The CMS Framework for Health Equity has the potential to make a significant impact on reducing health disparities and achieving health equity. By implementing the five priorities outlined in the framework, CMS can help ensure that the more than 170 million individuals supported by CMS programs have the opportunity to be healthy and well.
Healthy People 2030: A Plan to Address Health Equity
In August 2020, Healthy People 2030 was launched. This 10-year plan — the latest iteration of an initiative that was created more than four decades ago — is a comprehensive strategy to improve the health and well-being of all Americans by preventing disease, promoting healthy lifestyles, and eliminating health disparities. The initiative sets ambitious goals for improving health outcomes across a range of areas, including chronic diseases, mental health, and substance abuse.
Healthy People 2030 aims to address the root causes of health inequities while also placing a strong emphasis on improving health literacy, which is the ability to find, understand, and use health information and services to make informed decisions about one's health. The initiative will provide tools and resources to help people learn about their health, manage their conditions, and make healthy choices.
A bold and ambitious program, Healthy People 2030 has the potential to make a real difference in the lives of Americans. By addressing the root causes of health inequities and improving health literacy, the initiative can help to create a more just and equitable society where everyone has the opportunity to be healthy and well.
The Role Health Literacy Plays in Health Equity
Health literacy plays a crucial role in achieving health equity. When individuals lack health literacy, they may face difficulties understanding their health conditions, navigating the healthcare system, and making informed decisions about treatment options. This can lead to delayed or missed diagnoses, poor medication adherence, and increased utilization of emergency services.
Health inequities are often exacerbated by disparities in health literacy. Individuals from low-income communities, minority groups, and those with limited education may face additional barriers to accessing and understanding health information, resulting in poorer health outcomes.
To address these disparities, a website called Findhelp.org offers a valuable resource that can empower individuals to take control of their health. This user-friendly site provides a comprehensive directory of community resources, including healthcare providers, food banks, legal aid services, and mental health support groups. By connecting individuals with the resources they need, Findhelp.org can help to bridge the gap in health literacy and promote health equity.
Moving from Education to Action
"Health equity is a goal we can achieve, and it's within our power to do so," said American Public Health Association (APHA) Executive Director Georges Benjamin, MD in a U.S. News article. "We have the tools and the knowledge to make health equity happen, but it's up to all of us to use them."
Social determinants of health (SDOH) have a dramatic impact on an individual’s ability to achieve optimal health. A report on SDOH from the Department of Health and Human Services states that SDOH impacts as much as 50% of county level variation in health outcomes, whereas only 20% comes from clinical care. To help our communities achieve optimal health, we need to shift our focus to where the needs are.
As we learn more about health disparities and the healthcare challenges often faced by different groups of people, we also learn that knowledge is not enough. To make a difference in the lives of the people who need it, that knowledge has to translate to action. The plan has to be followed. And that's where community pharmacists — the nation's most accessible healthcare providers — are going to get a chance to shine.
(For more resources on health equity — including fact sheets, reports, and infographics about a number of health equity factors — visit the APHA health equity resource page.)
NEXT — Part 5: What Can My Pharmacy Do? »