New York State Focus-Building Health Equity
The following article was authored by Brown & Weinraub’s Lauren Tobias. While it is structured around health systems and health equity, the questions it poses about how we all can do better and where to start are important questions for all employers regarding their relationships with employees and consumers. Please contact Lauren with any questions at [email protected]
New York State Focus-Building Health Equity
New York State is preparing (another) transformative Medicaid waiver[1] and to welcome Dr. Mary Bassett as the new Commissioner of the New York State Department of Health. New York’s concept paper on the proposed waiver and Dr. Basset’s career focus on building health equity and reducing disparities, including racial disparities make this a critical moment to undertake real reform efforts at NY health systems.
Although our health care system believes it supports the health and well-being of all patients and treat everyone equally, the reality falls far short- especially Black, Indigenous, People of Color (BIPOC), who arrive at care with the trauma of navigating years of systemic barriers to that care. It is critical for health systems and health care practitioners to understand and acknowledge the trauma trying to overcome barriers may cause for these patients. Meeting the needs of the whole person goes beyond treating all people ‘equally’ but instead requires deliberately building a system of care that dismantles systemic barriers.
Now is the time for all of us to ask ourselves what we are doing to build health equity? Although, there is no single, simple approach, there are steps that support health equity, reduce disparities and position systems and providers to be the State’s partner in these goals:
- Build community trust:
How successfully we build community trust will determine if we succeed or fail. There is a lot of attention paid to the provider/patient relationship. But what about the relationship between a system of care and the community it serves? Building health equity depends on building trust and partnerships with community members. This includes meaningful and ongoing (not one and done) engagement with patients and staff.
It is important to be prepared to listen to community members. Meaningful engagement, like any relationship, takes time and continuous, active commitment. Taking this time shows communities we care, and actions show we are willing to take accountability and change. Community members who experience the barriers and challenges with health care systems often have the answers (or at least great recommendations) to what is needed to promote health equity.
- Data:
There is a saying ‘What gets measured gets improved.’ Addressing disparities can only be done using data inclusive of race and ethnicity demographics. The lack of such data (or failure to use the data), allows health disparities to perpetuate unchecked. Systemically collecting and analyzing this data is a cornerstone to addressing disparities.
As identified by Mital Patel, of the American Hospital Association: “Credible data will display patterns in health disparities and point leaders toward a solution. Many providers are surprised by what they learn when they look at the data. The AHA’s Institute for Diversity and Health Equity has created several dashboards to provide leaders with a list of potential measures to use to identify potential disparities and released a toolkit for stratifying and using data.”[2]
- Invest in cultural competence and implicit bias training.
A good starting point is the recognition we all have biases. This is not a judgement statement as much as a fact. Working to minimize how our individual and systemic biases inform our behavior, attitude and actions are foundational to building a more equitable system. Implicit bias training is not something that can be done over lunch. Trainings should and can support staff and gives them tools to engage with patients and each other. But implicit bias training is not a panacea, and in fact there is little evidence of it resulting in long-term changes without other systemic changes.
There are many implicit bias trainings available and like all tools some are better than others; finding training programs take a sustained and sustainable approach.[3] System change takes time and so does changing our behavior. Consider this as a long-term engagement and process. It can be part of ongoing trainings, onboarding of staff and part of measurement goals but should start at the leadership level with a commitment to the critical need and significant investment in training and cultural change
Together we can build a more equitable patient-centered health and social service system. Taking steps now will help all of us prepare to partner with the State in these efforts.
[1] If you would like a copy of the Medicaid waiver concept paper summary prepared by Brown & Weinraub, please email [email protected]
[2] Patal, Mital. “Telling a Story with Data to Improve Health Equity: AHA News.” American Hospital Association | AHA News, 25 Mar. 2021, www.aha.org/news/healthcareinnovation-thursday-blog/2021-03-25-telling-story-data-improve-health-equity.
[3] Holzman, Sam, et al. “Improve Your Implicit Bias Training With These 7 Tips.” TrainingIndustry, 30 July 2020, trainingindustry.com/articles/diversity-equity-and-inclusion/7-key-considerations-for-more-effective-implicit-bias-training/.
